Studies that measure the prevalence of antibodies to SARS-CoV-2 (“seroprevalence”) are essential to understand population exposure to SARS-CoV-2 among symptomatic and asymptomatic individuals. We aimed to measure seroprevalence in the Scottish population over the course of the COVID-19 pandemic – from prior to the first recorded case in Scotland, through to the second pandemic wave.

Study design

Serial cross-sectional.


We tested 41,477 residual samples retrieved from primary and antenatal care settings across Scotland for SARS-CoV-2 antibodies over a 12-month period from December 2019-December 2020 (pre-rollout of COVID-19 vaccination). Five-weekly rolling seroprevalence estimates were adjusted for the sensitivity and specificity of the assays and weighted to reference populations. Temporal trends in seroprevalence estimates and weekly SARS-CoV-2 PCR positive notifications were compared.


Five-weekly rolling seroprevalence rates were 0% until the end of March, when they increased contemporaneously with the first pandemic wave. Seroprevalence rates remained stable through the summer (range 3%–5%) during a period of social restrictions, following which they increased concurrently with the second wave, reaching 9.6% (95% CI 8.4%-10.8%) in week beginning 28th December 2020. Seroprevalence rates were lower in rural vs. urban areas (adjusted odds ratio[AOR] 0.70, 95% CI 0.61–0.79) and among individuals aged 20-39 and 60+ (AORs 0.74, 95% CI 0.64–0.86, and 0.80, 95% CI 0.69–0.91, respectively) relative to those aged 0-19 years.


After two waves of the COVID-19 pandemic, less than one in ten individuals in the Scottish population had antibodies to SARS-CoV-2. Seroprevalence may underestimate the true population exposure as a result of waning antibodies among individuals who were infected early in the first wave.


This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2021 Published by Elsevier Ltd on behalf of The Royal Society for Public Health.

Cite as

Palmateer, N., Dickson, E., Furrie, E., Godber, I., Goldberg, D., Gousias, P., Jarvis, L., Mathie, L., Mavin, S., McMenamin, J., McNeilly, T., Murcia, P., Murray, J., Reid, G., Robertson, C., Templeton, K., Von Wissman, B., Wallace, L., Waugh, C. & McAuley, A. 2021, 'National population prevalence of antibodies to SARS-CoV-2 in Scotland during the first and second waves of the COVID-19 pandemic', Public Health. https://doi.org/10.1016/j.puhe.2021.07.006

Downloadable citations

Download HTML citationHTML Download BIB citationBIB Download RIS citationRIS
Last updated: 28 October 2022
Was this page helpful?