EVALUATION OF POPULATION-LEVEL IMMUNITY TO SARS-COV-2 ACROSS BULGARIA (END OF 2023)
DOI:
https://doi.org/10.58395/03r0mk42Keywords:
COVID-19, seroprevalence, BulgariaAbstract
Background: The COVID-19 pandemic in Bulgaria was characterized by a high mortality rate and vaccination efforts yielded suboptimal results. Understanding population immunity is important as new SARS-CoV-2 variants continue to emerge. This study aimed to assess the seroprevalence of SARS-CoV-2 antibodies in the general population of Bulgaria and examine demographic variations in antibody presence.
Materials and methods: In December 2023, 1895 serum samples were randomly collected from healthy individuals across all 28 provinces. Samples were tested for SARS-CoV-2 spike protein-specific IgG antibodies using ELISA method. A subset of the positive samples was subsequently tested for neutralizing antibodies. Seroprevalence was analyzed by sex, age group, and geographic region. Statistical analyses were conducted using SPSS v.26.
Results: Overall seroprevalence was 91.9%, with similar rates between males (91.6%) and females (92.0%). Seroprevalence was highest in the 18-39 age group (95.1%) and lowest in those over 65 (89.3%). Regional seroprevalence ranged from 80.0% to 98.3%. Among samples tested for presence of neutralizing antibodies, 90.5% were positive, indicating effective immune response.
Conclusions: The high seroprevalence suggests widespread prior exposure to SARS-CoV-2 and/or vaccination among the Bulgarian population. The strong presence of neutralizing antibodies might provide potential protection against severe disease. Targeted interventions towards older age groups could be appropriate in order to sustain immunity as COVID-19 remains a public health concern.
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References
1. Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020; 91(1):157-160. https://doi.org/10.23750/abm.v91i1.9397
2. https://apps.who.int/gb/COVID-19/pdf_files/18_06/Bulgaria.pdf
5. https://old.mh.government.bg/media/filer_public/2020/03/16/rd-01-128.pdf
6. https://fra.europa.eu/sites/default/files/fra_uploads/bulgaria-report-covid-19-april-2020_en.pdf
7. https://old.mh.government.bg/media/filer_public/2020/12/25/zapowed__rd-01-726-23122020.pdf
8. Boytchev H. Covid-19: Why the Balkans' vaccine rollout lags behind most of Europe. BMJ. 2021; 375:n2412. https://doi.org/10.1136/bmj.n2412
9. Rohova M, Mihaylov N, Ivanova E, Pancheva R, Chamova R, Hadzhieva S, Kolarova M, Paunov T, Radeva N. Rumours, conspiracy beliefs and COVID-19 vaccination attitudes in Bulgaria: A cross-sectional study. Trakia Journal of Sciences. 2023; 21(2):148-154. https://doi.org/10.15547/tjs.2023.02.013
10. Popova M, Valkov I. Media Representations and the Politics of the COVID-19 Pandemic in Bulgaria. Journal of Media Ethics. 2022; 39(2), 143–146. https://doi.org/10.1080/23736992.2022.2057313
11. Hristova I, Georgieva D, Koleva G. Low Covid-19 Vaccination Rate in Bulgaria. International Journal of Current Research and Review. 2022; 14. 33-37. https://doi.org/10.31782/IJCRR.2022.141202
12. https://ourworldindata.org/covid-deaths#deaths-from-covid-19-background (accessed October 29, 2024)
13. Rangachev A, Marinov G, Mladenov M. The Impact and Progression of the COVID-19 Pandemic in Bulgaria in Its First Two Years. Vaccines. 2022; 10. https://doi.org/10.3390/vaccines10111901
14. https://ourworldindata.org/covid-vaccinations (accessed October 29, 2024)
16. https://ourworldindata.org/coronavirus/country/bulgaria (accessed October 29, 2024)
17. Garcia-Beltran WF, Lam EC, Astudillo MG, Yang D, Miller TE, Feldman J, Hauser BM, Caradonna TM, Clayton KL, Nitido AD, Murali MR, Alter G, Charles RC, Dighe A, Branda JA, Lennerz JK, Lingwood D, Schmidt AG, Iafrate AJ, Balazs AB. COVID-19-neutralizing antibodies predict disease severity and survival. Cell. 2021; 184(2):476-488.e11. https://doi.org/10.1016/j.cell.2020.12.015
18. Addetia A, Crawford KHD, Dingens A, Zhu H, Roychoudhury P, Huang ML, Jerome KR, Bloom JD, Greninger AL. Neutralizing Antibodies Correlate with Protection from SARS-CoV-2 in Humans during a Fishery Vessel Outbreak with a High Attack Rate. J Clin Microbiol. 2020; 58(11):e02107-20. https://doi.org/10.1128/JCM.02107-20
19. Mink S, Saely CH, Leiherer A, Frick M, Plattner T, Drexel H, Fraunberger P. Anti-SARS-CoV-2 antibody levels predict outcome in COVID-19 patients with type 2 diabetes: a prospective cohort study. Sci Rep. 2023; 13(1):18326. https://doi.org/10.1038/s41598-023-45700-4
20. García-Abellán J, Padilla S, Fernández-González M, García JA, Agulló V, Andreo M, Ruiz S, Galiana A, Gutiérrez F, Masiá M. Antibody Response to SARS-CoV-2 is Associated with Long-term Clinical Outcome in Patients with COVID-19: a Longitudinal Study. J Clin Immunol. 2021; 41(7):1490-1501. https://doi.org/10.1007/s10875-021-01083-7
21. Selvavinayagam TS, Somasundaram A, Selvam JM, Sampath P, Vijayalakshmi V, Kumar CAB, Subramaniam S, Kumarasamy P, Raju S, Avudaiselvi R, Prakash V, Yogananth N, Subramanian G, Roshini A, Dhiliban DN, Imad S, Tandel V, Parasa R, Sachdeva S, Ramachandran S, Malani A. Contribution of infection and vaccination to population-level seroprevalence through two COVID waves in Tamil Nadu, India. Sci Rep. 2024; 14(1):2091. https://doi.org/10.1038/s41598-023-50338-3
22. Paudel KP, Samuel R, Jha R, Pandey BD, Edirisuriya C, Shrestha NL, Gyawali P, Pokhrel A, Shrestha L, Mahato RK, Hossain SS, Arunkumar G, Bose AS, Dhimal M, Gautam D, Neupane S, Thakur N, Shrestha S, Bhusal N, Jha P, Gupta BP, Rayamajhi RB, Subedi KC, Kandel S, Poudel M, Thapa LB, Sharma GN, Gocotano AE, Sunny AK, Gautam R, Bhatta DR, Awale BK, Roka B, Ojha HC, Baral P, Adhikari MD, Lohani GR, Shrestha M, Singh DR, Aryal L, Pandav RS, Pokhrel R. Seroprevalence of SARS-CoV-2 infection in the general population of Nepal during the first and second generalized waves of the COVID-19 pandemic-2020-2021. Influenza Other Respir Viruses. 2023; 17(12):e13234. https://doi.org/10.1111/irv.13234
23. Yared S, Abera T, Ali SM, Muhummed AM, Ibrahim M, Hussen A, Hattendorf J, Zinsstag J, Tschopp R. A community based seroprevalence of SARS-CoV-2 antibodies in Somali Region, Eastern Ethiopia. Immun Inflamm Dis. 2024; 12(1):e1148. https://doi.org/10.1002/iid3.1148
24. Sana A, Djemaï E, De Vreyer P, Thivillon T, Badolo H, Berthé A, Kania D. Seroprevalence and risk factors for SARS-CoV-2 infection in middle-sized cities of Burkina Faso: A descriptive cross-sectional study. PLoS One. 2024; 19(8):e0305850. https://doi.org/10.1371/journal.pone.0305850
25. Padma MR, Dinesh P, Sundaresan R, Athreya S, Shiju S, Maroor PS, Hande RL, Akhtar J, Chandra T, Ravi D, Lobo E, Ana Y, Shriyan P, Desai A, Rangaiah A, Munivenkatappa A, Krishna S, Basawarajappa SG, Sreedhara HG, Siddesh KC, Amrutha Kumari B, Umar N, Mythri BA, Mythri KM, Sudarshan MK, Vasanthapuram R, Babu GR. Second round statewide sentinel-based population survey for estimation of the burden of active infection and anti-SARS-CoV-2 IgG antibodies in the general population of Karnataka, India, during January-February 2021. IJID Reg. 2021; 1:107-116. https://doi.org/10.1016/j.ijregi.2021.10.008
26. Rostami A, Sepidarkish M, Leeflang MMG, Riahi SM, Nourollahpour Shiadeh M, Esfandyari S, Mokdad AH, Hotez PJ, Gasser RB. SARS-CoV-2 seroprevalence worldwide: a systematic review and meta-analysis. Clin Microbiol Infect. 2021; 27(3):331-340. https://doi.org/10.1016/j.cmi.2020.10.020
27. Chisale MRO, Ramazanu S, Mwale SE, Kumwenda P, Chipeta M, Kaminga AC, Nkhata O, Nyambalo B, Chavura E, Mbakaya BC. Seroprevalence of anti-SARS-CoV-2 antibodies in Africa: A systematic review and meta-analysis. Rev Med Virol. 2022; 32(2):e2271. https://doi.org/10.1002/rmv.2271
28. de Jesus Á, Ernesto R, Massinga AJ, Nhacolo F, Munguambe K, Timana A, Nhacolo A, Messa A Jr, Massora S, Escola V, Enosse S, Gunjamo R, Funzamo C, Mwenda JM, Okeibunor J, Garcia-Basteiro A, Guinovart C, Mayor A, Mandomando I. High SARS-CoV-2 Exposure in Rural Southern Mozambique After Four Waves of COVID-19: Community-Based Seroepidemiological Surveys. Influenza Other Respir Viruses. 2024; 18(6):e13332. https://doi.org/10.1111/irv.13332
29. Ramadani N, Hoxha-Gashi S, Gexha-Bunjaku D, Kalaveshi A, Jakupi X, Humolli I, Vaughan A, Pebody R, Kacaniku-Gunga P, Jashari V. Prevalence of SARS-CoV-2 Antibodies in Kosovo-Wide Population-Based Seroepidemiological Study. Influenza Other Respir Viruses. 2024; 18(9):e70004. https://doi.org/10.1111/irv.70004
30. Montenegro P, Brotons C, Serrano J, Fernández D, Garcia-Ramos C, Ichazo B, Lemaire J, Moral I, Wienese RP, Pitarch M, Puig M, Vilella MT, Sellarès J. Community seroprevalence of COVID-19 in probable and possible cases at primary health care centres in Spain. Fam Pract. 2021; 38(2):154-159. https://doi.org/10.1093/fampra/cmaa096
31. Pagheh AS, Ziaee A, Abrari Romenjan K, Rezaei F, Bahman B, Alamzadeh E, Elhamirad S, Ziaee M. SARS-COV-2 IgG specific antibodies persistence in recovered COVID-19 individuals and its association with severity and time of illness. New Microbes New Infect. 2023; 52:101096. https://doi.org/10.1016/j.nmni.2023.101096
32. Wajnberg A, Amanat F, Firpo A, Altman DR, Bailey MJ, Mansour M, McMahon M, Meade P, Mendu DR, Muellers K, Stadlbauer D, Stone K, Strohmeier S, Simon V, Aberg J, Reich DL, Krammer F, Cordon-Cardo C. Robust neutralizing antibodies to SARS-CoV-2 infection persist for months. Science. 2020; 370(6521):1227-1230. https://doi.org/10.1126/science.abd7728
33. Zeng F, Wu M, Wang J, Li J, Hu G, Wang L. Over 1-year duration and age difference of SARS-CoV-2 antibodies in convalescent COVID-19 patients. J Med Virol. 2021; 93(12):6506-6511. https://doi.org/10.1002/jmv.27152
34. Swartz MD, DeSantis SM, Yaseen A, Brito FA, Valerio-Shewmaker MA, Messiah SE, Leon-Novelo LG, Kohl HW, Pinzon-Gomez CL, Hao T, Zhang S, Talebi Y, Yoo J, Ross JR, Gonzalez MO, Wu L, Kelder SH, Silberman M, Tuzo S, Pont SJ, Shuford JA, Lakey D, Boerwinkle E. Antibody Duration After Infection From SARS-CoV-2 in the Texas Coronavirus Antibody Response Survey. J Infect Dis. 2023; 227(2):193-201. https://doi.org/10.1093/infdis/jiac167
35. Movsisyan M, Truzyan N, Kasparova I, Chopikyan A, Sawaqed R, Bedross A, Sukiasyan M, Dilbaryan K, Shariff S, Kantawala B, Hakobjanyan G, Petrosyan G, Hakobyan A, Yenkoyan K. Tracking the evolution of anti-SARS-CoV-2 antibodies and long-term humoral immunity within 2 years after COVID-19 infection. Sci Rep. 2024; 14(1):13417. https://doi.org/10.1038/s41598-024-64414-9
36. https://www.ncipd.org/index.php?option=com_biuletin&view=view&year=2023&month=1&lang=bg)
37. https://www.who.int/docs/default-source/coronaviruse/09082023eg.5_ire_final.pdf
38. https://www.who.int/docs/default-source/coronaviruse/21112023_ba.2.86_ire.pdf
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