Article Category:
Short Report

Serologic Evidence for Early SARS–CoV-2 Circulation in Lima, Peru, 2020

Andres Moreira-Soto Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Virology, Berlin, Germany;
Tropical Disease Research Program, School of Veterinary Medicine, Universidad Nacional, Heredia, Costa Rica;

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Maria Paquita García National Institute of Health–INS (Instituto Nacional de Salud), Lima, Peru;

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Gloria Arotinco-Garayar National Institute of Health–INS (Instituto Nacional de Salud), Lima, Peru;

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Dana Figueroa-Romero National Institute of Health–INS (Instituto Nacional de Salud), Lima, Peru;

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Nancy Merino-Sarmiento National Institute of Health–INS (Instituto Nacional de Salud), Lima, Peru;

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Adolfo Marcelo-Ñique National Institute of Health–INS (Instituto Nacional de Salud), Lima, Peru;

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Edward Málaga-Trillo Universidad Peruana Cayetano Heredia, Facultad de Ciencias y Filosofía, Laboratorios de Investigación y Desarrollo, Lima, Peru;

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César Cabezas Sanchez National Institute of Health–INS (Instituto Nacional de Salud), Lima, Peru;

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Jan Felix Drexler Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Virology, Berlin, Germany;
German Centre for Infection Research (DZIF), associated partner Charité-Universitätsmedizin Berlin, Berlin, Germany

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DOI:
https://doi.org/10.4269/ajtmh.24-0260
Volume/Issue:
Volume 111: Issue 6
Page(s):
1290–1294
Restricted access
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ABSTRACT.

During early 2021, Peru had the highest COVID-19–associated per-capita mortality rate. Socioeconomic inequality, insufficiently prepared healthcare, and surveillance systems are factors explaining the mortality rate, which can be severely worsened by early undetected SARS–CoV-2 circulation. We tested 1,441 individuals with fever sampled during August 2019–May 2021, several months before the first SARS–CoV-2 seroprevalence study available so far in Lima, Peru, for SARS–CoV-2–specific antibodies. The testing algorithm included a chemiluminescence immunoassay and surrogate virus neutralization test. Early positive samples (N = 24) from January–March 2020 were further tested using a plaque-reduction neutralization test (PRNT) and avidity test against the SARS–CoV-2 spike and nucleoprotein. None of the early samples were PRNT-confirmed, in contrast to 81.8% (18/22) of a subsample from April 2020 onward (Fisher exact test; P <0.0001). Therefore, we excluded non-PRNT–confirmed samples from subsequent analyses. The SARS–CoV-2 antibody detection rate was 0.9% in mid-April 2020 (1/104; 95% CI: 0.1–5.8%), suggesting viral circulation in early-middle March 2020, consistent with the first molecular detection of SARS–CoV-2 in Peru on March 2020. Mean avidity increase of 62–77% to 81–94% from all PRNT-confirmed SARS–CoV-2–positive samples during early 2020 were consistent with onset of SARS–CoV-2 circulation during late February/March 2020. Early circulation was also confirmed in a susceptible, exposed, infected, and recovered mathematical model that calculated an effective reproduction number >1 during February–March 2020. Early introduction of SARS-CoV-2 thus contributed to the high COVID-19 mortality rate in Peru. Emphasizing the role of diagnostic confirmation in understanding the pandemic’s trajectory, this study highlights the importance of early detection and accurate testing in managing infectious disease outbreaks.

Author Notes

Financial support: This work was funded by the German Federal Ministry for Economic Cooperation and Development (BMZ) via the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH (project number: 81262528). The procedures were carried out with the approval of the institutional bioethics committee under the ethics protocol number 6528 from VIA LIBRE and EA2/031/22 from Charité-Universitaetsmedizin Berlin.

Current contact information: Andres Moreira-Soto, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Virology, Berlin, Germany, and Tropical Disease Research Program, School of Veterinary Medicine, Universidad Nacional, Heredia, Costa Rica, E-mail: andres.moreira-soto@charite.de. Maria Paquita García, Gloria Arotinco-Garayar, Dana Figueroa-Romero, Nancy Merino-Sarmiento, Adolfo Marcelo-Ñique, and César Cabezas Sanchez, National Institute of Health–INS (Instituto Nacional de Salud), Lima, Peru, E-mails: pgarcia@ins.gob.pe, gloria_arotinco24@hotmail.com, mfigueroa@ins.gob.pe, nmerino@ins.gob.pe, amarcelo@ins.gob.pe, and ccabezas@ins.gob.pe. Edward Málaga-Trillo, Universidad Peruana Cayetano Heredia, Facultad de Ciencias y Filosofía, Laboratorios de Investigación y Desarrollo, Lima, Peru, E-mail: edward.malaga@upch.pe. Jan Felix Drexler, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Virology, Berlin, Germany, and German Centre for Infection Research (DZIF), associated partner Charité-Universitätsmedizin Berlin, Berlin, Germany, E-mail: felix.drexler@charite.de.

Address correspondence to Jan Felix Drexler, Institute of Virology, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany. E-mail: felix.drexler@charite.de
Copyright:
© American Society of Tropical Medicine and Hygiene 2024
Received:
22 Apr 2024
|
Accepted:
17 Jun 2024
|
Published Online:
01 Oct 2024
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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