Lloyd B Mulenga1, Jonas Z Hines2, Sombo Fwoloshi3, Lameck Chirwa4, Mpanji Siwingwa4, Samuel Yingst5, Adam Wolkon5, Danielle T Barradas5, Jennifer Favaloro6, James E Zulu7, Dabwitso Banda7, Kotey I Nikoi4, Davies Kampamba4, Ngawo Banda8, Batista Chilopa8, Brave Hanunka5, Thomas L Stevens5, Aaron Shibemba3, Consity Mwale9, Suilanji Sivile3, Khozya D Zyambo10, Alex Makupe3, Muzala Kapina11, Aggrey Mweemba3, Nyambe Sinyange7, Nathan Kapata12, Paul M Zulu11, Duncan Chanda13, Francis Mupeta14, Chitalu Chilufya15, Victor Mukonka11, Simon Agolory5, Kennedy Malama15. 1. Zambia Ministry of Health, Lusaka, Zambia; University Teaching Hospital, Lusaka, Zambia; Levy Mwanawasa Medical University, Lusaka, Zambia; Vanderbilt Medical University, Nashville, TN, USA; School of Medicine, University of Zambia, Lusaka, Zambia. 2. Centers for Disease Control and Prevention, Lusaka, Zambia. Electronic address: jhines1@cdc.gov. 3. Zambia Ministry of Health, Lusaka, Zambia; University Teaching Hospital, Lusaka, Zambia; Levy Mwanawasa Medical University, Lusaka, Zambia; School of Medicine, University of Zambia, Lusaka, Zambia. 4. University Teaching Hospital, Lusaka, Zambia. 5. Centers for Disease Control and Prevention, Lusaka, Zambia. 6. Centers for Disease Control and Prevention, Atlanta, GA, USA. 7. Zambia Field Epidemiology Training Program, Lusaka, Zambia; Zambia National Public Health Institute, Lusaka, Zambia. 8. Zambia Statistics Agency, Lusaka, Zambia. 9. Levy Mwanawasa Medical University, Lusaka, Zambia; School of Medicine, University of Zambia, Lusaka, Zambia; Lusaka Provincial Health Office, Lusaka, Zambia. 10. Zambia Ministry of Health, Lusaka, Zambia; University Teaching Hospital, Lusaka, Zambia; Levy Mwanawasa Medical University, Lusaka, Zambia. 11. Zambia National Public Health Institute, Lusaka, Zambia. 12. Zambia National Public Health Institute, Lusaka, Zambia; Pan-African Network for Rapid Research, Response, Relief and Preparedness for Infectious Diseases Epidemics, Amsterdam, Netherlands. 13. University Teaching Hospital, Lusaka, Zambia; School of Medicine, University of Zambia, Lusaka, Zambia. 14. University Teaching Hospital, Lusaka, Zambia; Levy Mwanawasa Medical University, Lusaka, Zambia; School of Medicine, University of Zambia, Lusaka, Zambia. 15. Zambia Ministry of Health, Lusaka, Zambia.
Abstract
BACKGROUND: Between March and December, 2020, more than 20 000 laboratory-confirmed cases of SARS-CoV-2 infection were reported in Zambia. However, the number of SARS-CoV-2 infections is likely to be higher than the confirmed case counts because many infected people have mild or no symptoms, and limitations exist with regard to testing capacity and surveillance systems in Zambia. We aimed to estimate SARS-CoV-2 prevalence in six districts of Zambia in July, 2020, using a population-based household survey. METHODS: Between July 4 and July 27, 2020, we did a cross-sectional cluster-sample survey of households in six districts of Zambia. Within each district, 16 standardised enumeration areas were randomly selected as primary sampling units using probability proportional to size. 20 households from each standardised enumeration area were selected using simple random sampling. All members of selected households were eligible to participate. Consenting participants completed a questionnaire and were tested for SARS-CoV-2 infection using real-time PCR (rtPCR) and anti-SARS-CoV-2 antibodies using ELISA. Prevalence estimates, adjusted for the survey design, were calculated for each diagnostic test separately, and combined. We applied the prevalence estimates to census population projections for each district to derive the estimated number of SARS-CoV-2 infections. FINDINGS: Overall, 4258 people from 1866 households participated in the study. The median age of participants was 18·2 years (IQR 7·7-31·4) and 50·6% of participants were female. SARS-CoV-2 prevalence for the combined measure was 10·6% (95% CI 7·3-13·9). The rtPCR-positive prevalence was 7·6% (4·7-10·6) and ELISA-positive prevalence was 2·1% (1·1-3·1). An estimated 454 708 SARS-CoV-2 infections (95% CI 312 705-596 713) occurred in the six districts between March and July, 2020, compared with 4917 laboratory-confirmed cases reported in official statistics from the Zambia National Public Health Institute. INTERPRETATION: The estimated number of SARS-CoV-2 infections was much higher than the number of reported cases in six districts in Zambia. The high rtPCR-positive SARS-CoV-2 prevalence was consistent with observed community transmission during the study period. The low ELISA-positive SARS-CoV-2 prevalence might be associated with mitigation measures instituted after initial cases were reported in March, 2020. Zambia should monitor patterns of SARS-CoV-2 prevalence and promote measures that can reduce transmission. FUNDING: US Centers for Disease Control and Prevention.
BACKGROUND: Between March and December, 2020, more than 20 000 laboratory-confirmed cases of SARS-CoV-2 infection were reported in Zambia. However, the number of SARS-CoV-2 infections is likely to be higher than the confirmed case counts because many infectedpeople have mild or no symptoms, and limitations exist with regard to testing capacity and surveillance systems in Zambia. We aimed to estimate SARS-CoV-2 prevalence in six districts of Zambia in July, 2020, using a population-based household survey. METHODS: Between July 4 and July 27, 2020, we did a cross-sectional cluster-sample survey of households in six districts of Zambia. Within each district, 16 standardised enumeration areas were randomly selected as primary sampling units using probability proportional to size. 20 households from each standardised enumeration area were selected using simple random sampling. All members of selected households were eligible to participate. Consenting participants completed a questionnaire and were tested for SARS-CoV-2 infection using real-time PCR (rtPCR) and anti-SARS-CoV-2 antibodies using ELISA. Prevalence estimates, adjusted for the survey design, were calculated for each diagnostic test separately, and combined. We applied the prevalence estimates to census population projections for each district to derive the estimated number of SARS-CoV-2 infections. FINDINGS: Overall, 4258 people from 1866 households participated in the study. The median age of participants was 18·2 years (IQR 7·7-31·4) and 50·6% of participants were female. SARS-CoV-2 prevalence for the combined measure was 10·6% (95% CI 7·3-13·9). The rtPCR-positive prevalence was 7·6% (4·7-10·6) and ELISA-positive prevalence was 2·1% (1·1-3·1). An estimated 454 708 SARS-CoV-2 infections (95% CI 312 705-596 713) occurred in the six districts between March and July, 2020, compared with 4917 laboratory-confirmed cases reported in official statistics from the Zambia National Public Health Institute. INTERPRETATION: The estimated number of SARS-CoV-2 infections was much higher than the number of reported cases in six districts in Zambia. The high rtPCR-positive SARS-CoV-2 prevalence was consistent with observed community transmission during the study period. The low ELISA-positive SARS-CoV-2 prevalence might be associated with mitigation measures instituted after initial cases were reported in March, 2020. Zambia should monitor patterns of SARS-CoV-2 prevalence and promote measures that can reduce transmission. FUNDING: US Centers for Disease Control and Prevention.
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