IJID Regions 10 (2024) 179–182 Contents lists available at ScienceDirect IJID Regions journal homepage: www.elsevier.com/locate/ijregi Pre-vaccination seroprevalence of SARS-CoV-2 antibodies in the Volta Region, Ghana Enoch Aninagyei 1 , Reuben Ayivor-Djanie 1 , 2 , Jones Gyamfi3 , 4 , Marfo Edward Aboagye 1 , Grace Semabia Kpeli 1 , William Kwabena Ampofo 5 , John Owusu Gyapong 6 , Kwabena Obeng Duedu 1 , 7 , ∗ 1 Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana 2 West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Legon, Ghana 3 Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana 4 School of Health & Life Sciences, Teesside University, Middlesbrough, United Kingdom 5 Virology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana 6 Centre for Neglected Tropical Diseases, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana 7 College of Life Sciences, Faculty of Health, Education and Life Sciences, Birmingham City University, City South Campus, Birmingham, United Kingdom a r t i c l e i n f o Keywords: SARS-CoV-2 COVID-19 Vaccination Exposure Pandemic a b s t r a c t Objectives: Before administration of the first dose of the AstraZeneca 2019 SARS-CoV-2 vaccine to selected pri- oritized groups in the Volta regional capital of Ghana, we determined the pre-vaccination status of prospective recipients and established the baseline exposure status 1 year after the first case was reported. Methods: After informed consent, blood samples were collected for the detection of SARS-CoV-2 immunoglobulin (Ig) M/IgG antibodies using rapid diagnostic test kits. A total of 409 individuals (mean age 27 years) consented and participated in the study, comprising 70% students and others were health staff and educators who presented themselves for vaccination. Results: The overall exposure rate of SARS-CoV-2 was 12.7% (95% confidence interval [CI] 9.6-16.3). The preva- lence of SARS-CoV-2 IgM and IgG were 4.2% (95% CI 2.4-6.6) and 5.6% (95% CI 3.6-8.3), respectively. IgM and IgG were detected in 2.9% (95% CI 1.5-5.1) of the respondents. The exposure rates were higher in participants over 40 years old (15.5%). Participants without a history of COVID-19–like symptoms had an exposure rate of 13.0% and those without any chronic diseases was 13.2%. Conclusion: Pre-vaccination exposure was relatively low and underscored the need for vaccination i to increase protection in communities and disease outcomes. I w a r fi t c t e C s t m d S a [ e v i a n t c a h R 2 B ntroduction COVID-19 caused by the novel SARS-CoV-2 has spread rapidly orldwide and has caused over 760 million confirmed infections and lmost 7 million deaths as of September 27, 2023 [1] since it was first eported in Wuhan Province in China in late 2019 [2] . In Ghana, the rst two cases of COVID-19 were reported on March 12, 2020 in two re- urnees from Norway and Turkey, and as of August 13, 2023, 171,780 ases and 1462 deaths have been reported [3] . In Ghana, adherence o COVID-19 public health preventive measures was low in the gen- ral population [4 , 5] . When the government of Ghana gradually eased OVID-19 restrictions in July 2020, adherence to protective measures, uch as social distancing, wearing of face masks, and handwashing prac- ices, gradually decreased over time [4] . ∗ Corresponding author: E-mail addresses: kduedu@uhas.edu.gh , kwabena.duedu@bcu.ac.uk (K.O. Duedu) ttps://doi.org/10.1016/j.ijregi.2024.01.007 eceived 2 January 2024; Received in revised form 15 January 2024; Accepted 17 Ja 772-7076/© 2024 The Author(s). Published by Elsevier Ltd on behalf of Internation Y-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ) Vaccination is one of the key pharmaceutical interventions recom- ended as part of the public health interventions to precent severe isease and possible transmission of SARS-COV-2 in the communities. ARS-CoV-2 vaccines are recommended because they elicit protection gainst severe outcomes of COVID-19 such as hospitalization and death 6] . Aside from vaccination, natural infection with SARS-CoV-2 also licit some level of protection against subsequent infection and se- ere outcomes such as hospitalization and death [7 , 8] . Several stud- es have suggested that the levels and durability of natural infection nd vaccine-induced protection vary [9 , 10] ; hence, more studies are eeded to shed more insights [11] . The differences in the levels of pro- ection as well as waning could be due to several factors, such as mu- osal immunity, mechanism of action, levels and types of neutralizing ntibody titers, and circulating variants [12] . After an infection with . nuary 2024 al Society for Infectious Diseases. This is an open access article under the CC https://doi.org/10.1016/j.ijregi.2024.01.007 http://www.ScienceDirect.com http://www.elsevier.com/locate/ijregi http://crossmark.crossref.org/dialog/?doi=10.1016/j.ijregi.2024.01.007&domain=pdf mailto:kduedu@uhas.edu.gh mailto:kwabena.duedu@bcu.ac.uk https://doi.org/10.1016/j.ijregi.2024.01.007 http://creativecommons.org/licenses/by-nc-nd/4.0/ E. Aninagyei, R. Ayivor-Djanie, J. Gyamfi et al. IJID Regions 10 (2024) 179–182 a s ( c S w g a e n i l s i t t w d i t c t s M S e H a t S w w i S e t t a B E C a C i w s a a b s i t w Table 1 Demographic characteristics of the study participants. Variable Frequency N (%) SARS-CoV-2 antibody N (%) Age 17 - 20 52 (12.7%) 3 (5.8 %) 21 - 39 312 (76.3%) 42 (13.5 %) > 39 45 (11.0%) 7 (15.6 %) Gender Male 225 (55.0%) 27 (12 %) Female 184 (45.0%) 25 (13.6 %) Occupation Administrative officer 38 (9.3%) 7 (18.4 %) Janitor and engineering 31 (7.6%) 5 (16.1 %) Healthcare worker 18 (4.4%) 2 (11.1 %) Lecturer 36 (8.8%) 4 (11.1 %) Student 286 (70.0%) 34 (11.8 %) R P t d d I r ( o d D y m ( 4 ( H l c c ( l s l 1 t w ( f l 2 ( t m 1 w t s t coronavirus, B cells elicit an early response against the nucleocap- id (N) protein and immunoglobulin (Ig) M antibodies against the spike S) protein could be detected after a week, whereas SARS-CoV-2 IgG ould be detected after 14 days [13] . It has also been established that ARS-CoV-2 IgM decreases to about 30% its initial levels after 12 weeks, hereas SARS-CoV-2 IgG levels remain high for 3 months before be- inning to decrease [14] . It is, therefore, important to establish types nd levels of protection owing to either natural or vaccine-mediated xposure. Ghana, as in most other resource-limited settings, were not fortu- ate to access vaccines on time. Even when vaccines were available, t was rationed first for frontline workers before the general popu- ation. This study was designed to assess the pre-vaccination expo- ure among frontline personnel before receiving COVID-19 vaccines n the Volta Region of Ghana. This study was necessitated because of he hesitancy to receive the vaccine and instituted as a public opera- ional measure. Before administration of the vaccines, some frontline orkers and others argued that they had protection and needed evi- ence of their status before taking the vaccines. The study was also mportant because in cases where there is previous exposure and an- ibody presence, those antibodies could serve as primers for the vac- ines and hence boost the response after vaccination. In other words, he vaccines will work better as boosters of the existing immune tate. ethods tudy design, study sites, and study populations A cross-sectional study was conducted in health students and work- rs at the University of Health and Allied Sciences and the Ho Teaching ospital between March and May 2021. The two institutions established joint task force to tackle the pandemic and saw each other contributing o various aspects of the response. The University of Health and Allied ciences COVID-19 Centre performed all testing and its staff teamed up ith the teaching hospital staff to manage cases at the isolation center as ell as in the hospital. Convenience sampling was used to recruit partic- pants when they visited the vaccination points in the two institutions. ample collection and analysis From each study participant, 3-5 ml of blood was collected into an thylenediaminetetraacetic acid tube. The blood was centrifuged, and he plasma was separated and analyzed. The SARS-CoV-2 IgG/IgM an- ibodies in plasma were detected by the World Health Organization– pproved RightSignTM rapid diagnostic test kit (Hangzhou Biotest iotech Co., Ltd, China) according to the manufacturer’s instructions. pidemiological data, such as demographic information, history of OVID-19–like symptoms, and current chronic medical condition, if ny, were obtained. onsent to participate and ethics In response to concerns about potential pre-existing antibodies and ts impact, informed consent was administered to individuals who anted their samples tested before vaccination. Because this fell out- ide the public health response activities, the samples were archived nd a study protocol was developed to seek ethics approval before the rchived samples could be tested. This study was reviewed and approved y the research ethics committee of the University of Health and Allied ciences, with approval number UHAS-REC A.12 [15] 2021. All partic- pants provided written informed consent before participation. For par- icipants below 18 years old, written parental consent and child ascent ere obtained. 180 esults revalence of SARS-CoV-2 antigens and antibodies A total of 409 individuals consented and participated in the study. Of hese, 52 (12.7%) were exposed to SARS-CoV-2. SARS-CoV-2 IgM was etected in 17 (4.2%) of the participants, whereas SARS-CoV-2 IgG was etected in 23 (5.6%) of the participants. In addition, both SARS-CoV-2 gM/IgG were detected in 12 (2.9%) of the participants. The exposure ates were higher in participants over 40 years old (15.5%), females 13.6%), administrative officers (18.4%), participants without a history f COVID-19–like symptoms (13.0%), and participants without chronic iseases (13.2%), although the rates did not reach significant levels. emographic characteristics and SARS-CoV-2 exposure The mean and median ages of the participants were 27 years and 23 ears, respectively. The minimum age was 17 years, whereas the maxi- um age was 83 years. The majority of the participants were students 70%). SARS-CoV-2 exposure was relatively higher in participants over 0 years old (15.6%), females (13.6%), and administrative staff (18.4%) Table 1 ). istory of COVID-19–like symptoms, co-morbidities, and seropositivity Of the 409 study participants, 19.3% indicated they have had at east one COVID-19–like symptom within 3 months. Of these, the most ommon reported symptoms were headache (48.1%), sneezing (43%), ough (41.8%), sore throat (40.5%), fever (25.3%), and anosmia (19%) Table 2 ). Most of the study participants with a history of COVID-19– ike symptoms (76%) experienced between two and nine COVID-19–like ymptoms. Of the participants who previously experienced COVID-19– ike symptoms, 11.4% of them were exposed to SARS-CoV-2, whereas 3% of the participants without a history of COVID-19–like symp- oms were exposed to SARS-CoV-2. The SARS-CoV-2 exposure rates ere higher in participants who previously experienced abdominal pain 66.7%), ageusia (25%), chills (23%), difficulty in breathing (18.1%), ever (15%), and anosmia (13.3%). In all, 16.4% of the study participants reported to be living with at east one chronic condition that puts them at risk for a severe SARS-CoV- infection. The highest reported chronic condition was hypertension 5.1%) and the lowest was gastric ulcer (0.5%). Other conditions and heir proportions are presented in Table 2 . Nine of the participants had ultiple morbidities. Of those participants living with chronic diseases, 0.4% were exposed to SARS-CoV-2, whereas 13.2% of those not living ith any chronic disease were exposed to SARS-CoV-2. SARS-CoV-2 an- ibodies were not detected in participants living with diabetes mellitus, ickle cell, and gastric ulcer. However, SARS-CoV-2 antibodies were de- ected in participants with hypertension, bronchial asthma, and allergic E. Aninagyei, R. Ayivor-Djanie, J. Gyamfi et al. IJID Regions 10 (2024) 179–182 Table 2 Spectrum of COVID-19–like symptoms and co-morbidities. Variable Frequency N (%) SARS-CoV-2 antibodies N (%) COVID-19 like symptoms Headache 38 (48.1%) 4 (10.5 %) Sneezing 34 (43.0%) 1 (2.9 %) Cough 33 (41.8%) 2 (6.1 %) Sore throat 32 (40.5%) 3 (9.4 %) Fever 20 (25.3%) 3 (15.0 %) Anosmia 15 (19.0%) 2 (13.3 %) Muscle ache 14 (17.7%) 1 (7.1 %) Chills 13 (16.5%) 3 (23.0 %) Difficulty in breathing 11 (14.0%) 2 (18.1 %) Ageusia 8 (10.1%) 2 (25.0 %) Abdominal disturbances 3 (3.8%) 2 (66.7 %) Chronic co-morbidities at risk of severe SARS-CoV-2 illness Hypertension 21 (5.1%) 3 (14.3%) Bronchial asthma 19 (4.6%) 3 (15.8%) Sickle cell disease 14 (3.4%) 0 (0.0%) Allergy 16 (3.9%) 3 (18.8%) Diabetes mellitus 6 (1.5%) 0 (0.0%) Gastric ulcer 2 (0.5%) 0 (0.0%) Two or more chronic morbidity 9 (2.2%) 1 (11.1%) r c o D t ( [ r p i ( w [ p p 1 4 i d t S d i i p d p h [ w t i p o c t c t t w s c t t m a c i p p c a w t i t p l v c D F E m n i o A w eactions. Nine (13.4%) of the participants were living with multiple hronic diseases and SARS-CoV-2 antibodies were detected in only one f them (participant with hypertension and allergic reactions). iscussion The rate of exposure to SARS-CoV-2 in the study participants in his study was lower than that reported for the Greater Accra Region 29%) but higher than that reported for the Upper East Region (2%) 16] . The seroprevalence from the previously mentioned studies mir- or the case ratios in all the locations [3] . Beyond Ghana, the sero- revalence reported in other places was lower than in our study. This ncludes Virginia, USA (2.4%) [17] , Spain (5.0%) [15] , Switzerland 10.8%) [18] , Denmark (2.0%) [19] , and Togo (1.6%) [20] . Our finding as marginally higher than the seroprevalence reported in Italy (11%) 21] and Indonesia (11.4%) [22] . In addition, similar rates were re- orted in Malawi 12.3% [23] . In other locations, significantly higher revalence rates have been reported: 16.5% in Pakistan (15.6%) [24] , 7.6% in the Republic of the Congo [25] , 17.6% in Nigeria [26] , and 2. 3% prevalence in Kenya [27] . Antibody seropositivity from natural nfection is necessary for building protection against severe disease and eath [7] . Based on the IgM and IgG results, it can be deduced that some of he participants were carrying the infection at the time of vaccination. everal cases of asymptomatic infections were reported during the pan- emic worldwide. In a systematic review and meta-analysis of 350 stud- es, asymptomatic infections were found to be 35.1% (95% confidence nterval 30.7-39.9%) [28] , whereas another conducted on 38 studies re- orted asymptomatic infections in 44.1% (6556 of 14,850, 95% confi- ence interval 43.3-45.0%) [29] . Considering that majority of our study articipants were young people, our study aligns with other studies that ave reported that asymptomatic infection is high in that age group 29] . The levels of exposure based on antibody presence in our study ere, however, lower than those who had reported one or more symp- oms that were associated with COVID-19 at the time. This is not surpris- ng because the symptoms, which were used as primary pointers of sus- icion, were largely generic and will show if anyone has an infection or ther respiratory infections. It is worth noting that headache, sneezing, ough, sore throat, and fever were the most commonly reported symp- oms. Interpreting such data, however, should be done with caution be- ause, at the time of the pandemic, there was widespread education on hese symptoms and people were likely going to take note of them when hey occurred rather than if they had occurred in the past when there 181 as no COVID-19. Furthermore, it is also worth noting that hyperten- ion, bronchial asthma, and sickle cell disease were the most common o-morbidities reported. In a sample drawn from the same community, he prevalence of hypertension was reported to be 31.28% [30] and, herefore, not surprising that it was one of the commonly reported co- orbidity in the participants drawn into this study. In conclusion, the COVID-19 pandemic has taught us many lessons nd the way forward at present is to take stock, learn from the oc- urrences, and be better prepared for future pandemics. Several stud- es have found that natural infections provide better and longer lasting rotection against re-infection and severe disease than vaccine-induced rotection [7 , 10] . It is, however, important to also note that, there are ontrasting results and, hence, more analyses are needed to get a better nd more accurate picture [11] . The message from our study is that there as some level of protection from natural infection before the introduc- ion of the vaccines; however, this was in a relatively small proportion of ndividuals. Hence, to achieve high levels of protection, it was necessary o administer the vaccines. In future pandemics (and for public health urposes), however, it will be necessary to assess natural infections at arge scales before vaccine introductions as well as post-introduction of accines so that well informed assessments of the impact of the vaccines ould be performed. eclarations of competing interest The authors have no competing interest to declare. unding This study did not receive funding from any source. thical approval This study was reviewed and approved by the research ethics com- ittee of the University of Health and Allied sciences with approval umber UHAS-REC A.12 [15] 2021. All participants provided written nformed consent before participation. For participants below 18 years ld, written parental consent and child ascent were obtained. cknowledgments The authors would like to thank all the respondents of the study as ell as the management and staff of the University of Health and Allied E. Aninagyei, R. Ayivor-Djanie, J. Gyamfi et al. IJID Regions 10 (2024) 179–182 S m H a C A t c d d r d D t R [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ ciences and the Ho Teaching Hospital for their cooperation. Further- ore, the authors are grateful to the Ministry of Health and the Ghana ealth Service for facilitating the vaccination programs. The authors lso acknowledge Hubert K. Agbogli and Priscilla Essandoh of the UHAS OVID-19 Centre for providing some assistance for the laboratory work. uthor contributions EA: study design, investigation, data analysis, writing. RAD: concep- ualization, study design, data collection, review and editing. JG: con- eptualization, study design, data collection, review and editing. MEA: ata collection, investigation. GSK: study design, data collection. WKA: ata analysis, review & editing. JOG: conceptualization, study design, eview and editing, supervision. KOD: conceptualization, study design, ata collection, data analysis, writing, supervision. ata availability All data have been reported in the manuscript. Any further informa- ion may be requested. eferences [1] World Health Organization Coronavirus disease (COVID-19) pandemic ; 2023 https://www.who.int/emergencies/diseases/novel-coronavirus-2019 [accessed 30 September 2023] . [2] Zhu H, Wei L, Niu P. The novel coronavirus outbreak in Wuhan, China. Glob Health Res Policy 2020; 5 :6. doi: 10.1186/s41256-020-00135-6 . [3] Ghana Health Service Ghana’s outbreak response management updates Accra: Ghana Health Service ; 2023 https://www.ghs.gov.gh/covid19/ [accessed 30 September 2023] . [4] Apanga PA, Kumbeni MT. Adherence to COVID-19 preventive measures and associ- ated factors among pregnant women in Ghana. 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Int J Hypertens 2022; 2022 :2242901. doi: 10.1155/2022/2242901 . https://www.who.int/emergencies/diseases/novel-coronavirus-2019 https://doi.org/10.1186/s41256-020-00135-6 https://www.ghs.gov.gh/covid19/ https://doi.org/10.1111/tmi.13566 https://doi.org/10.1371/journal.pone.0238971 https://doi.org/10.1056/NEJMoa2034577 https://doi.org/10.1056/NEJMc2108120 https://doi.org/10.1056/NEJMc2200133 https://doi.org/10.1056/NEJMoa2035389 https://doi.org/10.1016/S2666-5247(22)00287-7 https://doi.org/10.1093/infdis/jiac257 https://doi.org/10.1016/j.eclinm.2021.100861 https://doi.org/10.1093/cid/ciaa310 https://doi.org/10.1016/j.intimp.2020.107271 https://doi.org/10.1016/S0140-6736(20)31483-5 https://doi.org/10.12688/wellcomeopenres.16890.1 https://doi.org/10.1001/jamanetworkopen.2020.35234 https://doi.org/10.1016/S0140-6736(20)31304-0 https://doi.org/10.1093/cid/ciaa849 https://doi.org/10.1371/journal.pone.0242124 https://doi.org/10.3390/jcm9092780 https://doi.org/10.1371/journal.pone.0251234 https://doi.org/10.12688/wellcomeopenres.16188.1 https://doi.org/10.29271/jcpsp.2020.07.735 https://doi.org/10.1016/j.ijid.2020.12.065 https://doi.org/10.1016/j.ijid.2021.07.040 https://doi.org/10.1093/ofid/ofab314 https://doi.org/10.1073/pnas.2109229118 https://doi.org/10.1097/INF.0000000000003791 https://doi.org/10.1155/2022/2242901 Pre-vaccination seroprevalence of SARS-CoV-2 antibodies in the Volta Region, Ghana Introduction Methods Study design, study sites, and study populations Sample collection and analysis Consent to participate and ethics Results Prevalence of SARS-CoV-2 antigens and antibodies Demographic characteristics and SARS-CoV-2 exposure History of COVID-19-like symptoms, co-morbidities, and seropositivity Discussion Declarations of competing interest Funding Ethical approval Acknowledgments Author contributions Data availability References