{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T04:10:06Z","timestamp":1748491806602,"version":"3.41.0"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T00:00:00Z","timestamp":1748390400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000008","name":"David and Lucile Packard Foundation","doi-asserted-by":"publisher","award":["#2021-72608"],"award-info":[{"award-number":["#2021-72608"]}],"id":[{"id":"10.13039\/100000008","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Accurate and timely surveillance of SARS-CoV-2 prevalence and immunity is critical to local and national COVID-19 pandemic responses. Representative surveillance surveys reveal more accurate estimates of COVID-19 infection than other measures based on reported test results. Our main research objectives were (i) to provide local health department officials with prevalence estimates calculated from a representative sample to better inform their decision-making efforts in response to the COVID-19 pandemic and (ii) to identify characteristics associated with COVID-19 infections among high-risk groups. Three municipalities were sampled at one timepoint (February, April, or October 2022) using a 2-stage cluster sampling design. Participants provided anterior nares swabs, which were tested for SARS-CoV-2 with a RT-PCR and for nucleocapsid protein and receptor binding domain antibodies by multiplex Luminex assay. Participants completed a survey on socio-demographics, SARS-CoV-2 prevention behaviors and attitudes, and vaccination and infection history. A total of 233 individuals from 221 households provided anterior nares swabs, and 215 samples were linked to survey data. After adjusting for study design, the household prevalence of PCR-positive tests was less than 5%, but approximately half of the population had antibodies from a prior infection and most (81% to 92%) had antibodies from either infection or vaccination. Discrepancies between self-reported positive test and vaccination status and antibody results suggested a high prevalence of asymptomatic infection and waning antibody titers. County-level infection prevalences, estimated from the county test reporting system, were 16.6% in February, 19.1% in April, and 23.8% in October, substantially lower than the prevalence of individuals with antibodies from infection in the surveys, also supporting a high prevalence of asymptomatic or unconfirmed infections. The overall small sample size precluded an analysis of characteristics associated with active or past infection. In conclusion, surveillance surveys can provide timely data on infection status and immunity to support public health responses.<\/jats:p>","DOI":"10.1371\/journal.pone.0323659","type":"journal-article","created":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T17:29:37Z","timestamp":1748453377000},"page":"e0323659","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence of SARS-CoV-2 infection and immunity in a New York county in 2022 reveals frequent asymptomatic or undiagnosed infections"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2290-1868","authenticated-orcid":true,"given":"Casey L.","family":"Cazer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeanne W.","family":"Lawless","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9569-4597","authenticated-orcid":true,"given":"Parshad","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bettina","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diego G.","family":"Diel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9187-4939","authenticated-orcid":true,"given":"Katherine R.","family":"McLaughlin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey W.","family":"Bethel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth F.","family":"Plocharczyk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin J.","family":"Cummings","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4170-4648","authenticated-orcid":true,"given":"Genevive R.","family":"Meredith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha","family":"Hillson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Lawlis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lara","family":"Parrilla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin D.","family":"Dalziel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,5,28]]},"reference":[{"issue":"3","key":"pone.0323659.ref001","first-page":"3","article-title":"Public health surveillance in the United States: evolution and challenges","volume":"61","author":"S Thacker","year":"2012","journal-title":"Morb Mortal Wkly Rep"},{"issue":"22","key":"pone.0323659.ref002","doi-asserted-by":"crossref","first-page":"680","DOI":"10.15585\/mmwr.mm6922e1","article-title":"Evidence for Limited Early Spread of COVID-19 Within the United States, January-February 2020","volume":"69","author":"CDC COVID-19 Response Team","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"17","key":"pone.0323659.ref003","doi-asserted-by":"crossref","first-page":"606","DOI":"10.15585\/mmwr.mm7117e3","article-title":"Seroprevalence of infection-induced SARS-CoV-2 antibodies - United States, September 2021-February 2022","volume":"71","author":"K Clarke","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"1","key":"pone.0323659.ref004","doi-asserted-by":"crossref","first-page":"38","DOI":"10.2105\/AJPH.2021.306568","article-title":"Accuracy of Case-Based Seroprevalence of SARS-CoV-2 Antibodies in Maricopa County, Arizona","volume":"112","author":"M Jehn","year":"2022","journal-title":"Am J Public Health"},{"issue":"5","key":"pone.0323659.ref005","doi-asserted-by":"crossref","first-page":"929","DOI":"10.3201\/eid2905.221541","article-title":"SARS-CoV-2 Seroprevalence Compared with Confirmed COVID-19 Cases among Children, Colorado, USA, May-July 2021","volume":"29","author":"SC O\u2019Brien","year":"2023","journal-title":"Emerg Infect Dis"},{"key":"pone.0323659.ref006","article-title":"Seroprevalence of antibodies to SARS-CoV-2 in 10 sites in the United States, March 23-May 12, 2020","author":"F Havers","year":"2020","journal-title":"JAMA Intern Med"},{"issue":"7896","key":"pone.0323659.ref007","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1038\/d41586-022-00336-8","article-title":"Tracking COVID-19 infections: time for change","volume":"602","author":"N Dean","year":"2022","journal-title":"Nature"},{"key":"pone.0323659.ref008","first-page":"1","article-title":"What is the active prevalence of COVID-19?","author":"M Yang","year":"2023","journal-title":"Rev Econ Stat"},{"key":"pone.0323659.ref009","doi-asserted-by":"crossref","DOI":"10.1017\/S0950268820002745","article-title":"Prevalence of asymptomatic COVID-19 infection using a seroepidemiological survey","volume":"148","author":"M Shakiba","year":"2020","journal-title":"Epidemiol Infect"},{"issue":"1","key":"pone.0323659.ref010","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1038\/s43856-023-00321-w","article-title":"The prevalence of SARS-CoV-2 infection and other public health outcomes during the BA.2\/BA.2.12.1 surge, New York City, April-May 2022","volume":"3","author":"SA Qasmieh","year":"2023","journal-title":"Commun Med (Lond)"},{"issue":"11","key":"pone.0323659.ref011","doi-asserted-by":"crossref","first-page":"2786","DOI":"10.3201\/eid2711.204435","article-title":"Probability-Based Estimates of Severe Acute Respiratory Syndrome Coronavirus 2 Seroprevalence and Detection Fraction, Utah, USA","volume":"27","author":"MH Samore","year":"2021","journal-title":"Emerg Infect Dis"},{"issue":"7","key":"pone.0323659.ref012","doi-asserted-by":"crossref","first-page":"768","DOI":"10.2105\/AJPH.2023.307303","article-title":"Stratified Simple Random Sampling Versus Volunteer Community-Wide Sampling for Estimates of COVID-19 Prevalence","volume":"113","author":"RJ Keith","year":"2023","journal-title":"Am J Public Health"},{"key":"pone.0323659.ref013","doi-asserted-by":"crossref","first-page":"960","DOI":"10.15585\/mmwr.mm6929e1","article-title":"Population point prevalence of SARS-CoV-2 infection based on a statewide random sample \u2014 Indiana, April 25\u201329, 2020","volume":"69","author":"N Menachemi","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"1","key":"pone.0323659.ref014","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.44258","article-title":"Seroprevalence of Antibodies Specific to Receptor Binding Domain of SARS-CoV-2 and Vaccination Coverage Among Adults in Los Angeles County, April 2021: The LA Pandemic Surveillance Cohort Study","volume":"5","author":"N Sood","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"4","key":"pone.0323659.ref015","doi-asserted-by":"crossref","first-page":"700","DOI":"10.2105\/AJPH.2020.306115","article-title":"Seroprevalence of SARS-CoV-2 Antibodies in Rhode Island From a Statewide Random Sample","volume":"111","author":"PA Chan","year":"2021","journal-title":"Am J Public Health"},{"issue":"22","key":"pone.0323659.ref016","doi-asserted-by":"crossref","first-page":"601","DOI":"10.15585\/mmwr.mm7222a3","article-title":"Estimates of SARS-CoV-2 Seroprevalence and Incidence of Primary SARS-CoV-2 Infections Among Blood Donors, by COVID-19 Vaccination Status - United States, April 2021-September 2022","volume":"72","author":"JM Jones","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"1","key":"pone.0323659.ref017","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s10900-021-01021-z","article-title":"Survey of Adherence with COVID-19 Prevention Behaviors During the 2020 Thanksgiving and Winter Holidays Among Members of the COVID-19 Community Research Partnership","volume":"47","author":"JE Peacock Jr","year":"2022","journal-title":"J Community Health"},{"issue":"2","key":"pone.0323659.ref018","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0246941","article-title":"Attitudes, current behaviours and barriers to public health measures that reduce COVID-19 transmission: A qualitative study to inform public health messaging","volume":"16","author":"JL Benham","year":"2021","journal-title":"PLoS One"},{"key":"pone.0323659.ref019","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.ijid.2021.03.056","article-title":"Mask use, risk-mitigation behaviours and pandemic fatigue during the COVID-19 pandemic in five cities in Australia, the UK and USA: A cross-sectional survey","volume":"106","author":"CR MacIntyre","year":"2021","journal-title":"Int J Infect Dis"},{"issue":"12","key":"pone.0323659.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0278335","article-title":"Population-based correlates of COVID-19 infection: An analysis from the DFW COVID-19 prevalence study","volume":"17","author":"AG Singal","year":"2022","journal-title":"PLoS One"},{"issue":"5","key":"pone.0323659.ref021","doi-asserted-by":"crossref","DOI":"10.1111\/tbed.14619","article-title":"Case-control study to identify risk factors for SARS-CoV-2 infection among university students in the northeastern USA","volume":"69","author":"KJ Cummings","year":"2022","journal-title":"Transbound Emerg Dis"},{"issue":"7","key":"pone.0323659.ref022","doi-asserted-by":"crossref","first-page":"980","DOI":"10.2105\/AJPH.2022.306838","article-title":"Integrated surveillance system for controlling COVID-19 on a university campus, 2020-2021","volume":"112","author":"G Meredith","year":"2022","journal-title":"Am J Public Health"},{"key":"pone.0323659.ref023","unstructured":"World Health Organization. Immunization coverage cluster survey - Reference manual. Report No: WHO\/IVB\/04.23B. 2005."},{"issue":"9","key":"pone.0323659.ref024","doi-asserted-by":"crossref","first-page":"2551","DOI":"10.1007\/s00705-021-05148-1","article-title":"Clinical evaluation of a multiplex real-time RT-PCR assay for detection of SARS-CoV-2 in individual and pooled upper respiratory tract samples","volume":"166","author":"M Laverack","year":"2021","journal-title":"Arch Virol"},{"issue":"7","key":"pone.0323659.ref025","doi-asserted-by":"crossref","DOI":"10.3390\/v15071555","article-title":"The Cornell COVID-19 testing laboratory: A model to high-capacity testing hubs for infectious disease emergency response and preparedness","volume":"15","author":"M Laverack","journal-title":"Viruses"},{"issue":"1","key":"pone.0323659.ref026","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0262868","article-title":"Development of a quantitative COVID-19 multiplex assay and its use for serological surveillance in a low SARS-CoV-2 incidence community","volume":"17","author":"C Guarino","year":"2022","journal-title":"PLoS One"},{"key":"pone.0323659.ref027","volume-title":"Package \u2018survey\u2019","author":"T Lumley","year":"2024"},{"key":"pone.0323659.ref028","article-title":"U.S. Census Bureau QuickFacts: Tompkins County, New York","author":"US Census Bureau","year":"2024"},{"issue":"3","key":"pone.0323659.ref029","doi-asserted-by":"crossref","first-page":"100085","DOI":"10.1016\/j.jcvp.2022.100085","article-title":"Duration of COVID-19 PCR positivity for Omicron vs earlier variants","volume":"2","author":"N Kojima","year":"2022","journal-title":"J Clin Virol Plus"},{"issue":"6","key":"pone.0323659.ref030","article-title":"Dynamics of SARS-CoV-2 neutralising antibody responses and duration of immunity: a longitudinal study","volume":"2","author":"WN Chia","year":"2021","journal-title":"Lancet Microbe"},{"issue":"12","key":"pone.0323659.ref031","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1016\/S2213-2600(21)00407-0","article-title":"Does infection with or vaccination against SARS-CoV-2 lead to lasting immunity?","volume":"9","author":"G Milne","year":"2021","journal-title":"Lancet Respir Med"},{"issue":"4","key":"pone.0323659.ref032","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1097\/PHH.0000000000001704","article-title":"Pandemic Response Officers: Integration Between Medical, Public Health, and Higher Education Systems to Expedite Prevention and Response","volume":"29","author":"AC Jones","year":"2023","journal-title":"J Public Health Manag Pract"},{"key":"pone.0323659.ref033","author":"Centers for Disease Control and Prevention","year":"2024","journal-title":"SARS-CoV-2 Variant Proportions"},{"issue":"24","key":"pone.0323659.ref034","doi-asserted-by":"crossref","first-page":"2524","DOI":"10.1001\/jama.2021.19996","article-title":"Durability of Antibody Levels After Vaccination With mRNA SARS-CoV-2 Vaccine in Individuals With or Without Prior Infection","volume":"326","author":"D Zhong","year":"2021","journal-title":"JAMA"},{"issue":"9","key":"pone.0323659.ref035","doi-asserted-by":"crossref","DOI":"10.1016\/j.cmi.2023.05.020","article-title":"Durability and determinants of anti-SARS-CoV-2 spike antibodies following the second and third doses of mRNA COVID-19 vaccine","volume":"29","author":"S Yamamoto","year":"2023","journal-title":"Clin Microbiol Infect"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0323659","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T17:29:52Z","timestamp":1748453392000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0323659"}},"subtitle":[],"editor":[{"given":"Harapan","family":"Harapan","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,28]]},"references-count":35,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0323659","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,28]]}}}