{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T01:04:48Z","timestamp":1759971888846,"version":"build-2065373602"},"reference-count":61,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100005561","name":"North Carolina Department of Health and Human Services","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005561","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005561","name":"North Carolina Department of Health and Human Services","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005561","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005561","name":"North Carolina Department of Health and Human Services","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005561","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR002553"],"award-info":[{"award-number":["UL1TR002553"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Claude D. Pepper Older Americans Independence Center, Duke University","award":["5P30AG028716-15"],"award-info":[{"award-number":["5P30AG028716-15"]}]},{"DOI":"10.13039\/100000066","name":"National Institute of Environmental Health Sciences","doi-asserted-by":"publisher","award":["T32ES007018"],"award-info":[{"award-number":["T32ES007018"]}],"id":[{"id":"10.13039\/100000066","id-type":"DOI","asserted-by":"publisher"}]},{"name":"David H. Murdock Institute for Business and Culture"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Surveillance estimates of SARS-CoV-2 infections over time have relied on mandatory clinician and laboratory reporting. These estimates increasingly underestimated true viral incidence due to asymptomatic infections, variable access to testing, and self-administered diagnostics. To overcome these limitations, the North Carolina Department of Health and Human Services partnered with academic researchers to conduct three concurrent population-based longitudinal cohort studies in three distinct North Carolina counties to offer more accurate estimates of the incidence, prevalence, and vaccination rates for SARS-CoV-2.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We enrolled and followed adult residents of three North Carolina counties from August 2020-February 2022. Demographic and health information was collected in biweekly surveys. Nasal swabs were collected biweekly and tested for SARS-CoV-2 using PCR testing. Blood samples were collected monthly and tested for antibodies to the SARS-CoV-2 nucleocapsid and spike proteins. We calculated monthly seroprevalence, sero-incidence, PCR test positivity, and vaccination uptake.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We enrolled 646 participants. Routine blood samples and nasal swab samples were contributed by 639 and 642 participants, respectively. By February 2022, 98% (95% CI: 97.4\u201398.2) had antibodies to the SARS-CoV-2 spike protein, and 13% (95% CI: 12.4\u201314.2) had antibodies to the nucleocapsid protein, indicating viral exposure. PCR testing detected infection among 14% (95% CI: 13.1\u201315.0) of participants, but cumulative PCR test positivity was only 1.3% (95% CI: 1.2\u20131.4). Over half of PCR-detected infections were asymptomatic. By February 2022, 97% of participants had completed the primary vaccine series, and 52% had received a booster dose.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Nearly all participants had anti-SARS-CoV-2 antibodies by the end of follow-up, primarily through vaccination. The incidence of PCR-detected infections was similar to antibody testing, but PCR test positivity substantially underestimated incident infections. These findings emphasize the importance of prospective infection monitoring via antibody testing in a comprehensive approach to tracking viral infections in the community setting.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0332645","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T17:35:36Z","timestamp":1759944936000},"page":"e0332645","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in North Carolina from December 2020 \u2013 February 2022"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5548-4450","authenticated-orcid":true,"given":"Elyse 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