{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T17:01:51Z","timestamp":1757610111836,"version":"3.44.0"},"reference-count":52,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,3]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Estimates of exposure to coronavirus disease 2019 (COVID-19) on the African continent are limited, constrained by availability of testing and case report data. To improve understanding of COVID-19 burden, monthly severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurveillance was implemented at first antenatal care visits (ANC1) across six sub-Saharan African countries (Kenya, Malawi, Mozambique, Nigeria, Uganda, and Zambia). A standardized questionnaire, including COVID-19 vaccination history, was administered, and a blood sample was collected. Serology was conducted with two assays: in Nigeria, a multiplex bead-based assay targetting spike protein, receptor binding domain (RBD) 591, and nucleocapsid (N) protein and in all other countries, a SARS-CoV-2 human IgG antibody test including RBD, N protein, and hybrid RBD-N. The largest monthly change in seropositivity was between December 2021 and January 2022 for five countries (Kenya: 33.2\u201370.3%, Malawi: 28.3\u201359.6%, Mozambique: 29.3\u201372.8%, Nigeria: 52.4\u201377.4%, Uganda: 55.7\u201380.6%), coinciding with the Omicron wave. Aside from Mozambique, there was an increase in the proportion of women reporting COVID-19 vaccination beginning in January 2022, with highest vaccination rates between April and August 2022. Relatedly, there was an increase in the proportion vaccinated among those with detectable SARS-CoV-2 antibodies. Adenoviral vector accounted for at least half of the vaccines reported in all countries. If pregnant women are not differentially infected, ANC1 can be leveraged for serosurveillance during a pandemic. Monthly seroprevalence estimates alongside vaccination rates can provide evidence for changes in protective immunity in response to case waves and the introduction of protective measures.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0826","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T12:04:56Z","timestamp":1751371496000},"page":"543-554","source":"Crossref","is-referenced-by-count":0,"title":["Severe Acute Respiratory Syndrome Coronavirus 2 Seroprevalence and Coronavirus Disease 2019 Vaccination Trends: Findings from Surveillance Conducted at First Antenatal Care Visits in Kenya, Nigeria, Malawi, Mozambique, Uganda, and Zambia, 2021\u20132022"],"prefix":"10.4269","volume":"113","author":[{"given":"Victoria","family":"Seffren","sequence":"first","affiliation":[{"name":"Malaria Branch, Division of Parasitic Diseases and Malaria, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruchi","family":"Yadav","sequence":"additional","affiliation":[{"name":"Malaria Branch, Division of Parasitic Diseases and Malaria, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nnaemeka C.","family":"Iriemenam","sequence":"additional","affiliation":[{"name":"CDC Nigeria, Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Abuja, Nigeria;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oluseye","family":"Ajayi","sequence":"additional","affiliation":[{"name":"APIN Public Health Initiatives, Nigeria, Abuja, Nigeria;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olabanjo","family":"Ogunsola","sequence":"additional","affiliation":[{"name":"APIN Public Health Initiatives, Nigeria, Abuja, Nigeria;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Conceptor","family":"Mulube","sequence":"additional","affiliation":[{"name":"PATH, Lusaka, Zambia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix Bwalya","family":"Chilambe","sequence":"additional","affiliation":[{"name":"Adult Centre of Excellence, University Teaching Hospital, Lusaka, Zambia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Soko","sequence":"additional","affiliation":[{"name":"Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis","family":"Ogollah","sequence":"additional","affiliation":[{"name":"ICAP Malawi, Lilongwe, Malawi;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam","family":"Chomba","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Seda","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Idal\u00e9cia","family":"Cossa-Moiane","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Sa\u00fade, National Institute of Health Mozambique, Maputo, Mozambique;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zainabo","family":"Langa","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Sa\u00fade, National Institute of Health Mozambique, Maputo, Mozambique;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Oboth","sequence":"additional","affiliation":[{"name":"Infectious Disease Institute, College of Health Sciences at Makerere University, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Kwizera","sequence":"additional","affiliation":[{"name":"Infectious Disease Institute, College of Health Sciences at Makerere University, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Rogier","sequence":"additional","affiliation":[{"name":"Malaria Branch, Division of Parasitic Diseases and Malaria, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie R.","family":"Gutman","sequence":"additional","affiliation":[{"name":"Malaria Branch, Division of Parasitic Diseases and Malaria, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Acta Biomed","first-page":"157","article-title":"WHO declares COVID-19 a pandemic","volume":"91","author":"Cucinotta","year":"2020"},{"key":"b2","series-title":"Bull Natl Res Cent","first-page":"44","article-title":"A critical evaluation of Nigeria\u2019s response to the first wave of COVID-19","volume":"46","author":"Jacobs","year":"2022"},{"year":"2020","key":"b3","article-title":"WHO COVID-19 Dashboard"},{"key":"b4","series-title":"Ann Intern Med","first-page":"286","article-title":"Prevalence of asymptomatic SARS-CoV-2 infection","volume":"174","author":"Oran","year":"2021"},{"key":"b5","series-title":"Influenza Other Respir Viruses","first-page":"7","article-title":"Early epidemiological investigations: World Health Organization UNITY protocols provide a standardized and timely international investigation framework during the COVID-19 pandemic","volume":"16","author":"Bergeri","year":"2022"},{"key":"b6","series-title":"Lancet Infect Dis","first-page":"e75","article-title":"SeroTracker: A global SARS-CoV-2 seroprevalence dashboard","volume":"21","author":"Arora","year":"2021"},{"year":"2022","key":"b7","article-title":"COVID-19 Vaccination in the WHO African Region Monthly Bulletin November 2022"},{"key":"b8","series-title":"Epidemiol Infect","first-page":"e143","article-title":"COVID-19 vaccination rollout in the World Health Organization African region: Status at end June 2022 and way forward","volume":"150","author":"Impouma","year":"2022"},{"key":"b9","series-title":"Malar J","first-page":"99","article-title":"Using antenatal care as a platform for malaria surveillance data collection: Study protocol","volume":"22","author":"Gutman","year":"2023"},{"key":"b10","series-title":"JMIR Public Health Surveill","first-page":"e85","article-title":"HIV surveillance among pregnant women attending antenatal clinics: Evolution and current direction","volume":"3","author":"Dee","year":"2017"},{"key":"b11","series-title":"J Hum Reprod Sci","first-page":"90","article-title":"Severe acute respiratory syndrome coronavirus 2 infection symptoms in pregnancy and maternal and neonatal complications due to COVID-19: A systematic review","volume":"16","author":"Miraj","year":"2023"},{"key":"b12","series-title":"BMC Pregnancy Childbirth","first-page":"726","article-title":"COVID-19 incidence in women of reproductive age: A population-based study in Reggio Emilia, northern Italy","volume":"23","author":"Sileo","year":"2023"},{"key":"b13","article-title":"ScanForm Registers"},{"key":"b14","series-title":"Influenza Other Respir Viruses","first-page":"e13143","article-title":"Prior SARS-CoV-2 infection and COVID-19 vaccine effectiveness against outpatient illness during widespread circulation of SARS-CoV-2 Omicron variant, US Flu VE network","volume":"17","author":"Tartof","year":"2023"},{"key":"b15","series-title":"J Clin Virol Plus","first-page":"100139","article-title":"Comparison of one single-antigen assay and three multi-antigen SARS-CoV-2 IgG assays in Nigeria","volume":"3","author":"Iriemenam","year":"2023"},{"key":"b16","series-title":"Am J Trop Med Hyg","first-page":"260","article-title":"Performance of SARS-CoV-2 antigens in a multiplex bead assay for integrated serological surveillance of neglected tropical and other diseases","volume":"107","author":"Gwyn","year":"2022"},{"year":"2020","key":"b17","article-title":"Tetracore\u00ae FlexImmArray\u2122 7-Plex SARS-CoV-2 Human IgG Antibody Test"},{"key":"b18","series-title":"JAMA Intern Med","article-title":"Seroprevalence of antibodies to SARS-CoV-2 in 10 sites in the United States, March 23\u2013May 12, 2020","author":"Havers","year":"2020"},{"key":"b19","series-title":"Microbiol Spectr","first-page":"e0105422","article-title":"Evaluation of a multiplex bead assay against single-target assays for detection of IgG antibodies to SARS-CoV-2","volume":"10","author":"Mitchell","year":"2022"},{"key":"b20","series-title":"Stat Med","first-page":"791","article-title":"Confidence intervals for directly standardized rates: A method based on the gamma distribution","volume":"16","author":"Fay","year":"1997"},{"article-title":"COVID-19 Pandemic","year":"2020","author":"Mathieu","key":"b21"},{"year":"2021","key":"b22","article-title":"Mozambique: Pregnant, Breastfeeding Women to be Vaccinated from Wednesday"},{"key":"b23","series-title":"Nat Commun","first-page":"3966","article-title":"Temporal trends of SARS-CoV-2 seroprevalence during the first wave of the COVID-19 epidemic in Kenya","volume":"12","author":"Adetifa","year":"2021"},{"key":"b24","series-title":"PLoS Glob Public Health","first-page":"e0000363","article-title":"Seroprevalence of SARS-CoV-2 in four states of Nigeria in October 2020: A population-based household survey","volume":"2","author":"Audu","year":"2022"},{"article-title":"High SARS-CoV-2 seroprevalence in health care workers but relatively low numbers of deaths in urban Malawi","year":"2020","author":"Chibwana","key":"b25"},{"key":"b26","series-title":"Open Forum Infect Dis","first-page":"ofab314","article-title":"Anti-Severe acute respiratory syndrome coronavirus 2 immunoglobulin G antibody seroprevalence among truck drivers and assistants in Kenya","volume":"8","author":"Kagucia","year":"2021"},{"key":"b27","series-title":"BMC Med","first-page":"303","article-title":"SARS-CoV-2 exposure in Malawian blood donors: An analysis of seroprevalence and variant dynamics between January 2020 and July 2021","volume":"19","author":"Mandolo","year":"2021"},{"key":"b28","series-title":"Lancet Glob Health","first-page":"e773","article-title":"Prevalence of SARS-CoV-2 in six districts in Zambia in July, 2020: A cross-sectional cluster sample survey","volume":"9","author":"Mulenga","year":"2021"},{"key":"b29","series-title":"Int J Infect Dis","first-page":"171","article-title":"Population seroprevalence of SARS-CoV-2 antibodies in Anambra State, South-East, Nigeria","volume":"110","author":"Okpala","year":"2021"},{"key":"b30","series-title":"Int J Infect Dis","first-page":"256","article-title":"SARS-CoV-2 seroprevalence and associated risk factors in periurban Zambia: A population-based study","volume":"118","author":"Shanaube","year":"2022"},{"key":"b31","series-title":"BMC Infect Dis","first-page":"174","article-title":"Severe acute respiratory syndrome coronavirus-2 seroprevalence in South-Central Uganda, during 2019\u20132021","volume":"22","author":"Ssuuna","year":"2022"},{"key":"b32","series-title":"Science","first-page":"79","article-title":"Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Kenyan blood donors","volume":"371","author":"Uyoga","year":"2021"},{"key":"b33","doi-asserted-by":"crossref","DOI":"10.2139\/ssrn.4040702","article-title":"Population-based serosurveys for SARS-CoV-2: Key findings from five African countries: November 2020 to June 2021","author":"Emily","year":"2022"},{"key":"b34","series-title":"BMJ Glob Health","first-page":"e008793","article-title":"SARS-CoV-2 infection in Africa: A systematic review and meta-analysis of standardised seroprevalence studies, from January 2020 to December 2021","volume":"7","author":"Lewis","year":"2022"},{"key":"b35","series-title":"PLoS One","first-page":"e0265478","article-title":"Sero-surveillance for IgG to SARS-CoV-2 at antenatal care clinics in three Kenyan referral hospitals: Repeated cross-sectional surveys 2020-21","volume":"17","author":"Lucinde","year":"2022"},{"key":"b36","series-title":"Int J Infect Dis","first-page":"109","article-title":"SARS-CoV-2 seroprevalence in pregnant women during the first three COVID-19 waves in The Gambia","volume":"135","author":"Janha","year":"2023"},{"key":"b37","series-title":"BMJ Open","first-page":"e055834","article-title":"Seroprevalence of anti-SARS-CoV-2 antibodies in women attending antenatal care in eastern Ethiopia: A facility-based surveillance","volume":"11","author":"Assefa","year":"2021"},{"key":"b38","series-title":"PLoS One","first-page":"e0280109","article-title":"Monitoring SARS-CoV-2 seroprevalence over time among pregnant women admitted to delivery units: Suitability for surveillance","volume":"18","author":"Miyadahira","year":"2023"},{"key":"b39","series-title":"PLoS Med","first-page":"e1004107","article-title":"Global SARS-CoV-2 seroprevalence from January 2020 to April 2022: A systematic review and meta-analysis of standardized population-based studies","volume":"19","author":"Bergeri","year":"2022"},{"key":"b40","series-title":"Influenza Other Respir Viruses","first-page":"e13173","article-title":"SARS-CoV-2 seroprevalence and implications for population immunity: Evidence from two Health and Demographic Surveillance System sites in Kenya, February\u2013December 2022","volume":"17","author":"Kagucia","year":"2023"},{"key":"b41","series-title":"Int J Infect Dis","first-page":"118","article-title":"Characterizing the evolving SARS-CoV-2 seroprevalence in urban and rural Malawi between February 2021 and April 2022: A population-based cohort study","volume":"137","author":"Banda","year":"2023"},{"key":"b42","series-title":"Int J Epidemiol","first-page":"1361","article-title":"SARS-CoV-2 seroprevalence at urban and rural sites in Kaduna State, Nigeria, during October\/November 2021, immediately prior to detection of the Omicron variant","volume":"51","author":"Chechet","year":"2022"},{"key":"b43","series-title":"Transfusion","first-page":"1354","article-title":"SARS-CoV-2 seroprevalence among blood donors in Uganda: 2019\u20132022","volume":"63","author":"Bloch","year":"2023"},{"key":"b44","series-title":"JAMA Netw Open","first-page":"e2255978","article-title":"Seroprevalence of antibodies to SARS-CoV-2 in rural households in eastern Uganda, 2020\u20132022","volume":"6","author":"Briggs","year":"2023"},{"key":"b45","series-title":"Int J Infect Dis","first-page":"577","article-title":"High prevalence of pre-existing serological cross-reactivity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in sub-Saharan Africa","volume":"102","author":"Tso","year":"2021"},{"key":"b46","series-title":"Vaccines (Basel)","first-page":"1010","article-title":"COVID-19 vaccination in the WHO African Region: Progress made in 2022 and factors associated","volume":"11","author":"Mboussou","year":"2023"},{"year":"2024","key":"b47","article-title":"AFRICA COVID-19 Vaccination Dashboard"},{"key":"b48","series-title":"J Infect Dis","first-page":"1141","article-title":"Comparative immunogenicity and effectiveness of mRNA-1273, BNT162b2, and Ad26.COV2.S COVID-19 vaccines","volume":"225","author":"Naranbhai","year":"2022"},{"key":"b49","series-title":"Nat Med","first-page":"1072","article-title":"Antibody responses and correlates of protection in the general population after two doses of the ChAdOx1 or BNT162b2 vaccines","volume":"28","author":"Wei","year":"2022"},{"key":"b50","series-title":"EClinicalMedicine","first-page":"100947","article-title":"Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis","volume":"37","author":"Townsend","year":"2021"},{"key":"b51","series-title":"Sci Rep","first-page":"22175","article-title":"Plasmodium infection is associated with cross-reactive antibodies to carbohydrate epitopes on the SARS-CoV-2 Spike protein","volume":"12","author":"Lapidus","year":"2022"},{"key":"b52","series-title":"J Clin Microbiol","first-page":"e0051421","article-title":"Cross-reactivity of two SARS-CoV-2 serological assays in a setting where malaria is endemic","volume":"59","author":"Steinhardt","year":"2021"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/3\/article-p543.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/3\/article-p543.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/3\/article-p543.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T13:13:41Z","timestamp":1756905221000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/3\/article-p543.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,3]]},"references-count":52,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.24-0826","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"type":"print","value":"0002-9637"},{"type":"electronic","value":"1476-1645"}],"subject":[],"published":{"date-parts":[[2025,9,3]]}}}