COVID-19 in Tunisia (North Africa): Seroprevalence of SARS-CoV-2 in the general population of the capital city Tunis

Abstract Background:Monitoring the coronavirus disease-19 (COVID-19) pandemic is primarily based on Reverse transcription polymerase chain reaction (RT PCR) detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As this test is mainly applied on persons with symptomatic disease, it may overlook individuals with pauci- or a-symptomatic infection. Seroprevalence studies are thus essential to get an accurate estimate of the actual SARS-CoV-2 diffusion within the populations. We report on the findings of the first serosurvey conducted in the capital city of Tunisia prior to the implementation of mass vaccination and analyzed factors associated with seropositivity. Methods:A cross sectional survey was conducted among households living in two areas of the governorate of Tunis, the capital city of the country. The survey was realized between March and April 2021, spanning the end of the second wave and the beginning of the third wave of COVID-19 and prior to the implementation of mass vaccination in Tunisia. SARS-CoV-2 specific immunoglobulin G (IgG) antibodies to the spike (S-RBD) or the nucleocapsid (N) proteins were detected using an in-house ELISA test. Results were adjusted for test performance. Multivariate logistic regression analysis was performed to determine factors independently associated with SARS-COV-2 seropositivity.Results:The survey included 1676 individuals from 431 households. The mean age and sex ratio were 43.3±20.9 years and 0.6 respectively. The weighted and test-performance adjusted prevalence of IgG antibodies to the N and the S-RBD proteins were 26.6% [22.9-30.8] and 25.1% [22.2-28.4] respectively. The weighted seroprevalence of anti-N and/or anti-S-RBD IgG antibodies was equal to 38.0% [34.6-41.5]. In multivariate analysis, age under 10, no tobacco use, previous diagnosis of COVID-19, a history of COVID-19 related symptoms and contact with a COVID-19 case within the household, were independently associated with higher SARS-CoV-2 seroprevalence. Conclusions:After the end of the second epidemic wave, more than one third of people living in Tunis got antibodies to SARS-CoV-2. Further studies are needed to monitor changes in these figures as Tunisian population is confronted to the subsequent epidemic waves and to guide the vaccine strategy.