接种率之外：社区总SARS-CoV-2免疫血清阳性率的合成随机代理指标
Beyond Vaccination Rates: A Synthetic Random Proxy Metric of Total SARS-CoV-2 Immunity Seroprevalence in the Community
摘要：
明确了解社区层面的总免疫血清阳性率对于制定政策以减轻SARS-CoV-2的社会和临床影响至关重要。公开的疫苗接种数据经常被引用作为人群免疫力的代表，但这一指标忽略了自然获得性免疫的影响，这种影响在全国和世界各地都有很大差异。如果不对人群进行广泛或随机抽样，通常无法准确测量自然感染后的持续免疫力。为了能够跟踪自然获得的和疫苗诱导的免疫力，我们建立了一个基于常规医院检测的合成随机代理，以估计样本社区中的总免疫球蛋白G（IgG）患病率。我们的方法分析了在医院系统内进行择期手术的无症状患者的病毒IgG检测数据。我们应用多级回归和后分层调整样本和社区人口之间的人口和地理差异。然后，我们应用基于状态的疫苗接种数据将免疫状态分类为自然感染或疫苗驱动。我们已经使用病毒和症状性疾病发病率的经验证的临床指标验证了该模型，以显示这些实体与血清阳性率的时间、速率和幅度的预期生物学相关性。于二零二一年七月中旬，两县的估计免疫水平为74%，接种率为45%。该指标提高了对COVID-19免疫力的实时了解，以及对该疾病的政策反应的协调，从而建立了一个廉价且易于操作的监测系统，超越了疫苗接种数据集的局限性。
英文摘要：
Explicit knowledge of total community-level immune seroprevalence is critical to developing policies to mitigate the social and clinical impact of SARS-CoV-2. Publicly available vaccination data are frequently cited as a proxy for population immunity, but this metric ignores the effects of naturally-acquired immunity, which varies broadly throughout the country and world. Without broad or random sampling of the population, accurate measurement of persistent immunity post natural infection is generally unavailable. To enable tracking of both naturally-acquired and vaccine-induced immunity, we set up a synthetic random proxy based on routine hospital testing for estimating total Immunoglobulin G (IgG) prevalence in the sampled community. Our approach analyzes viral IgG testing data of asymptomatic patients who present for elective procedures within a hospital system. We apply multilevel regression and poststratification to adjust for demographic and geographic discrepancies between the sample and the community population. We then apply state-based vaccination data to categorize immune status as driven by natural infection or by vaccine. We have validated the model using verified clinical metrics of viral and symptomatic disease incidence to show the expected biological correlation of these entities with the timing, rate, and magnitude of seroprevalence. In mid-July 2021, the estimated immunity level was 74% with the administered vaccination rate of 45% in the two counties. The metric improves real-time understanding of immunity to COVID-19 as it evolves and the coordination of policy responses to the disease, toward an inexpensive and easily operational surveillance system that transcends the limits of vaccination datasets alone.
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