ENE-COVID nationwide serosurvey served to characterize asymptomatic infections and to develop a symptom-based risk score to predict COVID-19
•In Spain, nearly 30% of SARS-CoV-2 infections in the first wave were asymptomatic.•Asymptomatic infections were more frequent in areas with lower viral circulation.•Men, young and old people, and smokers had more asymptomatic infections.•We developed a symptom-based score applicable in primary care...
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| Veröffentlicht in: | Journal of clinical epidemiology 2021-11, Vol.139, p.240-254 |
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| container_title | Journal of clinical epidemiology |
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| creator | Pérez-Gómez, Beatriz Pastor-Barriuso, Roberto Pérez-Olmeda, Mayte Hernán, Miguel A Oteo-Iglesias, Jesús Fernández de Larrea, Nerea Fernández-García, Aurora Martín, Mariano Fernández-Navarro, Pablo Cruz, Israel Sanmartín, Jose L León Paniagua, Jose Muñoz-Montalvo, Juan F Blanco, Faustino Yotti, Raquel Pollán, Marina |
| description | •In Spain, nearly 30% of SARS-CoV-2 infections in the first wave were asymptomatic.•Asymptomatic infections were more frequent in areas with lower viral circulation.•Men, young and old people, and smokers had more asymptomatic infections.•We developed a symptom-based score applicable in primary care or community settings.•A score ≥3 detects over 70% of cases among symptomatic people with specificity >70%.
To characterize asymptomatic SARS-CoV-2 infections and develop a symptom-based risk score useful in primary healthcare.
Sixty-one thousand ninty-two community-dwelling participants in a nationwide population-based serosurvey completed a questionnaire on COVID-19 symptoms and received an immunoassay for SARS-CoV-2 IgG antibodies between April 27 and June 22, 2020. Standardized prevalence ratios for asymptomatic infection were estimated across participant characteristics. We constructed a symptom-based risk score and evaluated its ability to predict SARS-CoV-2 infection.
Of all, 28.7% of infections were asymptomatic (95% CI 26.1–31.4%). Standardized asymptomatic prevalence ratios were 1.19 (1.02–1.40) for men vs. women, 1.82 (1.33–2.50) and 1.45 (0.96–2.18) for individuals |
| doi_str_mv | 10.1016/j.jclinepi.2021.06.005 |
| format | Article |
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To characterize asymptomatic SARS-CoV-2 infections and develop a symptom-based risk score useful in primary healthcare.
Sixty-one thousand ninty-two community-dwelling participants in a nationwide population-based serosurvey completed a questionnaire on COVID-19 symptoms and received an immunoassay for SARS-CoV-2 IgG antibodies between April 27 and June 22, 2020. Standardized prevalence ratios for asymptomatic infection were estimated across participant characteristics. We constructed a symptom-based risk score and evaluated its ability to predict SARS-CoV-2 infection.
Of all, 28.7% of infections were asymptomatic (95% CI 26.1–31.4%). Standardized asymptomatic prevalence ratios were 1.19 (1.02–1.40) for men vs. women, 1.82 (1.33–2.50) and 1.45 (0.96–2.18) for individuals <20 and ≥80 years vs. those aged 40–59, 1.27 (1.03–1.55) for smokers vs. nonsmokers, and 1.91 (1.59–2.29) for individuals without vs. with case contact. In symptomatic population, a symptom-based score (weights: severe tiredness = 1; absence of sore throat = 1; fever = 2; anosmia/ageusia = 5) reached standardized seroprevalence ratio of 8.71 (7.37–10.3), discrimination index of 0.79 (0.77–0.81), and sensitivity and specificity of 71.4% (68.1–74.4%) and 74.2% (73.1–75.2%) for a score ≥3.
The presence of anosmia/ageusia, fever with severe tiredness, or fever without sore throat should serve to suspect COVID-19 in areas with active viral circulation. The proportion of asymptomatics in children and adolescents challenges infection control.
[Display omitted]</description><identifier>ISSN: 0895-4356</identifier><identifier>EISSN: 1878-5921</identifier><identifier>DOI: 10.1016/j.jclinepi.2021.06.005</identifier><identifier>PMID: 34126206</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anosmia ; Antibodies ; Asymptomatic ; Asymptomatic infection ; Asymptomatic Infections - epidemiology ; Censuses ; Child ; Child, Preschool ; Children ; Coronaviruses ; COVID-19 ; COVID-19 - epidemiology ; Epidemiology ; Female ; Fever ; General population ; Households ; Humans ; Immunoassay ; Immunoglobulin G ; Infant ; Infant, Newborn ; Infections ; Laboratories ; Male ; Middle Aged ; Nationwide serosurvey ; Olfaction disorders ; Pandemics ; Pharyngitis ; Population ; Prediction model ; Primary care ; Primary Health Care ; Questionnaires ; Risk ; Risk Factors ; SARS-CoV-2 infection ; Seroepidemiologic Studies ; Serology ; Severe acute respiratory syndrome coronavirus 2 ; Smoking ; Spain - epidemiology ; Symptoms ; Taste disorders ; Viral diseases ; Young Adult</subject><ispartof>Journal of clinical epidemiology, 2021-11, Vol.139, p.240-254</ispartof><rights>2021</rights><rights>Copyright © 2021. Published by Elsevier Inc.</rights><rights>Copyright Elsevier Limited Nov 2021</rights><rights>2021 The Author(s). Published by Elsevier Inc. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c499t-e73138b2d66cacb32f821fb153f9139fa83efba1881510ab9cc3abdda61561e33</citedby><cites>FETCH-LOGICAL-c499t-e73138b2d66cacb32f821fb153f9139fa83efba1881510ab9cc3abdda61561e33</cites><orcidid>0000-0001-9427-2581 ; 0000-0002-4299-8214 ; 0000-0003-1619-8456 ; 0000-0003-4553-5423 ; 0000-0003-3327-8263 ; 0000-0002-7325-3960 ; 0000-0002-2200-2360 ; 0000-0002-4328-1565</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0895435621001839$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34126206$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pérez-Gómez, Beatriz</creatorcontrib><creatorcontrib>Pastor-Barriuso, Roberto</creatorcontrib><creatorcontrib>Pérez-Olmeda, Mayte</creatorcontrib><creatorcontrib>Hernán, Miguel A</creatorcontrib><creatorcontrib>Oteo-Iglesias, Jesús</creatorcontrib><creatorcontrib>Fernández de Larrea, Nerea</creatorcontrib><creatorcontrib>Fernández-García, Aurora</creatorcontrib><creatorcontrib>Martín, Mariano</creatorcontrib><creatorcontrib>Fernández-Navarro, Pablo</creatorcontrib><creatorcontrib>Cruz, Israel</creatorcontrib><creatorcontrib>Sanmartín, Jose L</creatorcontrib><creatorcontrib>León Paniagua, Jose</creatorcontrib><creatorcontrib>Muñoz-Montalvo, Juan F</creatorcontrib><creatorcontrib>Blanco, Faustino</creatorcontrib><creatorcontrib>Yotti, Raquel</creatorcontrib><creatorcontrib>Pollán, Marina</creatorcontrib><creatorcontrib>ENE-COVID Study Group</creatorcontrib><title>ENE-COVID nationwide serosurvey served to characterize asymptomatic infections and to develop a symptom-based risk score to predict COVID-19</title><title>Journal of clinical epidemiology</title><addtitle>J Clin Epidemiol</addtitle><description>•In Spain, nearly 30% of SARS-CoV-2 infections in the first wave were asymptomatic.•Asymptomatic infections were more frequent in areas with lower viral circulation.•Men, young and old people, and smokers had more asymptomatic infections.•We developed a symptom-based score applicable in primary care or community settings.•A score ≥3 detects over 70% of cases among symptomatic people with specificity >70%.
To characterize asymptomatic SARS-CoV-2 infections and develop a symptom-based risk score useful in primary healthcare.
Sixty-one thousand ninty-two community-dwelling participants in a nationwide population-based serosurvey completed a questionnaire on COVID-19 symptoms and received an immunoassay for SARS-CoV-2 IgG antibodies between April 27 and June 22, 2020. Standardized prevalence ratios for asymptomatic infection were estimated across participant characteristics. We constructed a symptom-based risk score and evaluated its ability to predict SARS-CoV-2 infection.
Of all, 28.7% of infections were asymptomatic (95% CI 26.1–31.4%). Standardized asymptomatic prevalence ratios were 1.19 (1.02–1.40) for men vs. women, 1.82 (1.33–2.50) and 1.45 (0.96–2.18) for individuals <20 and ≥80 years vs. those aged 40–59, 1.27 (1.03–1.55) for smokers vs. nonsmokers, and 1.91 (1.59–2.29) for individuals without vs. with case contact. In symptomatic population, a symptom-based score (weights: severe tiredness = 1; absence of sore throat = 1; fever = 2; anosmia/ageusia = 5) reached standardized seroprevalence ratio of 8.71 (7.37–10.3), discrimination index of 0.79 (0.77–0.81), and sensitivity and specificity of 71.4% (68.1–74.4%) and 74.2% (73.1–75.2%) for a score ≥3.
The presence of anosmia/ageusia, fever with severe tiredness, or fever without sore throat should serve to suspect COVID-19 in areas with active viral circulation. The proportion of asymptomatics in children and adolescents challenges infection control.
[Display omitted]</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anosmia</subject><subject>Antibodies</subject><subject>Asymptomatic</subject><subject>Asymptomatic infection</subject><subject>Asymptomatic Infections - epidemiology</subject><subject>Censuses</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>COVID-19 - epidemiology</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Fever</subject><subject>General population</subject><subject>Households</subject><subject>Humans</subject><subject>Immunoassay</subject><subject>Immunoglobulin G</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infections</subject><subject>Laboratories</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nationwide serosurvey</subject><subject>Olfaction disorders</subject><subject>Pandemics</subject><subject>Pharyngitis</subject><subject>Population</subject><subject>Prediction model</subject><subject>Primary care</subject><subject>Primary Health Care</subject><subject>Questionnaires</subject><subject>Risk</subject><subject>Risk Factors</subject><subject>SARS-CoV-2 infection</subject><subject>Seroepidemiologic Studies</subject><subject>Serology</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>Smoking</subject><subject>Spain - epidemiology</subject><subject>Symptoms</subject><subject>Taste disorders</subject><subject>Viral diseases</subject><subject>Young Adult</subject><issn>0895-4356</issn><issn>1878-5921</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkc2O0zAUhS0EYsrAK4wssWGT4mvXrrNBoFJgpBGzAbaW49wwLkkc7CSoPAMPjTvtjIANK1_J3zn35xByAWwJDNTL3XLnWt_j4JeccVgytWRMPiAL0GtdyJLDQ7JgupTFSkh1Rp6ktGMM1mwtH5MzsQKuOFML8mv7cVtsrr9cvqW9HX3of_gaacIY0hRn3B_KGWs6BupubLRuxOh_IrVp3w1j6LLGUd836A7iRG1_y9Y4YxsGaumJKyqbsk306RtNLkQ8UEPE2ruR3vYvoHxKHjW2Tfjs9J6Tz--2nzYfiqvr95ebN1eFW5XlWOBagNAVr5Vy1lWCN5pDU4EUTQmibKwW2FQWtAYJzFalc8JWdW0VSAUoxDl5dfQdpqrD2mE_RtuaIfrOxr0J1pu_f3p_Y76G2WgouRYqG7w4GcTwfcI0ms4nh21rewxTMlyuQHCQjGf0-T_oLkyxz-sZrlieiOmVzJQ6Ui4fPkVs7ocBZg6Bm525C9wcAjdMmRx4Fl78ucq97C7hDLw-ApgPOnuMJjmPvcuXjzk0Uwf_vx6_AdfKwow</recordid><startdate>20211101</startdate><enddate>20211101</enddate><creator>Pérez-Gómez, Beatriz</creator><creator>Pastor-Barriuso, Roberto</creator><creator>Pérez-Olmeda, Mayte</creator><creator>Hernán, Miguel A</creator><creator>Oteo-Iglesias, Jesús</creator><creator>Fernández de Larrea, Nerea</creator><creator>Fernández-García, Aurora</creator><creator>Martín, Mariano</creator><creator>Fernández-Navarro, Pablo</creator><creator>Cruz, Israel</creator><creator>Sanmartín, Jose L</creator><creator>León Paniagua, Jose</creator><creator>Muñoz-Montalvo, Juan F</creator><creator>Blanco, Faustino</creator><creator>Yotti, Raquel</creator><creator>Pollán, Marina</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><general>The Author(s). 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of clinical epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pérez-Gómez, Beatriz</au><au>Pastor-Barriuso, Roberto</au><au>Pérez-Olmeda, Mayte</au><au>Hernán, Miguel A</au><au>Oteo-Iglesias, Jesús</au><au>Fernández de Larrea, Nerea</au><au>Fernández-García, Aurora</au><au>Martín, Mariano</au><au>Fernández-Navarro, Pablo</au><au>Cruz, Israel</au><au>Sanmartín, Jose L</au><au>León Paniagua, Jose</au><au>Muñoz-Montalvo, Juan F</au><au>Blanco, Faustino</au><au>Yotti, Raquel</au><au>Pollán, Marina</au><aucorp>ENE-COVID Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>ENE-COVID nationwide serosurvey served to characterize asymptomatic infections and to develop a symptom-based risk score to predict COVID-19</atitle><jtitle>Journal of clinical epidemiology</jtitle><addtitle>J Clin Epidemiol</addtitle><date>2021-11-01</date><risdate>2021</risdate><volume>139</volume><spage>240</spage><epage>254</epage><pages>240-254</pages><issn>0895-4356</issn><eissn>1878-5921</eissn><abstract>•In Spain, nearly 30% of SARS-CoV-2 infections in the first wave were asymptomatic.•Asymptomatic infections were more frequent in areas with lower viral circulation.•Men, young and old people, and smokers had more asymptomatic infections.•We developed a symptom-based score applicable in primary care or community settings.•A score ≥3 detects over 70% of cases among symptomatic people with specificity >70%.
To characterize asymptomatic SARS-CoV-2 infections and develop a symptom-based risk score useful in primary healthcare.
Sixty-one thousand ninty-two community-dwelling participants in a nationwide population-based serosurvey completed a questionnaire on COVID-19 symptoms and received an immunoassay for SARS-CoV-2 IgG antibodies between April 27 and June 22, 2020. Standardized prevalence ratios for asymptomatic infection were estimated across participant characteristics. We constructed a symptom-based risk score and evaluated its ability to predict SARS-CoV-2 infection.
Of all, 28.7% of infections were asymptomatic (95% CI 26.1–31.4%). Standardized asymptomatic prevalence ratios were 1.19 (1.02–1.40) for men vs. women, 1.82 (1.33–2.50) and 1.45 (0.96–2.18) for individuals <20 and ≥80 years vs. those aged 40–59, 1.27 (1.03–1.55) for smokers vs. nonsmokers, and 1.91 (1.59–2.29) for individuals without vs. with case contact. In symptomatic population, a symptom-based score (weights: severe tiredness = 1; absence of sore throat = 1; fever = 2; anosmia/ageusia = 5) reached standardized seroprevalence ratio of 8.71 (7.37–10.3), discrimination index of 0.79 (0.77–0.81), and sensitivity and specificity of 71.4% (68.1–74.4%) and 74.2% (73.1–75.2%) for a score ≥3.
The presence of anosmia/ageusia, fever with severe tiredness, or fever without sore throat should serve to suspect COVID-19 in areas with active viral circulation. The proportion of asymptomatics in children and adolescents challenges infection control.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34126206</pmid><doi>10.1016/j.jclinepi.2021.06.005</doi><tpages>15</tpages><orcidid>https://orcid.org/0000-0001-9427-2581</orcidid><orcidid>https://orcid.org/0000-0002-4299-8214</orcidid><orcidid>https://orcid.org/0000-0003-1619-8456</orcidid><orcidid>https://orcid.org/0000-0003-4553-5423</orcidid><orcidid>https://orcid.org/0000-0003-3327-8263</orcidid><orcidid>https://orcid.org/0000-0002-7325-3960</orcidid><orcidid>https://orcid.org/0000-0002-2200-2360</orcidid><orcidid>https://orcid.org/0000-0002-4328-1565</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0895-4356 |
| ispartof | Journal of clinical epidemiology, 2021-11, Vol.139, p.240-254 |
| issn | 0895-4356 1878-5921 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8192836 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adolescent Adult Aged Aged, 80 and over Anosmia Antibodies Asymptomatic Asymptomatic infection Asymptomatic Infections - epidemiology Censuses Child Child, Preschool Children Coronaviruses COVID-19 COVID-19 - epidemiology Epidemiology Female Fever General population Households Humans Immunoassay Immunoglobulin G Infant Infant, Newborn Infections Laboratories Male Middle Aged Nationwide serosurvey Olfaction disorders Pandemics Pharyngitis Population Prediction model Primary care Primary Health Care Questionnaires Risk Risk Factors SARS-CoV-2 infection Seroepidemiologic Studies Serology Severe acute respiratory syndrome coronavirus 2 Smoking Spain - epidemiology Symptoms Taste disorders Viral diseases Young Adult |
| title | ENE-COVID nationwide serosurvey served to characterize asymptomatic infections and to develop a symptom-based risk score to predict COVID-19 |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-08T11%3A06%3A34IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=ENE-COVID%20nationwide%20serosurvey%20served%20to%20characterize%20asymptomatic%20infections%20and%20to%20develop%20a%20symptom-based%20risk%20score%20to%20predict%20COVID-19&rft.jtitle=Journal%20of%20clinical%20epidemiology&rft.au=P%C3%A9rez-G%C3%B3mez,%20Beatriz&rft.aucorp=ENE-COVID%20Study%20Group&rft.date=2021-11-01&rft.volume=139&rft.spage=240&rft.epage=254&rft.pages=240-254&rft.issn=0895-4356&rft.eissn=1878-5921&rft_id=info:doi/10.1016/j.jclinepi.2021.06.005&rft_dat=%3Cproquest_pubme%3E2606150845%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2606150845&rft_id=info:pmid/34126206&rft_els_id=S0895435621001839&rfr_iscdi=true |