Estimated US Infection- And Vaccine-Induced SARS-CoV-2 Seroprevalence Based on Blood Donations, July 2020-May 2021

Jefferson M. Jones, Mars Stone, Hasan Sulaeman, Rebecca V. Fink, Honey Dave, Matthew E. Levy, Clara Di Germanio, Valerie Green, Edward Notari, Paula Saa, Brad J. Biggerstaff, Donna Strauss, Debra Kessler, Ralph Vassallo, Rita Reik, Susan Rossmann, Mark Destree, Kim Anh Nguyen, Merlyn Sayers, Chris LoughDaniel W. Bougie, Megan Ritter, Gerardo Latoni, Billy Weales, Stacy Sime, Jed Gorlin, Nicole E. Brown, Carolyn V. Gould, Kevin Berney, Tina J. Benoit, Maureen J. Miller, Dane Freeman, Deeksha Kartik, Alicia M. Fry, Eduardo Azziz-Baumgartner, Aron J. Hall, Adam Macneil, Adi V. Gundlapalli, Sridhar V. Basavaraju, Susan I. Gerber, Monica E. Patton, Brian Custer, Phillip Williamson, Graham Simmons, Natalie J. Thornburg, Steven Kleinman, Susan L. Stramer, Jean Opsomer, Michael P. Busch

Research output: Contribution to journalArticlepeer-review

110 Scopus citations


Importance: People who have been infected with or vaccinated against SARS-CoV-2 have reduced risk of subsequent infection, but the proportion of people in the US with SARS-CoV-2 antibodies from infection or vaccination is uncertain. Objective: To estimate trends in SARS-CoV-2 seroprevalence related to infection and vaccination in the US population. Design, Setting, and Participants: In a repeated cross-sectional study conducted each month during July 2020 through May 2021, 17 blood collection organizations with blood donations from all 50 US states; Washington, DC; and Puerto Rico were organized into 66 study-specific regions, representing a catchment of 74% of the US population. For each study region, specimens from a median of approximately 2000 blood donors were selected and tested each month; a total of 1594363 specimens were initially selected and tested. The final date of blood donation collection was May 31, 2021. Exposure: Calendar time. Main Outcomes and Measures: Proportion of persons with detectable SARS-CoV-2 spike and nucleocapsid antibodies. Seroprevalence was weighted for demographic differences between the blood donor sample and general population. Infection-induced seroprevalence was defined as the prevalence of the population with both spike and nucleocapsid antibodies. Combined infection- and vaccination-induced seroprevalence was defined as the prevalence of the population with spike antibodies. The seroprevalence estimates were compared with cumulative COVID-19 case report incidence rates. Results: Among 1443519 specimens included, 733052 (50.8%) were from women, 174842 (12.1%) were from persons aged 16 to 29 years, 292258 (20.2%) were from persons aged 65 years and older, 36654 (2.5%) were from non-Hispanic Black persons, and 88773 (6.1%) were from Hispanic persons. The overall infection-induced SARS-CoV-2 seroprevalence estimate increased from 3.5% (95% CI, 3.2%-3.8%) in July 2020 to 20.2% (95% CI, 19.9%-20.6%) in May 2021; the combined infection- and vaccination-induced seroprevalence estimate in May 2021 was 83.3% (95% CI, 82.9%-83.7%). By May 2021, 2.1 SARS-CoV-2 infections (95% CI, 2.0-2.1) per reported COVID-19 case were estimated to have occurred. Conclusions and Relevance: Based on a sample of blood donations in the US from July 2020 through May 2021, vaccine- and infection-induced SARS-CoV-2 seroprevalence increased over time and varied by age, race and ethnicity, and geographic region. Despite weighting to adjust for demographic differences, these findings from a national sample of blood donors may not be representative of the entire US population..

Original languageEnglish (US)
Pages (from-to)1400-1409
Number of pages10
JournalJAMA - Journal of the American Medical Association
Issue number14
StatePublished - Oct 12 2021
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)


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