Low Seroprevalence of COVID-19 in Lao PDR, Late 2020

Abstract

Background: Lao PDR has low reported COVID-19 cases but it is unclear whether this masks silent transmission. A nationwide seroprevalence study was done between August and September 2020 to determine SARS-CoV-2 exposure.Methods: Participants were from the general community/healthcare workers in five provinces. Bat/wildlife contacts were from Vientiane province. ELISAs detected anti-Nucleoprotein (N; n=3173 tested) and anti-Spike (S; n=1417 tested) SARS-CoV-2 antibodies. Double-positive samples were checked by IgM/IgG rapid tests. Positive controls were confirmed COVID-19 cases and negative controls were pre-COVID-19 samples.Findings: In pre-COVID-19 samples, 14/265 (5·3%, [95% CI=3·1-8·7%]) were anti-N antibody single-positive and 3/265 (1·1% [0·3-3·5%]) were anti-S antibody single positive. None were anti-N and anti-S antibody double positive. Anti-N and anti-S antibodies were detected in 131/2417 (5·4% [4·5-6·3%]) and 19/1061 (1·8% [1·1-2·8%]) of the general population, 13/666 (2·0% [1·1-3·3%]) and 4/282 (1·4% [0·5-3·7%]) of healthcare workers and 15/74 (20·3% [12·6-31·0%]) and 5/74 (6·8% [2·8-15·3%]) of bat/wildlife contacts. Only 2/3173 (0·1% [0·02-0·3%]) were double positive for anti-N and anti-S antibodies (rapid test negative).Interpretation: We find no evidence for significant circulation of SARS-CoV-2 in Lao PDR during or before September 2020. This likely results from decisive measures taken by the government early in the pandemic, social behavior, and low population density. High anti-N antibodies/low anti-S antibodies in bat/wildlife contacts may indicate exposure to cross-reactive animal coronaviruses with threat of emerging novel viruses.Funding: Core; Agence Française de Développement. Additional support; Institut Pasteur du Laos, Institute Pasteur, Paris and Luxembourg Ministry of Foreign and European Affairs (“PaReCIDS II”). Declaration of Interests: The authors have no conflict of interest to declare.Ethics Approval Statement: The study protocol was approved by all participating institutes and by the Lao National Ethics Committee for Health Research (NECHR) (Ref #052/2020).