Use of U.S. Blood Donors for National Serosurveillance of SARS-CoV-2 Antibodies: Basis for an Expanded National Donor Serosurveillance Program

Abstract

Introduction: The REDS-IV-P Epidemiology, Surveillance and Preparedness of the Novel SARS-CoV-2 Epidemic (RESPONSE) seroprevalence study conducted monthly cross-sectional testing for SARS-CoV-2 antibodies on blood donors in six U.S. metropolitan regions to estimate the extent of SARS-COV-2 infections over time. Study Design/Methods During March-August 2020, approximately ≥1,000 serum specimens were collected monthly from each region and tested for SARS-CoV-2 antibodies using a well-validated algorithm. Regional seroprevalence estimates were weighted based on demographic differences with the general population. Seroprevalence was compared with reported COVID-19 case rates over time. Results/Findings: For all regions, seroprevalence was <1.0% in March 2020. New York experienced the biggest increase (peak seroprevalence, 15.8 % in May). All other regions experienced modest increases in seroprevalence(1-2% in May-June to 2-4% in July-August). Seroprevalence was higher in younger, non-Hispanic Black, and Hispanic donors. Temporal increases in donor seroprevalence correlated with reported case rates in each region. In August, 1.3-5.6 estimated cumulative infections (based on seroprevalence data) per COVID-19 case reported to CDC. Conclusion: Increases in seroprevalence were found in all regions, with the largest increase in New York. Seroprevalence was higher in non-Hispanic Black and Hispanic blood donors than in non-Hispanic White blood donors. SARS-CoV-2 antibody testing of blood donor samples can be used to estimate the seroprevalence in the general population by region and demographic group. The methods derived from the RESPONSE seroprevalence study served as the basis for expanding SARS-CoV-2 seroprevalence surveillance to all 50 states and Puerto Rico.

The Recipient Epidemiology and Donor Evaluation Study‐IV‐Pediatric (REDS‐IV‐P): A research program striving to improve blood donor safety and optimize transfusion outcomes across the lifespan

“…Investigators who are not part of REDS‐IV‐P are encouraged to collaborate with the program. Examples of already established collaborations that access REDS‐IV‐P data and biospecimen resources include investigations into SARS‐CoV‐2 variants, severity score modeling for SCD, and metabolomics characterization of linked blood donation and recipient biospecimens 9,10 …”

“…Examples of already established collaborations that access REDS-IV-P data and biospecimen resources include investigations into SARS-CoV-2 variants, severity score modeling for SCD, and metabolomics characterization of linked blood donation and recipient biospecimens. 9,10 Finally, the REDS-IV-P program is committed to mentoring the next generation of transfusion medicine investigators. A testimony to this important mission is that many of the mentors in REDS-IV-P were once mentees in previous iterations of REDS (Figure 1).…”

Serological Testing of Blood Donors to Characterise the Impact of Covid-19 in Melbourne, Australia, 2020

“…A key methodological challenge for surveillance of any type is sampling populations of interest in a manner that is broadly representative of the underlying target population. Blood donor specimens have been used to monitor the prevalence of antibodies to a wide range of infectious agents [14,15], and for COVID-19, have been adopted by serosurveillance programs in the USA, UK and elsewhere to infer the spread of population infection over time [16,17]. However, it is also well recognised that blood donors are a selected population, a limitation of using these samples.…”

“…In the absence of additional individual-level data to include in the modelling, our results may have been biased towards lower overall seroprevalence estimates. Despite the above, seroprevalence estimates based on blood donor sampling can provide valuable information on population patterns of infection, against which the effectiveness of ongoing responses to the pandemic can be assessed, particularly if conducted over multiple rounds using repeatable methods [17]. This population have been extensively utilised in seroprevalence studies of COVID-19 infection [22].…”

“…They are a well-defined healthy, and demographically diverse population with respect to age, sex, and geography, with specimen collection and storage systems well embedded into routine workloads. This provides a mechanism for sampling that is convenient and repeatable over time to produce comparable estimates [17].…”