{"doi":"10.1016/j.ijid.2021.08.062","title":"High seroprevalence of SARS-CoV-2 but low infection fatality ratio eight months after introduction in Nairobi, Kenya","abstract":"BACKGROUND: The lower than expected COVID-19 morbidity and mortality in Africa has been attributed to multiple factors, including weak surveillance. This study estimated the burden of SARS-CoV-2 infections eight months into the epidemic in Nairobi, Kenya. METHODS: A population-based, cross-sectional survey was conducted using multi-stage random sampling to select households within Nairobi in November 2020. Sera from consenting household members were tested for antibodies to SARS-CoV-2. Seroprevalence was estimated after adjusting for population structure and test performance. Infection fatality ratios (IFRs) were calculated by comparing study estimates with reported cases and deaths. RESULTS: Among 1,164 individuals, the adjusted seroprevalence was 34.7% (95% CI 31.8-37.6). Half of the enrolled households had at least one positive participant. Seropositivity increased in more densely populated areas (spearman's r=0.63; p=0.009). Individuals aged 20-59 years had at least two-fold higher seropositivity than those aged 0-9 years. The IFR was 40 per 100,000 infections, with individuals ≥60 years old having higher IFRs. CONCLUSION: Over one-third of Nairobi residents had been exposed to SARS-CoV-2 by November 2020, indicating extensive transmission. However, the IFR was >10-fold lower than that reported in Europe and the USA, supporting the perceived lower morbidity and mortality in sub-Saharan Africa.","journal":"International Journal of Infectious Diseases","year":2021,"id":154113,"datarank":0.6284482113039639,"base_score":4.189654742026425,"endowment":4.189654742026425,"self_citation_contribution":0.6284482113039639,"citation_network_contribution":0.0,"self_endowment_contribution":0.6284482113039639,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":65,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8953,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":653370,"name":"Jeanette Dawa","orcid":"0000-0001-9405-148X","position":1,"is_corresponding":false},{"id":653371,"name":"Elizabeth Hunsperger","orcid":"0000-0002-4450-621X","position":2,"is_corresponding":false},{"id":345156,"name":"Nancy A. Otieno","orcid":"0000-0002-7083-4735","position":3,"is_corresponding":false},{"id":653372,"name":"Moses Masika","orcid":"0000-0003-3385-0821","position":4,"is_corresponding":false},{"id":653373,"name":"Patrick Amoth","orcid":"0000-0001-8049-0879","position":5,"is_corresponding":false},{"id":654335,"name":"Lyndah Makayotto","orcid":null,"position":6,"is_corresponding":false},{"id":653374,"name":"Carolyne Nasimiyu","orcid":"0000-0002-7559-3109","position":7,"is_corresponding":false},{"id":283936,"name":"Bronwyn M. Gunn","orcid":"0000-0001-8904-9334","position":8,"is_corresponding":false},{"id":653375,"name":"Bryan O. Nyawanda","orcid":"0000-0003-0069-1473","position":9,"is_corresponding":false},{"id":654336,"name":"Ouma Oluga","orcid":null,"position":10,"is_corresponding":false},{"id":654337,"name":"Carolyne Ngunu","orcid":null,"position":11,"is_corresponding":false},{"id":653376,"name":"Harriet Mirieri","orcid":"0000-0002-8342-5957","position":12,"is_corresponding":false},{"id":653377,"name":"John Gachohi","orcid":"0000-0001-9854-7490","position":13,"is_corresponding":false},{"id":653378,"name":"Doris Marwanga","orcid":"0000-0002-9716-6052","position":14,"is_corresponding":false},{"id":227065,"name":"Patrick K. Munywoki","orcid":"0000-0001-9419-7155","position":15,"is_corresponding":false},{"id":654338,"name":"Dennis Odhiambo","orcid":null,"position":16,"is_corresponding":false},{"id":654339,"name":"Moshe Dayan Alando","orcid":null,"position":17,"is_corresponding":false},{"id":228842,"name":"Robert F. Breiman","orcid":"0000-0002-7099-2936","position":18,"is_corresponding":false},{"id":495103,"name":"Omu Anzala","orcid":"0000-0001-5186-1415","position":19,"is_corresponding":false},{"id":653379,"name":"M. Kariuki Njenga","orcid":"0000-0002-7629-7002","position":20,"is_corresponding":false},{"id":24186,"name":"Marc Bulterys","orcid":null,"position":21,"is_corresponding":false},{"id":372473,"name":"Amy Herman-Roloff","orcid":"0000-0002-3027-5940","position":22,"is_corresponding":false},{"id":654340,"name":"Eric Osoro","orcid":null,"position":23,"is_corresponding":false},{"id":653369,"name":"Isaac Ngere","orcid":"0000-0002-6688-3390","position":0,"is_corresponding":true}],"reference_count":48,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:43:49.684414Z","pmid":"34481966","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}