Accepted for/Published in: JMIR Research Protocols
Date Submitted: Oct 20, 2023
Date Accepted: Jan 19, 2024
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Investigating SARS-CoV-2 Incidence and Morbidity in Ponce, Puerto Rico: Protocol and Baseline Results from a Community Cohort Study
ABSTRACT
Background:
A better understanding of SARS-CoV-2 infection risk among Hispanic and Latino populations and in low-resource settings in the U.S. is needed to inform control efforts and strategies to improve health equity. Puerto Rico has a high poverty rate and other population characteristics associated with increased vulnerability to COVID-19 and limited data to determine community incidence.
Objective:
This report describes the protocol and baseline seroprevalence of SARS-CoV-2 in a prospective community-based cohort study (COCOVID) to investigate SARS-CoV-2 infection incidence and morbidity in Ponce, Puerto Rico.
Methods:
In June 2020, we implemented the COCOVID study within the Communities Organized to Prevent Arboviruses (COPA) project platform among residents of 15 communities in Ponce, Puerto Rico age 1 year and older. Weekly, participants answered questionnaires on acute symptoms and preventive behaviors and provided anterior nasal swab samples for SARS-CoV-2 PCR testing; additional anterior nasal swabs were collected for expedited PCR testing from participants that reported ≥1 COVID-like symptoms. At enrollment and every 6 months during follow-up, participants answered more comprehensive questionnaires and provided venous blood samples for SARS-CoV-2 IgG antibody testing (indicative of seroprevalence). Weekly follow-up activities concluded in April 2022 and 6-month follow-up in August 2022.
Results:
We enrolled a total of 1,030 participants from 388 households. Relative to the general populations of Ponce and Puerto Rico, our cohort overrepresented middle-income households, employed and middle-aged adults, and older children (P<.001). Almost all participants (99.6%) identified as Latino/a, 17% had annual household incomes less than $10,000, and 45% reported one or more chronic medical conditions. Baseline SARS-CoV-2 seroprevalence was low (1%) overall and increased with later study enrollment time (P=.003).
Conclusions:
The COCOVID study will provide a valuable opportunity to better estimate the burden of SARS-CoV-2 in the Ponce region, assess the limitations of surveillance, and inform mitigation measures in Puerto Rico and other similar populations.
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