Malaria and other infections induce polyreactive antibodies that impact
SARS-CoV-2 seropositivity estimations in endemic settings
Abstract
Anti-SARS-CoV-2 seroprevalence is used as marker of viral exposure to
estimate the proportion of previously infected population, track
transmission, and monitor naturally- and vaccine-induced protection.
However, in sub-Saharan African settings, antibodies induced by higher
exposure to pathogens may increase unspecific seroreactivity to
SARS-CoV-2 antigens, resulting in false positive responses. To
investigate the level and type of unspecific seroreactivitiy to
SARS-CoV-2 in Africa, we measured IgG, IgA and IgM to a broad panel of
antigens from different pathogens by Luminex in 659 plasma samples from
African and European subjects differing in COVID-19, malaria and other
exposures. Seroreactivity to SARS-CoV-2 antigens in pre-pandemic African
was higher compared to European samples, and positively correlated with
antibodies against HuCoV, helminths, protozoa, and especially P.
falciparum. African subjects presented higher levels of autoantibodies,
a surrogate of polyreactivity, which correlated with P.
falciparum and SARS-CoV-2 antibodies. Finally, we found an improved
sensitivity in the IgG assay in African samples when using urea as
chaotropic agent. In conclusion, our data suggests that polyreactive
antibodies induced mostly by malaria are important mediators of the
unspecific anti-SARS-CoV-2 responses, and that the use of dissociating
agents in immunoassays could be useful for more accurate estimations of
SARS-CoV-2 seroprevalence in African settings.