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Utility of Newborn Dried Blood Spots to Ascertain Seroprevalence of SARS-CoV-2 Antibodies Among Individuals Giving Birth in New York State, November 2019 to November 2021

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To identify the key insights or developments described in this article
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Key Points

Question  Can analysis of newborn dried blood spot (DBS) samples be used to monitor SARS-CoV-2 seroprevalence in infants and individuals giving birth?

Findings  In this repeated cross-sectional study, DBS samples from 415 293 infants born in New York State from November 1, 2019, to November 30, 2021, were analyzed for SARS-CoV-2 antibodies. Statewide and regional seroprevalence data reflect the fluctuations in reported COVID-19 cases and vaccinations among reproductive-aged females during this period in New York State.

Meaning  These findings suggest that antibody testing of newborn DBS samples is an effective way to conduct large-scale monitoring of SARS-CoV-2 seroprevalence among individuals recently giving birth.


Importance  Serosurveys can be used to monitor population-level dynamics of COVID-19 and vaccination. Dried blood spots (DBSs) collected from infants contain maternal IgG antibodies and are useful for serosurveys of individuals recently giving birth.

Objectives  To examine SARS-CoV-2 antibody prevalence in pregnant individuals in New York State, identify associations between SARS-CoV-2 antibody status and maternal and infant characteristics, and detect COVID-19 vaccination among this population.

Design, Setting, and Participants  A population-based, repeated cross-sectional study was conducted to detect SARS-CoV-2 nucleocapsid (N) and spike (S) IgG antibodies. Deidentified DBS samples and data submitted to the New York State Newborn Screening Program between November 1, 2019, and November 30, 2021, were analyzed.

Exposures  Prenatal exposure to SARS-CoV-2 antibodies.

Main Outcomes and Measures  The presence of IgG antibodies to SARS-CoV-2 N and S antigens was measured using a microsphere immunoassay. Data were analyzed by geographic region and compared with reported COVID-19 cases and vaccinations among reproductive-aged females (15-44 years of age). Data were stratified by infant birth weight, gestational age, maternal age, and multiple birth status.

Results  Dried blood spot samples from 415 293 infants (median [IQR] age, 1.04 [1.00-1.20] days; 210 805 [51.1%] male) were analyzed for SARS-CoV-2 antibodies. The first known antibody-positive infant in New York State was born on March 29, 2020. SARS-CoV-2 seroprevalence reflected statewide and regional COVID-19 cases among reproductive-aged females in the prevaccine period. From February through November 2021, S seroprevalence was strongly correlated with cumulative vaccinations in each New York State region and in the state overall (rs = 0.92-1.00, P ≤ .001). S and N seroprevalences were significantly lower in newborns with very low birth weight (720 [14.8%] for S and 138 [2.8%] for N, P < .001) and low birth weight (5160 [19.3%] for S and 1233 [4.6%] for N, P = .009) compared with newborns with normal birth weight (77 116 [20.1%] for S and 19 872 [5.2%] for N). Lower N and higher S seroprevalences were observed in multiple births (odds ratio [OR], 0.84; 95% CI, 0.75-0.94; P = .002 for N and OR, 1.24; 95% CI, 1.18-1.31; P < .001 for S) vs single births and for maternal age older than 30 years (OR, 0.87; 95% CI, 0.80-0.94; P < .001 for N and OR, 1.17; 95% CI, 1.11-1.23; P < .001 for S) vs younger than 20 years.

Conclusions and Relevance  In this study, seroprevalence in newborn DBS samples reflected COVID-19 case fluctuations and vaccinations among reproductive-aged women during the study period. These results demonstrate the utility of using newborn DBS testing to estimate SARS-CoV-2 seroprevalence in pregnant individuals.

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Article Information

Accepted for Publication: June 22, 2022.

Published: August 22, 2022. doi:10.1001/jamanetworkopen.2022.27995

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Damjanovic A et al. JAMA Network Open.

Corresponding Author: Monica M. Parker, PhD, Wadsworth Center, New York State Department of Health, David Axelrod Institute, 120 New Scotland Avenue Albany, NY 12208 (monica.parker@health.ny.gov).

Author Contributions: Drs Damjanovic and Styer had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Damjanovic and Styer contributed equally to this work and share first authorship of this work. Drs Caggana and Parker served equally as principal investigators for this study.

Concept and design: Damjanovic, Styer, Caggana, Parker.

Acquisition, analysis, or interpretation of data: Damjanovic, Styer, Nemeth, Yauney, Rock, Bievenue, Hoen, Ehrbar, Kay, Parker.

Drafting of the manuscript: Damjanovic, Styer, Caggana, Parker.

Critical revision of the manuscript for important intellectual content: Damjanovic, Styer, Nemeth, Yauney, Rock, Bievenue, Hoen, Ehrbar, Kay, Parker.

Statistical analysis: Damjanovic, Styer, Ehrbar.

Obtained funding: Caggana.

Administrative, technical, or material support: Nemeth, Yauney, Rock, Bievenue, Hoen, Kay.

Supervision: Styer, Parker.

Conflict of Interest Disclosures: Dr Caggana reported receiving grants from the CDC during the conduct of the study. Dr Parker reported receiving grants from the National Cancer Institute and the CDC during the conduct of the study and subcontract support from the National Heart, Lung, and Blood Institute via the University of Vermont, contract support from the Association of Public Health Laboratories for HIV Reference Center Testing, contract support from City University of New York for hepatitis C virus testing, and contract support from New York University for hepatitis C virus sequencing outside the submitted work. No other disclosures were reported.

Funding/Support: This study was supported by the CDC Foundation through contributions to its Emergency Response Fund. Dr Damjanovic, Ms Yauney, and Ms Nemeth were supported by cooperative agreement NU50CK000516 with the CDC. Mr Ehrbar was supported by Serological Sciences Network grant U01CA260508 from the National Cancer Institute.

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: The members of the Wadsworth Center’s Newborn Screening Laboratory and Bloodborne Viruses Laboratory assisted with retrieving and punching blood spot cards. Andrew Bentley, BS, Wadsworth Center Multimedia Services, provided the New York State regional map. Jill Taylor, PhD, Association of Public Health Laboratories, and Dale Morse, MD, Emory University, provided valuable contributions to the initial concept of the study. Compensation was not provided for any of these individuals.

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