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Original article Korea Seroprevalence Study of Monitoring of SARS-COV-2 Antibody Retention and Transmission (K-Sero SMART): findings from national representative sample
Jina Han1orcid , Hye Jin Baek1orcid , Eunbi Noh2orcid , Kyuhyun Yoon3orcid , Jung Ae Kim4orcid , Sukhyun Ryu5orcid , Kay O Lee6orcid , No Yai Park7orcid , Eunok Jung8orcid , Sangil Kim9orcid , Hyukmin Lee10orcid , Yoo-Sung Hwang11orcid , Jaehun Jung12orcid , Hun Jae Lee13orcid , Sung-il Cho14orcid , Sangcheol Oh15orcid , Migyeong Kim16orcid , Chang-Mo Oh17orcid , Byengchul Yu18orcid , Young-Seoub Hong19orcid , Keonyeop Kim20orcid , Sunjae Jung21orcid , Mi Ah Han22orcid , Moo-Sik Lee23orcid , Jung-Jeung Lee24orcid , Young Hwangbo25orcid , Hyeon Woo Yim26orcid , Yu-Mi Kim27,28orcid , Joongyub Lee29,30orcid , Weon-Young Lee31orcid , Jae-Hyun Park32orcid , Sungsoo Oh33orcid , Heui Sug Jo34orcid , Hyeongsu Kim35orcid , Gilwon Kang36orcid , Hae-Sung Nam37orcid , Ju-Hyung Lee38orcid , Gyung-Jae Oh39orcid , Min-Ho Shin40orcid , Soyeon Ryu41orcid , Tae-Yoon Hwang42orcid , Soon-Woo Park43orcid , Sang Kyu Kim44orcid , Roma Seol45orcid , Ki-Soo Park46orcid , Su Young Kim47orcid , Jun-wook Kwon48orcid , Sung Soon Kim49orcid , Byoungguk Kim50orcid , June-Woo Lee50orcid , Eun Young Jang50orcid , Ah-Ra Kim50orcid , Jeonghyun Nam50orcid , The Korea Community Health Survey Group, Soon Young Lee1orcid , Dong-Hyun Kim51orcid
Epidemiol Health 2023;e2023075
DOI: https://doi.org/10.4178/epih.e2023075 [Accepted]
Published online: August 17, 2023
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1Ajou Univiersity School of Medicine, Suwon, Korea
2National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
3Institute of Health and Environment, Seoul National University, Seoul, Korea
4Department of Nursing, Kyungmin University, Uijeongbu, Korea
5Department of preventive medicine, Konyang University College of Medicine, Daejeon, Korea
6Gallup Korea, Department of Business Statistics, Hannam University, Daejeon, Korea
7Inje University Graduate School of Public Health, Seoul, Korea
8Department of Mathematics, Konkuk University, Seoul, Korea
9Department of Internal Medicine, Seoul St. Mary Hospital, The Catholic University College of Medicine, Seoul, Korea
10Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
11Seegene Medical Foundation, Seoul, Korea
12Department of Preventive Medicine, College of Medicine, Gachon University, Incheon, Korea
13Department of Social and Preventive Medicine, College of Medicine, Inha University, Incheon, Korea
14Department of Public Health Science, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Korea
15MAPO-gu Public Health Center, Seoul, Korea
16GUNPO-Si Public Health Center, Gunpo, Korea
17Department of Preventive medicine, School of medicine, Kyung Hee University, Seoul, Korea
18Department of Preventive Medicine, College of Medicine, Kosin University, Busan, Korea
19Department of Preventive Medicine School of Medicine, Dong-A University, Busan, Korea
20Department of Preventive Medicine School of Medicine, Kyungpook National University, Daegu, Korea
21Department of Preventive Medicine, College of Medicine, Yonsei University, Incheon, Republic of Korea
22Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
23Department of Preventive Medicine, College of Medicine, Konyang University, Daejeon, Republic of Korea
24Department of Preventive Medicine, School of Medicine, Keimyung University, Daegu, Republic of Korea
25Department of Preventive Medicine, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
26Department of Preventive Medicine, The Catholic University College of Medicine, Seoul, Republic of Korea
27Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
28School of Public Health, Hanyang University, Seoul, Republic of Korea
29Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
30Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Republic of Korea
31Department of Preventive Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
32Department of Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
33Department of Occupational & Environmental Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
34Department of Health Policy and Management, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
35Department of Preventive Medicine, School of Medicine, Konkuk University, Chungju, Republic of Korea
36Department of Health Information and Management, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
37Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, Korea
38Department of Preventive Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea
39Department of Preventive Medicine, School of Medicine, Wonkwang University, Iksan, Republic of Korea
40Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Republic of Korea
41Department of Preventive Medicine, Chosun University Medical School, Gwangju, Republic of Korea
42Department of Preventive Medicine & Public Health, College of Medicine, Yeungnam University, Gyeongsan, Republic of Korea
43Department of Preventive Medicine, Daegu Catholic University School of Medicine, Gyeongsan, Republic of Korea
44Department of Preventive Medicine, College of Medicine, Dongguk University, Gyeongju, Korea
45Department of Preventive Medicine, College of Medicine, Inje University, Busan, Korea
46Department of Preventive Medicine, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
47Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea
48National Institute of Health, Korea Disease Control and Prevention Agency, CheongJu, Republic of Korea
49Center for Vaccine Research, National Institute of Infectious Diseases, Korea Disease Control and Prevention Agency, CheongJu, Republic of Korea
50Division of Vaccine Clinical Research, Center for Vaccine Research, National Institute of Infectious Diseases, CheongJu, Republic of Korea
51Institute of Social Medicine, Hallym University, Chuncheon, Republic of Korea
Corresponding author:  Soon Young Lee, Tel: 82-31-219-4878, 
Email: solee5301@gmail.com
Dong-Hyun Kim, Tel: 82-33-248-3120, 
Email: dhkims@hallym.ac.kr
Received: 3 March 2023   • Revised: 1 June 2023   • Accepted: 13 June 2023
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Abstract

OBJECTIVES
We estimated the population prevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including unreported infections, through a Seroprevalence Study of Monitoring of SARS-CoV-2 Antibody Retention and Transmission (K-SMART) in 258 communities throughout Korea.
METHODS
In August 2022, a survey was conducted among 10,000 household members aged 5 years and older, in households selected through two stage probability random sampling. During face-to-face household interviews, participants self-reported their health status, COVID-19 diagnosis and vaccination history, and general characteristics. Subsequently, participants visited a community health center or medical clinic for blood sampling. Blood samples were analyzed for the presence of anti-spike (anti-S) and anti-nucleocapsid (anti-N) SARS-CoV-2 proteins using an electrochemiluminescence immunoassay. To estimate the population prevalence, the PROC SURVEYMEANS statistical procedure was employed, with weighting to reflect demographic data from July 2022.
RESULTS
In total, 9,945 individuals from 5,041 households were surveyed across 258 communities, representing all basic local governments in South Korea. The overall population-adjusted prevalence rates of anti-S and anti-N were 97.6% and 57.1%, respectively. Since the Korea Disease Control and Prevention Agency has reported a cumulative incidence of confirmed cases of 37.8% through July 31, 2022, the proportion of unreported infections among all COVID-19 infection was suggested to be 33.9%.
CONCLUSIONS
The K-SMART represents the first nationwide, community-based seroepidemiologic survey of COVID-19, confirming that most individuals possess antibodies to SARS-CoV-2 and that a significant number of unreported cases existed. Furthermore, this study lays the foundation for a surveillance system to continuously monitor transmission at the community level and the response to COVID-19.

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