Prevalence of SARS-CoV-2 IgG antibodies in a large prospective cohort study of elite football players in Germany (May-June 2020): implications for a testing protocol in asymptomatic individuals and estimation of the rate of underreported cases

Objectives: Elite professional football players and staff are a unique group that might give insight into the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in Germany and thus can serve as a model for geographical distribution and an estimation of undetected infections.

Methods: In this prospective cohort study seroprevalence was determined twice in May and June 2020 in players and staff from the German Bundesliga. As screening assays, a commercial ELISA (Euroimmun) and a chemiluminescent immunoassay (CLIA) (Roche) were used, and an in-house neutralization assay (NT) was used as reference standard. Participants were tested twice weekly using PCR from nasopharyngeal and/or oropharyngeal swabs.

Results: Seroprevalence (NT used as confirmation) in 2164 samples from 1184 players and staff was rather similar in May (23/1157, 1.99%) and June (21/1007, 2.09%). All participants were PCR-negative during the study period. Significant regional differences in seroprevalence were not observed. When comparing seroprevalence with the cumulative incidence of infections derived from the German notification system (subgroup matching to cohort; men, age 20-69 years), IgG was found eight to ten times more frequently, pointing to a high rate of undetected infection. ELISA and CLIA correlated only moderately (κ 0.52).

Conclusions: Seroprevalence with a high-quality diagnostic in Germany seemed to be around 2%. The number of undetected infections seems to be eight to ten times higher than in notification data. The quality of antibody assays is rather variable, thus results should ideally be confirmed at least by a second assay to prove IgG positivity.