Prevalence of SARS-CoV-2 antibodies in Denmark: Nationwide, population-based seroepidemiological surveys

Background. Seroprevalence studies have proven an important tool to monitor the progression of the coronavirus disease 2019 (COVID-19) epidemic. We present results of consecutive population-based seroprevalence surveys performed in Denmark in 2020. Methods. Invitation letters including a questionnaire covering symptoms were sent to representatively drawn samples of the population in spring, late summer and autumn/winter of 2020. Blood samples from participants taken at public test-centers were analyzed for total Ig and seroprevalence estimates per population segment calculated and compared to other surveillance parameters. Results. From 34,081 participating individuals (response rate 33%), we obtained seroprevalence estimates increasing from 1.1% (95%CI: 0.7%-1.7) in May to 4.0 % (95%CI: 3.4%-4.7%) in December 2020. By December 2020, 1.5% of the population 12 years and older had tested positive by PCR. Seroprevalence estimates were roughly 3 times higher in those aged 12-29 compared to 65+ and higher in metropolitan municipalities. Among seropositives, loss of taste/smell were the more specific symptoms, 32%-56% did not report any symptoms. In half of seroconverted families, we did not see evidence of transmission between generations. Infected individuals in older age groups were hospitalized several fold more often than in younger. Conclusions. Seroprevalence increased during 2020; younger age groups were primarily infected in the autumn/winter surge. Approximately half were asymptomatically infected. Denmark has a high per capita test rate; roughly two undiagnosed infections of COVID-19 were estimated to occur for each diagnosed case. The epidemic appears to have progressed relatively modestly during 2020 in Denmark.