# Tracking SARS-CoV-2 seropositivity in rural communities using blood-fed mosquitoes: a proof-of-concept study

## TL;DR

This study shows that blood-fed mosquitoes can be used to detect SARS-CoV-2 antibodies in humans, enabling large-scale, non-invasive disease surveillance in rural areas.

## Contribution

The novel use of naturally blood-fed mosquitoes for human seropositivity surveillance in resource-limited settings.

## Key findings

- Mosquito bloodmeals can detect SARS-CoV-2 antibodies with high sensitivity and specificity.
- Seropositivity rates in mosquito blood samples increased from 6.3% in late 2020 to 25.1% by early 2021.
- The method aligns with independent sero-surveillance estimates and is viable for large-scale use.

## Abstract

The spread of SARS-CoV-2 cannot be well monitored and understood in areas without capacity for effective disease surveillance. Countries with a young population will have disproportionately large numbers of asymptomatic or pauci-symptomatic infections, further hindering detection of infection. Sero-surveillance on a country-wide scale by trained medical professionals may be limited in a resource-limited setting such as Mali. Novel ways of broadly sampling the human population in a non-invasive method would allow for large-scale surveillance at a reduced cost.

Here we evaluate the collection of naturally blood-fed mosquitoes to test for human anti-SARS-CoV-2 antibodies in the laboratory and at five field locations in Mali.

Immunoglobulin-G antibodies to multiple SARS-CoV-2 antigens were readily detected in mosquito bloodmeals by bead-based immunoassay through at least 10 h after feeding [mean sensitivity of 0.92 (95% CI 0.78–1) and mean specificity of 0.98 (95% CI 0.88–1)], indicating that most blood-fed mosquitoes collected indoors during early morning hours (and likely to have fed the previous night) are viable samples for analysis. We found that reactivity to four SARS-CoV-2 antigens rose during the pandemic from pre-pandemic levels. The crude seropositivity of blood sampled via mosquitoes was 6.3% in October and November 2020 across all sites, and increased to 25.1% overall by February 2021, with the most urban site reaching 46.7%, consistent with independent venous blood-based sero-surveillance estimates.

We have demonstrated that using mosquito bloodmeals, country-wide sero-surveillance of human diseases (both vector-borne and non-vector-borne) is possible in areas where human-biting mosquitoes are common, offering an informative, cost-effective, and non-invasive sampling option.