# Occult Serologically Confirmed Cases of SARS-CoV-2 Coronavirus among the General Population in the Era of the Fourth Vaccination

## TL;DR

The study found that 12.5% of people in Israel had hidden SARS-CoV-2 infections, with chronic disease linked to a lower chance of being infected.

## Contribution

The study identifies chronic disease as a novel independent predictor for the absence of occult SARS-CoV-2 infection.

## Key findings

- The prevalence of occult serologically confirmed SARS-CoV-2 was 12.5% among 504 participants.
- Chronic disease was an independent predictor for the absence of occult SARS-CoV-2 (aOR 0.4).

## Abstract

Background: Asymptomatic SARS-CoV-2 infection can significantly increase the spread of the COVID-19 pandemic. We aimed to investigate the epidemiological and clinical predictors of occult serologically confirmed SARS-CoV-2 cases among the general population during the fourth vaccination era in Israel. Methods: We conducted a cross-sectional study among individuals aged ≥18 years who had not been tested for COVID-19 in the preceding 5 months. Occult serologically confirmed cases were based on the presence of anti-N IgG antibodies. Potential risk factors were examined. Multivariable regression analysis identified independent predictors of subclinical SARS-CoV-2 infection. Results: This study included 504 participants. The prevalence of occult serologically confirmed SARS-CoV-2 was 12.5%. Chronic disease was found to be an independent predictor for the absence of occult disease (aOR) 0.4 [95% (CI): 0.18–0.87], p-value = 0.02). No significant differences were observed in age, sex, marital status, number of children, vaccination status, or exposure to COVID-19 infection between participants with and without SARS-CoV-2 sub-infection. Conclusions: We found a lower prevalence of occult serologically confirmed SARS-CoV-2 cases, compared to previous reports, and a negative correlation between chronic disease and occult SARS-CoV-2. Continued research, surveillance, and intervention strategies are needed to optimize long-term health outcomes and provide valuable insights for public health policymakers and clinicians.