Published in PLOS One on 2026-05-28, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: George Agyei, Philip El-Duah, Rexford Mawunyo Dumevi, Therese Muzeniek, Sherihane Aryeetey, Brice Armel Nembot Fogang, Jonathan M Gmanyami, Augustina Angelina Sylverken, Yaw Adu-Sarkodie, Richard Odame Phillips, Michael Owusu, Christian Drosten
Source: PLOS One • DOI 10.1371/journal.pone.0348281
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Ghana exhibits geographic variation across northern and southern regions alongside differences between urban and rural communities, which may influence SARS-CoV-2 exposure and immune response. This study aimed to assess the differences in seroprevalence, and seroconversion status after exposure to SARS-CoV-2 in selected urban and rural Ghanaian communities.
A longitudinal study design was employed. Serum samples (n = 987) were collected during a baseline survey (August 2023–February 2024) with longitudinal follow-up (n = 212) sampling after one year (August 2024-February 2025) among consenting community participants aged ≥10 years selected through household-based sampling in urban and rural settings. Socio-demographic data, clinical symptoms, and vaccination status were collected using structured questionnaires. Serum samples were inactivated and tested with semi-quantitative Anti-SARS-CoV-2 IgG ELISA assays targeting spike (S) and nucleocapsid (N) proteins. Presence of SARS-CoV-2 neutralizing antibodies in serum was determined by a surrogate virus neutralization assay.
Of 987 participants aged 10–88 years (67.3% female), SARS-CoV-2 seroprevalence was comparable between urban (47.4%) and rural (47.7%) areas. Among the 212 participants followed longitudinally, 50.9% (108 participants) had both infection or vaccine-induced anti-spike and infection-induced anti-nucleocapsid antibodies after one year, indicating sustained immune responses from prior exposure or vaccination. There was a significant increase in paired spike and nucleocapsid antibody responses between baseline and follow-up (McNemar’s test, χ²(1) = 104.00, p < 0.0001), reflecting ongoing immune boosting despite evidence of antibody waning. Neutralizing antibodies, were detected in 147/148 (99.3%) individuals at timepoint-1 and in all 12 (100%) selected individuals for follow-up at timepoint-2, demonstrating robust functional immunity.
This study demonstrates widespread serological evidence of prior SARS-CoV-2 exposure and vaccine-induced immunity in both urban and rural Ghana. Functional neutralising antibodies were detected in a longitudinal subset, suggesting persistence of antibody-mediated protection in some individuals. Larger longitudinal studies with repeated functional immune assessments are needed to better define durable protection in West African settings.
1. Introduction
Ghana and neighbouring West African countries have experienced heterogeneous SARS-CoV-2 transmission shaped by cross-border mobility, urbanisation, and differences in access to testing and healthcare. In Ghana, routine case-based surveillance is likely to underestimate cumulative exposure because many infections are asymptomatic or mildly symptomatic and because testing coverage has varied over time and place. As a result, population-based serological data are essential to characterise true exposure patterns and identify potential disparities between communities.
Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first emerged in late 2019, Wuhan, China [1]. Following its rapid global spread, the World Health Organization (WHO) declared COVID-19 a pandemic in early 2020 [2]. By May 2022, over 500 million confirmed cases and more than 6 million deaths had been recorded globally, with over 11.5 billion vaccine doses administered [3]. Common symptoms of COVID-19 ranged from fever, dry cough, and anosmia to gastrointestinal disturbances, headaches, and musculoskeletal pain [4,5]. Severe cases often present with complications such as lymphopenia, secondary bacterial infections, acute respiratory distress syndrome (ARDS), thrombosis, myocardial injury, and multi-organ dysfunction [6,7]. As a respiratory infection, COVID-19 adds to the global burden of acute respiratory tract infections (ARIs), which have long posed a significant public health challenge worldwide [8]. Like other ARIs often caused by viruses such as influenza, respiratory syncytial virus (RSV), and human coronaviruses, COVID-19 necessitates robust surveillance and response systems.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 George Agyei, Philip El-Duah, Rexford Mawunyo Dumevi, Therese Muzeniek, Sherihane Aryeetey, Brice Armel Nembot Fogang, Jonathan M Gmanyami, Augustina Angelina Sylverken, Yaw Adu-Sarkodie, Richard Odame Phillips, Michael Owusu, Christian Drosten. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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