A systematic review and meta-analysis of seroprevalence surveys of ebolavirus infection

Asymptomatic ebolavirus infection could greatly influence transmission dynamics, but there is little consensus on how frequently it occurs or even if it exists. This paper summarises the available evidence on seroprevalence of Ebola, Sudan and Bundibugyo virus IgG in people without known ebolavirus disease. Through systematic review, we identified 51 studies with seroprevalence results in sera collected from 1961 to 2016. We tabulated findings by study population, contact, assay, antigen and positivity threshold used, and present seroprevalence point estimates and 95% confidence intervals. We classified sampled populations in three groups: those with household or known case-contact; those living in outbreak or epidemic areas but without reported case-contact; and those living in areas with no recorded cases of ebolavirus disease. We performed meta-analysis only in the known case-contact group since this is the only group with comparable exposures between studies. Eight contact studies fitted our inclusion criteria, giving an overall estimate of seroprevalence in contacts with no reported symptoms of 3.3% (95% CI 2.4-4.4, P < 0.001), but with substantial heterogeneity.