Elsevier

Epidemics

Volume 35, June 2021, 100446
Epidemics

Modelling suggests ABO histo-incompatibility may substantially reduce SARS-CoV-2 transmission

https://doi.org/10.1016/j.epidem.2021.100446Get rights and content
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Highlights

  • Modelling suggests that blood type incompatibility may reduce the chance of transmitting SARS-CoV-2 by 60 % or more.

  • Type O individuals are less likely to be infected, but are “universal donors” and more likely to spread infection.

  • The risk to type A and B individuals depends upon which is more frequent in the population.

  • Blood group frequencies may partly explain the different epidemic severity in different regions of the world.

  • It is important for individuals of ALL blood types to be vaccinated rather than targeting any specific group.

Abstract

Several independent datasets suggest blood type A is over-represented and type O under-represented among COVID-19 patients. However, blood group antigens appear not to be conventional susceptibility factors in that they do not affect disease severity, and the relative risk to non-O individuals is attenuated when population prevalence is high. Here, I model a scenario in which ABO transfusion incompatibility reduces the chance of a patient transmitting the virus to an incompatible recipient – thus in Western populations type A and AB individuals are “super-recipients” while type O individuals are “super-spreaders”. This results in an offset in the timing of the epidemic among individuals of different blood types, and an increased relative risk to type A/AB patients that is most pronounced during early stages of the epidemic. However, once the majority of any given population is infected, the relative risk to each blood type approaches unity. Published data on COVID-19 prevalence from regions in the early stages of the SARS-CoV-2 epidemic suggests that if this model holds true, ABO incompatibility reduces virus transmissibility by at least 60 %. Exploring the implications of this model for vaccination strategies shows that paradoxically, targeted vaccination of either high-susceptibility type A/AB or “super-spreader” type O individuals is less effective than random vaccination at blocking community spread of the virus. Instead, the key is to maintain blood type diversity among the remaining susceptible individuals. Given the good agreement between this model and observational data on disease prevalence, the underlying biochemistry urgently requires experimental investigation.

Keywords

SARS-CoV-2
Enveloped virus
Glycoprotein
ABO blood group
Modelling

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