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Bohn MK, Lippi G, Horvath AR, Erasmus R, Grimmler M, Gramegna M, Mancini N, Mueller R, Rawlinson WD, Menezes ME, Patru MM, Rota F, Sethi S, Singh K, Yuen KY, Wang CB, Adeli K. IFCC interim guidelines on rapid point-of-care antigen testing for SARS-CoV-2 detection in asymptomatic and symptomatic individuals. Clin Chem Lab Med 2021; 59:1507-1515. [PMID: 33908222 DOI: 10.1515/cclm-2021-0455] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 12/16/2022]
Abstract
With an almost unremittent progression of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections all around the world, there is a compelling need to introduce rapid, reliable, and high-throughput testing to allow appropriate clinical management and/or timely isolation of infected individuals. Although nucleic acid amplification testing (NAAT) remains the gold standard for detecting and theoretically quantifying SARS-CoV-2 mRNA in various specimen types, antigen assays may be considered a suitable alternative, under specific circumstances. Rapid antigen tests are meant to detect viral antigen proteins in biological specimens (e.g. nasal, nasopharyngeal, saliva), to indicate current SARS-CoV-2 infection. The available assay methodology includes rapid chromatographic immunoassays, used at the point-of-care, which carries some advantages and drawbacks compared to more conventional, instrumentation-based, laboratory immunoassays. Therefore, this document by the International Federation for Clinical Chemistry and Laboratory Medicine (IFCC) Taskforce on COVID-19 aims to summarize available data on the performance of currently available SARS-CoV-2 antigen rapid detection tests (Ag-RDTs), providing interim guidance on clinical indications and target populations, assay selection, and evaluation, test interpretation and limitations, as well as on pre-analytical considerations. This document is hence mainly aimed to assist laboratory and regulated health professionals in selecting, validating, and implementing regulatory approved Ag-RDTs.
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Affiliation(s)
- Mary Kathryn Bohn
- Department of Paediatric Laboratory Medicine, CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | | | - Andrea R Horvath
- Department of Clinical Chemistry, NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Rajiv Erasmus
- Stellenbosch University, Cape Town, Western Cape, Republic of South Africa
| | | | | | | | | | - William D Rawlinson
- Department of Virology, NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | | | | | | | - Sunil Sethi
- National University Hospital, Singapore, Singapore
| | | | | | | | - Khosrow Adeli
- Department of Paediatric Laboratory Medicine, CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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52
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Design considerations for point-of-need devices based on nucleic acid amplification for COVID-19 diagnostics and beyond. Biotechniques 2021; 71:505-509. [PMID: 34392709 PMCID: PMC8366723 DOI: 10.2144/btn-2021-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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53
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Esso L, Epée E, Bilounga C, Abah A, Hamadou A, Dibongue E, Kamga Y, Belinga S, Eyangoh S, Okomo MC, Mounagué C, Tiwoda C, Mandeng N, Onana T, Mendjime P, Mahamat F, Mballa GAE, Boum Y. Cameroon's bold response to the COVID-19 pandemic during the first and second waves. THE LANCET. INFECTIOUS DISEASES 2021; 21:1064-1065. [PMID: 34331876 PMCID: PMC8318523 DOI: 10.1016/s1473-3099(21)00388-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/24/2021] [Accepted: 06/21/2021] [Indexed: 10/29/2022]
Affiliation(s)
- Linda Esso
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon; Department for the Control of Disease, Epidemics, and Pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Emilienne Epée
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon; Department for the Control of Disease, Epidemics, and Pandemics, Ministry of Public Health, Yaoundé, Cameroon; Faculty of Medicine, University of Yaoundé I, Yaoundé, Cameroon
| | - Chanceline Bilounga
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon; Department for the Control of Disease, Epidemics, and Pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Aristide Abah
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon; Department for the Control of Disease, Epidemics, and Pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Achta Hamadou
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon; Centre Pasteur du Cameroun, Yaoundé, Cameroon
| | - Elisabeth Dibongue
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon; Department for the Control of Disease, Epidemics, and Pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Yannick Kamga
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon; Department for the Control of Disease, Epidemics, and Pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Sandrine Belinga
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon
| | - Sara Eyangoh
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon; Centre Pasteur du Cameroun, Yaoundé, Cameroon
| | - Marie-Claire Okomo
- Faculty of Medicine, University of Yaoundé I, Yaoundé, Cameroon; National Public Health Laboratory, Yaoundé, Cameroon
| | - Christian Mounagué
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon; Department for the Control of Disease, Epidemics, and Pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Christie Tiwoda
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon
| | - Nadia Mandeng
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon
| | - Thadée Onana
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon; Department for the Control of Disease, Epidemics, and Pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Patricia Mendjime
- Department for the Control of Disease, Epidemics, and Pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Fanne Mahamat
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon; Department of Health Promotion, Ministry of Public Health, Yaoundé, Cameroon; National Public Health Laboratory, Yaoundé, Cameroon
| | - Georges Alain Etoundi Mballa
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon; Department for the Control of Disease, Epidemics, and Pandemics, Ministry of Public Health, Yaoundé, Cameroon; Faculty of Medicine, University of Yaoundé I, Yaoundé, Cameroon
| | - Yap Boum
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon; Faculty of Medicine, University of Yaoundé I, Yaoundé, Cameroon; Epicentre, Yaoundé, Cameroon.
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54
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Brümmer LE, Katzenschlager S, Gaeddert M, Erdmann C, Schmitz S, Bota M, Grilli M, Larmann J, Weigand MA, Pollock NR, Macé A, Carmona S, Ongarello S, Sacks JA, Denkinger CM. Accuracy of novel antigen rapid diagnostics for SARS-CoV-2: A living systematic review and meta-analysis. PLoS Med 2021; 18:e1003735. [PMID: 34383750 PMCID: PMC8389849 DOI: 10.1371/journal.pmed.1003735] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/26/2021] [Accepted: 07/14/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND SARS-CoV-2 antigen rapid diagnostic tests (Ag-RDTs) are increasingly being integrated in testing strategies around the world. Studies of the Ag-RDTs have shown variable performance. In this systematic review and meta-analysis, we assessed the clinical accuracy (sensitivity and specificity) of commercially available Ag-RDTs. METHODS AND FINDINGS We registered the review on PROSPERO (registration number: CRD42020225140). We systematically searched multiple databases (PubMed, Web of Science Core Collection, medRvix, bioRvix, and FIND) for publications evaluating the accuracy of Ag-RDTs for SARS-CoV-2 up until 30 April 2021. Descriptive analyses of all studies were performed, and when more than 4 studies were available, a random-effects meta-analysis was used to estimate pooled sensitivity and specificity in comparison to reverse transcription polymerase chain reaction (RT-PCR) testing. We assessed heterogeneity by subgroup analyses, and rated study quality and risk of bias using the QUADAS-2 assessment tool. From a total of 14,254 articles, we included 133 analytical and clinical studies resulting in 214 clinical accuracy datasets with 112,323 samples. Across all meta-analyzed samples, the pooled Ag-RDT sensitivity and specificity were 71.2% (95% CI 68.2% to 74.0%) and 98.9% (95% CI 98.6% to 99.1%), respectively. Sensitivity increased to 76.3% (95% CI 73.1% to 79.2%) if analysis was restricted to studies that followed the Ag-RDT manufacturers' instructions. LumiraDx showed the highest sensitivity, with 88.2% (95% CI 59.0% to 97.5%). Of instrument-free Ag-RDTs, Standard Q nasal performed best, with 80.2% sensitivity (95% CI 70.3% to 87.4%). Across all Ag-RDTs, sensitivity was markedly better on samples with lower RT-PCR cycle threshold (Ct) values, i.e., <20 (96.5%, 95% CI 92.6% to 98.4%) and <25 (95.8%, 95% CI 92.3% to 97.8%), in comparison to those with Ct ≥ 25 (50.7%, 95% CI 35.6% to 65.8%) and ≥30 (20.9%, 95% CI 12.5% to 32.8%). Testing in the first week from symptom onset resulted in substantially higher sensitivity (83.8%, 95% CI 76.3% to 89.2%) compared to testing after 1 week (61.5%, 95% CI 52.2% to 70.0%). The best Ag-RDT sensitivity was found with anterior nasal sampling (75.5%, 95% CI 70.4% to 79.9%), in comparison to other sample types (e.g., nasopharyngeal, 71.6%, 95% CI 68.1% to 74.9%), although CIs were overlapping. Concerns of bias were raised across all datasets, and financial support from the manufacturer was reported in 24.1% of datasets. Our analysis was limited by the included studies' heterogeneity in design and reporting. CONCLUSIONS In this study we found that Ag-RDTs detect the vast majority of SARS-CoV-2-infected persons within the first week of symptom onset and those with high viral load. Thus, they can have high utility for diagnostic purposes in the early phase of disease, making them a valuable tool to fight the spread of SARS-CoV-2. Standardization in conduct and reporting of clinical accuracy studies would improve comparability and use of data.
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Affiliation(s)
- Lukas E. Brümmer
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Mary Gaeddert
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Stephani Schmitz
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc Bota
- Agaplesion Bethesda Hospital, Hamburg, Germany
| | - Maurizio Grilli
- Library, University Medical Center Mannheim, Mannheim, Germany
| | - Jan Larmann
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A. Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Nira R. Pollock
- Department of Laboratory Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | | | | | | | | | - Claudia M. Denkinger
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
- Partner Site Heidelberg University Hospital, German Center for Infection Research (DZIF), Heidelberg, Germany
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Deng Q, Ye G, Pan Y, Xie W, Yang G, Li Z, Li Y. High Performance of SARS-Cov-2N Protein Antigen Chemiluminescence Immunoassay as Frontline Testing for Acute Phase COVID-19 Diagnosis: A Retrospective Cohort Study. Front Med (Lausanne) 2021; 8:676560. [PMID: 34336884 PMCID: PMC8317577 DOI: 10.3389/fmed.2021.676560] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/18/2021] [Indexed: 01/18/2023] Open
Abstract
Objectives: COVID-19 emerged and rapidly spread throughout the world. Testing strategies focussing on patients with COVID-19 require assays that are high-throughput, low-risk of infection, and with small sample volumes. Antigen surveillance can be used to identify exposure to pathogens and measure acute infections. Methods: A total of 914 serum samples, collected from 309 currently infected COVID-19 patients, 48 recovered ones, and 410 non-COVID-19 patients, were used to measure N protein antigen levels by a chemilumineseent immunoassay. Diagnostic performances were analyzed in different periods after onset. Results: There was a high level of N protein antigen in COVID-19 patients (0.56 COI), comparing to the recovered patients (0.12 COI) and controls (0.19 COI). In receiver-operating characteristic curve analysis, the area under the curve of serum N protein antigen was 0.911 in the first week after onset. In this period, Sensitivity and specificity of serologic N protein antigen testing was 76.27 and 98.78%. Diagnosis performance of specific antibodies became better from the third week after onset. Subgroup analysis suggested that severe patients had higher levels of antigens than mild patients. Conclusions: High level of serum antigen suggested early infection and serious illness. Serum N protein antigen testing by chemiluminescence immunoassay is considered as a viable assay used to improve diagnostic sensitivity for current patients.
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Affiliation(s)
- Qiaoling Deng
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Guangming Ye
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Yunbao Pan
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Wen Xie
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Gui Yang
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Zhiqiang Li
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Yirong Li
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
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García-Fiñana M, Hughes DM, Cheyne CP, Burnside G, Stockbridge M, Fowler TA, Fowler VL, Wilcox MH, Semple MG, Buchan I. Performance of the Innova SARS-CoV-2 antigen rapid lateral flow test in the Liverpool asymptomatic testing pilot: population based cohort study. BMJ 2021; 374:n1637. [PMID: 34230058 PMCID: PMC8259455 DOI: 10.1136/bmj.n1637] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the performance of the SARS-CoV-2 antigen rapid lateral flow test (LFT) versus polymerase chain reaction testing in the asymptomatic general population attending testing centres. DESIGN Observational cohort study. SETTING Community LFT pilot at covid-19 testing sites in Liverpool, UK. PARTICIPANTS 5869 asymptomatic adults (≥18 years) voluntarily attending one of 48 testing sites during 6-29 November 2020. INTERVENTIONS Participants were tested using both an Innova LFT and a quantitative reverse-transcriptase polymerase chain reaction (RT-qPCR) test based on supervised self-administered swabbing at testing sites. MAIN OUTCOME MEASURES Sensitivity, specificity, and predictive values of LFT compared with RT-qPCR in an epidemic steady state of covid-19 among adults with no classic symptoms of the disease. RESULTS Of 5869 test results, 22 (0.4%) LFT results and 343 (5.8%) RT-qPCR results were void (that is, when the control line fails to appear within 30 minutes). Excluding the void results, the LFT versus RT-qPCR showed a sensitivity of 40.0% (95% confidence interval 28.5% to 52.4%; 28/70), specificity of 99.9% (99.8% to 99.99%; 5431/5434), positive predictive value of 90.3% (74.2% to 98.0%; 28/31), and negative predictive value of 99.2% (99.0% to 99.4%; 5431/5473). When the void samples were assumed to be negative, a sensitivity was observed for LFT of 37.8% (26.8% to 49.9%; 28/74), specificity of 99.6% (99.4% to 99.8%; 5431/5452), positive predictive value of 84.8% (68.1% to 94.9%; 28/33), and negative predictive value of 93.4% (92.7% to 94.0%; 5431/5814). The sensitivity in participants with an RT-qPCR cycle threshold (Ct) of <18.3 (approximate viral loads >106 RNA copies/mL) was 90.9% (58.7% to 99.8%; 10/11), a Ct of <24.4 (>104 RNA copies/mL) was 69.4% (51.9% to 83.7%; 25/36), and a Ct of >24.4 (<104 RNA copies/mL) was 9.7% (1.9% to 23.7%; 3/34). LFT is likely to detect at least three fifths and at most 998 in every 1000 people with a positive RT-qPCR test result with high viral load. CONCLUSIONS The Innova LFT can be useful for identifying infections among adults who report no symptoms of covid-19, particularly those with high viral load who are more likely to infect others. The number of asymptomatic adults with lower Ct (indicating higher viral load) missed by LFT, although small, should be considered when using single LFT in high consequence settings. Clear and accurate communication with the public about how to interpret test results is important, given the chance of missing some cases, even at high viral loads. Further research is needed to understand how infectiousness is reflected in the viral antigen shedding detected by LFT versus the viral loads approximated by RT-qPCR.
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Affiliation(s)
- Marta García-Fiñana
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - David M Hughes
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Christopher P Cheyne
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Girvan Burnside
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | - Tom A Fowler
- Department of Health and Social Care, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Mark H Wilcox
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Malcolm G Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections and Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Iain Buchan
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
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Menchinelli G, De Angelis G, Cacaci M, Liotti FM, Candelli M, Palucci I, Santangelo R, Sanguinetti M, Vetrugno G, Franceschi F, Posteraro B. SARS-CoV-2 Antigen Detection to Expand Testing Capacity for COVID-19: Results from a Hospital Emergency Department Testing Site. Diagnostics (Basel) 2021; 11:diagnostics11071211. [PMID: 34359294 PMCID: PMC8304665 DOI: 10.3390/diagnostics11071211] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND SARS-CoV-2 antigen detection has currently expanded the testing capacity for COVID-19, which yet relies on the SARS-CoV-2 RNA RT-PCR amplification. OBJECTIVES To report on a COVID-19 testing algorithm from a tertiary care hospital emergency department (ED) that combines both antigen (performed on the ED) and RT-PCR (performed outside the ED) testing. METHODS Between December 2020 and January 2021, in a priori designated, spatially separated COVID-19 or non-COVID-19 ED areas, respectively, symptomatic or asymptomatic patients received SARS-CoV-2 antigen testing on nasopharyngeal swab samples. Antigen results were promptly accessible to guide subsequent, outside performed confirmatory (RT-PCR) testing. RESULTS Overall, 1083 (100%) of 1083 samples in the COVID-19 area and 1815 (49.4%) of 3670 samples in the non-COVID-19 area had antigen results that required confirmation by RT-PCR. Antigen positivity rates were 12.4% (134/1083) and 3.7% (66/1815), respectively. Compared to RT-PCR testing results, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of antigen testing were, respectively, 68.0%, 98.3%, 88.8%, and 94.1% in the COVID-19 area, and 41.9%, 97.3%, 27.3%, and 98.6% in non-COVID-19 area. Practically, RT-PCR tests were avoided in 50.6% (1855/3670) of non-COVID-19 area samples (all antigen negative) from patients who, otherwise, would have needed antigen result confirmation. CONCLUSIONS Our algorithm had value to preserve RT-PCR from avoidable usage and, importantly, to save time, which translated into a timely RT-PCR result availability in the COVID-19 area.
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Affiliation(s)
- Giulia Menchinelli
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giulia De Angelis
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Margherita Cacaci
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Flora Marzia Liotti
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Marcello Candelli
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Ivana Palucci
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Rosaria Santangelo
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giuseppe Vetrugno
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Risk Management Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Franceschi
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Brunella Posteraro
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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Mandeng N, Fai KN, Bebell LM, Boum Y. Negative antigen RDT and RT-PCR results do not rule out COVID-19 if clinical suspicion is strong - Authors' reply. THE LANCET. INFECTIOUS DISEASES 2021; 21:1210. [PMID: 34058129 PMCID: PMC8163293 DOI: 10.1016/s1473-3099(21)00288-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Nadia Mandeng
- Centre de Coordination des Opérations d'Urgence de Santé Publique, Ministère de la Santé Publique, Yaoundé, Cameroon
| | - Karl Njuwa Fai
- Epicentre, Médecins Sans Frontières, Yaoundé BP 12069, Cameroon
| | - Lisa M Bebell
- Massachusetts General Hospital Center for Global Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Yap Boum
- Epicentre, Médecins Sans Frontières, Yaoundé BP 12069, Cameroon; University of Yaoundé I, Faculty of Medicine, Yaoundé, Cameroon.
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Lekpa FK, Njonnou SRS, Balti E, Luma HN, Choukem SP. Negative antigen RDT and RT-PCR results do not rule out COVID-19 if clinical suspicion is strong. THE LANCET. INFECTIOUS DISEASES 2021; 21:1209. [PMID: 34058127 PMCID: PMC8163292 DOI: 10.1016/s1473-3099(21)00271-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/30/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Fernando Kemta Lekpa
- Department of Internal Medicine and Specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon; Health and Human Development Research Network, Douala, Cameroon; Internal Medicine Department, Douala General Hospital, Douala, Cameroon.
| | - Sylvain Raoul Simeni Njonnou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon; Health and Human Development Research Network, Douala, Cameroon
| | - Eric Balti
- Department of Internal Medicine and Specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon; Health and Human Development Research Network, Douala, Cameroon; Diabetes Research Center and Department of Internal Medicine, Universiteit Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium; Intensive Care Unit, Critical Care Department, Brugmann University Hospital, Brussels, Belgium
| | - Henry Namme Luma
- Internal Medicine Department, Douala General Hospital, Douala, Cameroon
| | - Simeon Pierre Choukem
- Department of Internal Medicine and Specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon; Health and Human Development Research Network, Douala, Cameroon; Internal Medicine Department, Douala General Hospital, Douala, Cameroon
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Epidemiological feature, viral shedding, and antibody seroconversion among asymptomatic SARS-CoV-2 carriers and symptomatic/presymptomatic COVID-19 patients. J Infect Public Health 2021; 14:845-851. [PMID: 34118734 PMCID: PMC8154191 DOI: 10.1016/j.jiph.2021.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/01/2021] [Accepted: 05/14/2021] [Indexed: 12/15/2022] Open
Abstract
Background Novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is pandemic. However, data concerning the epidemiological features, viral shedding, and antibody dynamics between asymptomatic SARS-CoV-2 carriers and COVID-19 patients remain controversial. Methods We enrolled 193 SARS-CoV-2 infected subjects in Ningbo and Zhoushan, Zhejiang, China, from January 21 to March 6, 2020. All subjects were followed up to monitor the dynamics of serum antibody immunoglobulin M (IgM) and IgG against SARS-CoV-2 using colloidal gold-labeled and enzyme-linked immunosorbent assays. Results Of those, 31 were asymptomatic SARS-CoV-2 carriers, 148 symptomatic COVID-19 patients, and 14 presymptomatic COVID-19 patients. Compared to symptomatic COVID-19 patients, asymptomatic carriers were younger and had higher levels of white blood cell and lymphocyte, lower level of C-reactive protein, and shorter viral shedding duration. Conversion of IgM from positive to negative was shorter in asymptomatic carriers than in COVID-19 patients (7.5 vs. 25.5 days, P = 0.030). The proportion of those persistently seropositive for IgG against SARS-CoV-2 was higher in COVID-19 patients than in asymptomatic carriers (66.1% vs. 33.3%, P = 0.037). Viral load was higher in symptomatic patients than presymptomatic patients (P = 0.003) and asymptomatic carriers (P = 0.004). Viral shedding duration was longer in presymptomatic COVID-19 patients than in asymptomatic carriers (48.0 vs. 24.0 days, P = 0.002). Asymptomatic carriers acquired infection more from intra-familial transmission than did COVID-19 patients (89.0% vs. 61.0%, P = 0.028). In 4 familial clusters of SARS-CoV-2 infection, asymptomatic carriers were mainly children and young adults while severe COVID-19 was mainly found in family members older than 60 years with comorbidities. Conclusion Asymptomatic carriers might have a higher antiviral immunity to clear SARS-CoV-2 than symptomatic COVID-19 patients and this antiviral immunity should be contributable to innate and adaptive cellular immunity rather than humoral immunity. The severity of COVID-19 is associated with older age and comorbidities in familial clustering cases.
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The importance of timely contact tracing - A simulation study. Int J Infect Dis 2021; 108:309-319. [PMID: 33862210 PMCID: PMC8041741 DOI: 10.1016/j.ijid.2021.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background While the role of contact tracing in the containment of the COVID-19 epidemic remains important until vaccines are widely available, literature on objectively measurable indicators for the effectiveness of contact tracing is scarce. We suggest the diagnostic serial interval, the time between the diagnosis of the infector and infectee, as a new indicator for the effectiveness of contact tracing. Methods Using an agent-based simulation model, we demonstrate how the diagnostic serial interval correlates with the course of the epidemic. We consider four scenarios of how diagnosis and subsequent isolation are triggered: 1. never, 2. by symptoms, 3. by symptoms and loose contact tracing, 4. by symptoms and tight contact tracing. We further refine scenarios 3 and 4 with different lengths of target diagnostic serial intervals. Results Scenarios 1 and 2 did not yield a notable difference. In scenarios 3 and 4, however, contact tracing led to a decrease of the height of the epidemic as well as the cumulative proportion of infected agents. Generally, the shorter the diagnostic serial interval was, the smaller the peak of the epidemic became, and the more proportion of the population remained susceptible at the end of the epidemic. Conclusion A short target diagnosis interval is critical for contact tracing to be effective in the epidemic control. The diagnosis interval can be used to assess and guide the contact tracing strategy.
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Boum Y, Eyangoh S, Okomo MC. Beyond COVID-19-will self-sampling and testing become the norm? THE LANCET. INFECTIOUS DISEASES 2021; 21:1194-1195. [PMID: 33857408 PMCID: PMC8041358 DOI: 10.1016/s1473-3099(21)00197-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Yap Boum
- Epicentre, Yaoundé BP 12069, Cameroon.
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Peeling RW, Olliaro P. Rolling out COVID-19 antigen rapid diagnostic tests: the time is now. THE LANCET. INFECTIOUS DISEASES 2021; 21:1052-1053. [PMID: 33773617 PMCID: PMC7993925 DOI: 10.1016/s1473-3099(21)00152-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Rosanna W Peeling
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Piero Olliaro
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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