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Harutyunyan H, Hovhannisyan A, Torosyan H, Hakobjanyan G, Grigoryan A, Petrosyan G, Movsisyan M, Poland D, Monkel R, Lommen J, Tuaillon E, Yenkoyan K. Clinical performance and application of novel serum collection "Ser-Col" device in the practice of laboratory diagnosis of infection diseases and several other immunochemical tests. Clin Chim Acta 2024; 565:119970. [PMID: 39313064 DOI: 10.1016/j.cca.2024.119970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 09/06/2024] [Accepted: 09/12/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Dried blood collection devices might be beneficial for diagnosing infectious diseases in areas far from the medical facilities and in lockdown situations. There are several reports on the efficacy of such applications for qualitative tests. Here we demonstrated the feasibility of a novel Ser-Col blood collection device as a standardized approach for qualitative and quantitative detection of infectious markers and several over immunochemical tests. METHODS In the current study, we included 395 adult participants, 191 men and 204 women, with a median age of 41 years, as well as 75 children with a median age of 3 years. Serological status was determined by testing serum samples for three groups of infection diseases: hepatitis A and C, SARS-CoV-2, and herpes family viruses, as well as for thyroid peroxidase (TPO), prolactin, vitamin B12, and folate. Blood collected on the Ser-Col device (Labonovum) was eluted using an automated system (SCAUT Ser-Col automation, Blok System Supply) and manually. Ser-Col results were compared with serum sampled via standard venipuncture considered as the reference. RESULTS High correlation coefficients (r = 0.95-0.99) were observed between serum samples collected with Ser-Col and via standard venipuncture for the following tests: anti-HCV, anti-SARS-CoV-2 IgG, anti-HSV-2 IgG, and anti-CMV IgM. Correlation coefficients between Ser-Col and standard venipuncture serum for anti-HSV-1 IgG, anti-CMV IgG, and anti-EBV tests were relatively low (r = 0.73-0.77). Correlation coefficients for anti-TPO, prolactin, vitamin B12, and folate were also characterized with high values (r = 0.97-0.99). CONCLUSIONS High accuracy and quantitative correlation were demonstrated between Ser-Col and samples collected by standard venipuncture. Hence, the Ser-Col blood collection device should be considered as a promising alternative for blood collection, storage, and transportation in both adult and pediatric populations.
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Affiliation(s)
- Hayk Harutyunyan
- Neuroscience Laboratory, Cobrain Center, Yerevan State Medical University named after Mkhitar Heratsi, Yerevan, Armenia
| | - Alvard Hovhannisyan
- Department of Infectious Diseases, Yerevan State Medical University named after Mkhitar Heratsi, Yerevan, Armenia
| | - Hamlet Torosyan
- Neuroscience Laboratory, Cobrain Center, Yerevan State Medical University named after Mkhitar Heratsi, Yerevan, Armenia
| | - Gohar Hakobjanyan
- Laboratory-Diagnostic Center of Heratsi Clinical Hospital, Yerevan State Medical University named after Mkhitar Heratsi, Yerevan, Armenia
| | - Ani Grigoryan
- Neuroscience Laboratory, Cobrain Center, Yerevan State Medical University named after Mkhitar Heratsi, Yerevan, Armenia
| | - Gayane Petrosyan
- Laboratory-Diagnostic Center of Heratsi Clinical Hospital, Yerevan State Medical University named after Mkhitar Heratsi, Yerevan, Armenia
| | - Mariam Movsisyan
- Neuroscience Laboratory, Cobrain Center, Yerevan State Medical University named after Mkhitar Heratsi, Yerevan, Armenia; Department of Allergology and Clinical Immunology, Yerevan State Medical University named after Mkhitar Heratsi, Yerevan, Armenia
| | | | | | | | - Edouard Tuaillon
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, INSERM, Établissement Français du Sang, Antilles University, Montpellier University Hospital, Montpellier, France
| | - Konstantin Yenkoyan
- Neuroscience Laboratory, Cobrain Center, Yerevan State Medical University named after Mkhitar Heratsi, Yerevan, Armenia; Department of Biochemistry, Yerevan State Medical University named after Mkhitar Heratsi, Yerevan, Armenia.
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Fogaça MBT, Lopes-Luz L, Saavedra DP, de Oliveira NKAB, Jesus Sousa MBD, Perez JDP, de Andrade IA, Crispim GJB, Pinto LDS, Ferreira MRA, Ribeiro BM, Nagata T, Conceição FR, Stefani MMDA, Bührer-Sékula S. Production of antigens expressed in Nicotiana benthamiana plant and Escherichia coli for the SARS-CoV-2 IgG antibody detection by ELISA. J Virol Methods 2024; 329:114969. [PMID: 38834144 DOI: 10.1016/j.jviromet.2024.114969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/06/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
The recent COVID-19 pandemic disclosed a critical shortage of diagnostic kits worldwide, emphasizing the urgency of utilizing all resources available for the development and production of diagnostic tests. Different heterologous protein expression systems can be employed for antigen production. This study assessed novel SARS-CoV-2 proteins produced by a transient expression system in Nicotiana benthamiana utilizing an infectious clone vector based on pepper ringspot virus (PepRSV). These proteins included the truncated S1-N protein (spike protein N-terminus residues 12-316) and antigen N (nucleocapsid residues 37-402). Two other distinct SARS-CoV-2 antigens expressed in Escherichia coli were evaluated: QCoV9 chimeric antigen protein (spike protein residues 449-711 and nucleocapsid protein residues 160-406) and QCoV7 truncated antigen (nucleocapsid residues 37-402). ELISAs using the four antigens individually and the same panel of samples were performed for the detection of anti-SARS-CoV-2 IgG antibodies. Sensitivity was evaluated using 816 samples from 351 COVID-19 patients hospitalized between 5 and 65 days after symptoms onset; specificity was tested using 195 samples collected before 2018, from domiciliary contacts of leprosy patients. Our findings demonstrated consistent test sensitivity, ranging from 85 % to 88 % with specificity of 97.5 %, regardless of the SARS-CoV2 antigen and the expression system used for production. Our results highlight the potential of plant expression systems as useful alternative platforms to produce recombinant antigens and for the development of diagnostic tests, particularly in resource-constrained settings.
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Affiliation(s)
- Matheus Bernardes Torres Fogaça
- Laboratório de Produção e Desenvolvimento de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Goiás, Brazil; Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A. Alliance, Goiânia, Goiás 74690-900, Brazil
| | - Leonardo Lopes-Luz
- Laboratório de Produção e Desenvolvimento de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Goiás, Brazil; Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A. Alliance, Goiânia, Goiás 74690-900, Brazil
| | - Djairo Pastor Saavedra
- Laboratório de Produção e Desenvolvimento de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Goiás, Brazil; Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A. Alliance, Goiânia, Goiás 74690-900, Brazil
| | - Nicolle Kathlen Alves Belem de Oliveira
- Laboratório de Produção e Desenvolvimento de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Maria Beatris de Jesus Sousa
- Laboratório de Produção e Desenvolvimento de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Julio Daniel Pacheco Perez
- Laboratório de Produção e Desenvolvimento de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Ikaro Alves de Andrade
- Departamento de Biologia Celular, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF 70910-900, Brazil
| | - Gildemar José Bezerra Crispim
- Departamento de Biologia Celular, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF 70910-900, Brazil; Hospital Regional de Santa Maria, Brasília, DF 72502-100, Brazil
| | - Luciano da Silva Pinto
- Centro de Desenvolvimento Tecnológico, Núcleo de Biotecnologia, Universidade Federal de Pelotas, CP 354, Pelotas, RS CEP 96160-000, Brazil
| | - Marcos Roberto Alves Ferreira
- Centro de Desenvolvimento Tecnológico, Núcleo de Biotecnologia, Universidade Federal de Pelotas, CP 354, Pelotas, RS CEP 96160-000, Brazil
| | - Bergmann Morais Ribeiro
- Departamento de Biologia Celular, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF 70910-900, Brazil
| | - Tatsuya Nagata
- Departamento de Biologia Celular, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF 70910-900, Brazil
| | - Fabricio Rochedo Conceição
- Centro de Desenvolvimento Tecnológico, Núcleo de Biotecnologia, Universidade Federal de Pelotas, CP 354, Pelotas, RS CEP 96160-000, Brazil
| | - Mariane Martins de Araújo Stefani
- Laboratório de Produção e Desenvolvimento de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Samira Bührer-Sékula
- Laboratório de Produção e Desenvolvimento de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Goiás, Brazil; Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A. Alliance, Goiânia, Goiás 74690-900, Brazil.
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Zhang YV, Kumanovics A, Wiencek J, Melanson SEF, Love T, Wu AHB, Zhao Z, Meng QH, Koch DD, Apple FS, Ondracek CR, Christenson RH. Performance of Three Anti-SARS-CoV-2 Anti-S and One Anti-N Immunoassays for the Monitoring of Immune Status and Vaccine Response. Viruses 2024; 16:292. [PMID: 38400067 PMCID: PMC10891747 DOI: 10.3390/v16020292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
This study aimed to evaluate and compare the performance of three anti-S and one anti-N assays that were available to the project in detecting antibody levels after three commonly used SARS-CoV-2 vaccines (Pfizer, Moderna, and Johnson & Johnson). It also aimed to assess the association of age, sex, race, ethnicity, vaccine timing, and vaccine side effects on antibody levels in a cohort of 827 individuals. In September 2021, 698 vaccinated individuals donated blood samples as part of the Association for Diagnostics & Laboratory Medicine (ADLM) COVID-19 Immunity Study. These individuals also participated in a comprehensive survey covering demographic information, vaccination status, and associated side effects. Additionally, 305 age- and gender-matched samples were obtained from the ADLM 2015 sample bank as pre-COVID-19-negative samples. All these samples underwent antibody level analysis using three anti-S assays, namely Beckman Access SARS-CoV-2 IgG (Beckman assay), Ortho Clinical Diagnostics VITROS Anti-SARS-CoV-2 IgG (Ortho assay), Siemens ADVIA Centaur SARS-CoV-2 IgG (Siemens assay), and one anti-N antibody assay: Bio-Rad Platelia SARS-CoV-2 Total Ab assay (BioRad assay). A total of 827 samples (580 COVID-19 samples and 247 pre-COVID-19 samples) received results for all four assays and underwent further analysis. Beckman, Ortho, and Siemens anti-S assays showed an overall sensitivity of 99.5%, 97.6%, and 96.9%, and specificity of 90%, 100%, and 99.6%, respectively. All three assays indicated 100% sensitivity for individuals who received the Moderna vaccine and boosters, and over 99% sensitivity for the Pfizer vaccine. Sensitivities varied from 70.4% (Siemens), 81.5% (Ortho), and 96.3% (Beckman) for individuals who received the Johnson & Johnson vaccine. BioRad anti-N assays demonstrated 46.2% sensitivity and 99.25% specificity based on results from individuals with self-reported infection. The highest median anti-S antibody levels were measured in individuals who received the Moderna vaccine, followed by Pfizer and then Johnson & Johnson vaccines. Higher anti-S antibody levels were significantly associated with younger age and closer proximity to the last vaccine dose but were not associated with gender, race, or ethnicity. Participants with higher anti-S levels experienced significantly more side effects as well as more severe side effects (e.g., muscle pain, chills, fever, and moderate limitations) (p < 0.05). Anti-N antibody levels only indicated a significant correlation with headache. This study indicated performance variations among different anti-S assays, both among themselves and when analyzing individuals with different SARS-CoV-2 vaccines. Caution should be exercised when conducting large-scale studies to ensure that the same platform and/or assays are used for the most effective interpretation of the data.
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Affiliation(s)
- Y. Victoria Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Attila Kumanovics
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Joesph Wiencek
- Department of Pathology, Microbiology and Immunology, Vanderbilt School of Medicine, Nashville, TN 37240, USA;
| | - Stacy E. F. Melanson
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA 02115, USA;
- Harvard Medical School, Boston, MA 02115, USA
| | - Tanzy Love
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY 14642, USA;
| | - Alan H. B. Wu
- Department of Laboratory Medicine, University of California, San Francisco, CA 94143, USA;
| | - Zhen Zhao
- Department of Laboratory Medicine and Pathology, Weill Cornell Medicine, New York, NY 10065, USA;
| | - Qing H. Meng
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - David D. Koch
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30303, USA;
| | - Fred S. Apple
- Department of Laboratory Medicine and Pathology, Hennepin Healthcare/Hennepin County Medical Center, Minneapolis, MN 55404, USA;
- Hennepin Healthcare Research Institute, Minneapolis, MN 55404, USA
| | - Caitlin R. Ondracek
- Association for Diagnostics & Laboratory Medicine, Washington, DC 22203, USA;
| | - Robert H. Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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King ER, Garrett HE, Abernathy H, Cassidy CA, Cabell CR, Shook-Sa BE, Juliano JJ, Boyce RM, Aiello AE, Ciccone EJ. Comparison of capillary blood self-collection using the Tasso-SST device with venous phlebotomy for anti-SARS-CoV-2 antibody measurement. J Immunol Methods 2023; 520:113523. [PMID: 37423588 PMCID: PMC10528948 DOI: 10.1016/j.jim.2023.113523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/24/2023] [Accepted: 07/06/2023] [Indexed: 07/11/2023]
Abstract
Measuring seroprevalence over time is a valuable epidemiological tool for improving our understanding of COVID-19 immunity. Due to the large number of collections required for population surveillance as well as concerns about potential infection risk to the collectors, self-collection approaches are being increasingly pursued. To advance this methodology, we collected paired venous and capillary blood samples by routine phlebotomy and Tasso-SST device respectively from 26 participants and measured total immunoglobulin (Ig) and IgG antibodies to the SARS-CoV-2 receptor binding domain (RBD) by enzyme-linked immunosorbent assay (ELISA) on both specimens. Qualitatively, no discrepancies were noted in binary results between Tasso and venipuncture-derived plasma. Furthermore, in vaccinated participants, correlation between Tasso and venous total Ig and IgG specific antibody quantitative levels was high (Total Ig: Spearman ρ = 0.72, 95% CI (0.39,0.90); IgG: Spearman ρ = 0.85, 95% CI (0.54, 0.96)). Our results support the use of Tasso at-home collection devices for antibody testing.
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Affiliation(s)
- Elise R King
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Haley E Garrett
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Haley Abernathy
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Caitlin A Cassidy
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Cameron R Cabell
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Bonnie E Shook-Sa
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jonathan J Juliano
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Ross M Boyce
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Allison E Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Emily J Ciccone
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
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Hütter-Krönke ML, Neagoie A, Blau IW, Wais V, Vuong L, Gantner A, Ahn J, Penack O, Schnell J, Nogai KA, Eberspächer B, Saadati M, Benner A, Bullinger L, Döhner H, Bunjes D, Sala E. Risk factors and characteristics influencing humoral response to COVID-19 vaccination in patients after allogeneic stem cell transplantation. Front Immunol 2023; 14:1174289. [PMID: 37207199 PMCID: PMC10190126 DOI: 10.3389/fimmu.2023.1174289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/12/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction Vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is approved and recommended for immunocompromised patients such as patients after allogeneic stem cell transplantation (allo-SCT). Since infections represent a relevant cause of transplant related mortality we analyzed the advent of immunization to SARS-CoV-2 vaccination in a bicentric population of allogeneic transplanted patients. Methods We retrospectively analyzed data of allo-SCT recipients in two German transplantation centers for safety and serologic response after two and three SARS-CoV-2 vaccinations. Patients received mRNA vaccines or vector-based vaccines. All patients were monitored for antibodies against SARS-CoV2-spike protein (anti-S-IgG) with an IgG ELISA assay or an EIA Assay after two and three doses of vaccination. Results A total of 243 allo-SCT patients underwent SARS-CoV-2 vaccination. The median age was 59 years (range 22-81). While 85% of patients received two doses of mRNA vaccines, 10% had vector-based vaccines and 5% received a mixed vaccination. The two vaccine doses were well tolerated with only 3% patients developing a reactivation of graft versus host disease (GvHD). Overall, 72% of patients showed a humoral response after two vaccinations. In the multivariate analysis age at time of allo-SCT (p=0.0065), ongoing immunosuppressive therapy (p= 0.029) and lack of immune reconstitution (CD4-T-cell counts <200/μl, p< 0.001) were associated with no response. Sex, intensity of conditioning and the use of ATG showed no influence on seroconversion. Finally, 44 out of 69 patients that did not respond after the second dose received a booster and 57% (25/44) showed a seroconversion. Discussion We showed in our bicentric allo-SCT patient cohort, that a humoral response could be achieve after the regular approved schedule, especially for those patients who underwent immune reconstitution and were free from immunosuppressive drugs. In over 50% of the initial non-responders after 2-dose vaccination, a seroconversion can be achieved by boostering with a third dose.
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Affiliation(s)
- Marie Luise Hütter-Krönke
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
- *Correspondence: Marie Luise Hütter-Krönke,
| | - Adela Neagoie
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Igor Wolfgang Blau
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
| | - Verena Wais
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Lam Vuong
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
| | - Andrea Gantner
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Johann Ahn
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
| | - Olaf Penack
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
| | - Jacqueline Schnell
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Klaus Axel Nogai
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
| | - Bettina Eberspächer
- Department of Microbiology and Hygiene, Labor Berlin- Charité Vivantes GmbH, Berlin, Germany
| | | | - Axel Benner
- Division of Biostatistics, Deutsches Krebsforschungszentrum Heidelberg, Heidelberg, Germany
| | - Lars Bullinger
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, Berlin, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Donald Bunjes
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Elisa Sala
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
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Fox T, Geppert J, Dinnes J, Scandrett K, Bigio J, Sulis G, Hettiarachchi D, Mathangasinghe Y, Weeratunga P, Wickramasinghe D, Bergman H, Buckley BS, Probyn K, Sguassero Y, Davenport C, Cunningham J, Dittrich S, Emperador D, Hooft L, Leeflang MM, McInnes MD, Spijker R, Struyf T, Van den Bruel A, Verbakel JY, Takwoingi Y, Taylor-Phillips S, Deeks JJ. Antibody tests for identification of current and past infection with SARS-CoV-2. Cochrane Database Syst Rev 2022; 11:CD013652. [PMID: 36394900 PMCID: PMC9671206 DOI: 10.1002/14651858.cd013652.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The diagnostic challenges associated with the COVID-19 pandemic resulted in rapid development of diagnostic test methods for detecting SARS-CoV-2 infection. Serology tests to detect the presence of antibodies to SARS-CoV-2 enable detection of past infection and may detect cases of SARS-CoV-2 infection that were missed by earlier diagnostic tests. Understanding the diagnostic accuracy of serology tests for SARS-CoV-2 infection may enable development of effective diagnostic and management pathways, inform public health management decisions and understanding of SARS-CoV-2 epidemiology. OBJECTIVES To assess the accuracy of antibody tests, firstly, to determine if a person presenting in the community, or in primary or secondary care has current SARS-CoV-2 infection according to time after onset of infection and, secondly, to determine if a person has previously been infected with SARS-CoV-2. Sources of heterogeneity investigated included: timing of test, test method, SARS-CoV-2 antigen used, test brand, and reference standard for non-SARS-CoV-2 cases. SEARCH METHODS The COVID-19 Open Access Project living evidence database from the University of Bern (which includes daily updates from PubMed and Embase and preprints from medRxiv and bioRxiv) was searched on 30 September 2020. We included additional publications from the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) 'COVID-19: Living map of the evidence' and the Norwegian Institute of Public Health 'NIPH systematic and living map on COVID-19 evidence'. We did not apply language restrictions. SELECTION CRITERIA We included test accuracy studies of any design that evaluated commercially produced serology tests, targeting IgG, IgM, IgA alone, or in combination. Studies must have provided data for sensitivity, that could be allocated to a predefined time period after onset of symptoms, or after a positive RT-PCR test. Small studies with fewer than 25 SARS-CoV-2 infection cases were excluded. We included any reference standard to define the presence or absence of SARS-CoV-2 (including reverse transcription polymerase chain reaction tests (RT-PCR), clinical diagnostic criteria, and pre-pandemic samples). DATA COLLECTION AND ANALYSIS We use standard screening procedures with three reviewers. Quality assessment (using the QUADAS-2 tool) and numeric study results were extracted independently by two people. Other study characteristics were extracted by one reviewer and checked by a second. We present sensitivity and specificity with 95% confidence intervals (CIs) for each test and, for meta-analysis, we fitted univariate random-effects logistic regression models for sensitivity by eligible time period and for specificity by reference standard group. Heterogeneity was investigated by including indicator variables in the random-effects logistic regression models. We tabulated results by test manufacturer and summarised results for tests that were evaluated in 200 or more samples and that met a modification of UK Medicines and Healthcare products Regulatory Agency (MHRA) target performance criteria. MAIN RESULTS We included 178 separate studies (described in 177 study reports, with 45 as pre-prints) providing 527 test evaluations. The studies included 64,688 samples including 25,724 from people with confirmed SARS-CoV-2; most compared the accuracy of two or more assays (102/178, 57%). Participants with confirmed SARS-CoV-2 infection were most commonly hospital inpatients (78/178, 44%), and pre-pandemic samples were used by 45% (81/178) to estimate specificity. Over two-thirds of studies recruited participants based on known SARS-CoV-2 infection status (123/178, 69%). All studies were conducted prior to the introduction of SARS-CoV-2 vaccines and present data for naturally acquired antibody responses. Seventy-nine percent (141/178) of studies reported sensitivity by week after symptom onset and 66% (117/178) for convalescent phase infection. Studies evaluated enzyme-linked immunosorbent assays (ELISA) (165/527; 31%), chemiluminescent assays (CLIA) (167/527; 32%) or lateral flow assays (LFA) (188/527; 36%). Risk of bias was high because of participant selection (172, 97%); application and interpretation of the index test (35, 20%); weaknesses in the reference standard (38, 21%); and issues related to participant flow and timing (148, 82%). We judged that there were high concerns about the applicability of the evidence related to participants in 170 (96%) studies, and about the applicability of the reference standard in 162 (91%) studies. Average sensitivities for current SARS-CoV-2 infection increased by week after onset for all target antibodies. Average sensitivity for the combination of either IgG or IgM was 41.1% in week one (95% CI 38.1 to 44.2; 103 evaluations; 3881 samples, 1593 cases), 74.9% in week two (95% CI 72.4 to 77.3; 96 evaluations, 3948 samples, 2904 cases) and 88.0% by week three after onset of symptoms (95% CI 86.3 to 89.5; 103 evaluations, 2929 samples, 2571 cases). Average sensitivity during the convalescent phase of infection (up to a maximum of 100 days since onset of symptoms, where reported) was 89.8% for IgG (95% CI 88.5 to 90.9; 253 evaluations, 16,846 samples, 14,183 cases), 92.9% for IgG or IgM combined (95% CI 91.0 to 94.4; 108 evaluations, 3571 samples, 3206 cases) and 94.3% for total antibodies (95% CI 92.8 to 95.5; 58 evaluations, 7063 samples, 6652 cases). Average sensitivities for IgM alone followed a similar pattern but were of a lower test accuracy in every time slot. Average specificities were consistently high and precise, particularly for pre-pandemic samples which provide the least biased estimates of specificity (ranging from 98.6% for IgM to 99.8% for total antibodies). Subgroup analyses suggested small differences in sensitivity and specificity by test technology however heterogeneity in study results, timing of sample collection, and smaller sample numbers in some groups made comparisons difficult. For IgG, CLIAs were the most sensitive (convalescent-phase infection) and specific (pre-pandemic samples) compared to both ELISAs and LFAs (P < 0.001 for differences across test methods). The antigen(s) used (whether from the Spike-protein or nucleocapsid) appeared to have some effect on average sensitivity in the first weeks after onset but there was no clear evidence of an effect during convalescent-phase infection. Investigations of test performance by brand showed considerable variation in sensitivity between tests, and in results between studies evaluating the same test. For tests that were evaluated in 200 or more samples, the lower bound of the 95% CI for sensitivity was 90% or more for only a small number of tests (IgG, n = 5; IgG or IgM, n = 1; total antibodies, n = 4). More test brands met the MHRA minimum criteria for specificity of 98% or above (IgG, n = 16; IgG or IgM, n = 5; total antibodies, n = 7). Seven assays met the specified criteria for both sensitivity and specificity. In a low-prevalence (2%) setting, where antibody testing is used to diagnose COVID-19 in people with symptoms but who have had a negative PCR test, we would anticipate that 1 (1 to 2) case would be missed and 8 (5 to 15) would be falsely positive in 1000 people undergoing IgG or IgM testing in week three after onset of SARS-CoV-2 infection. In a seroprevalence survey, where prevalence of prior infection is 50%, we would anticipate that 51 (46 to 58) cases would be missed and 6 (5 to 7) would be falsely positive in 1000 people having IgG tests during the convalescent phase (21 to 100 days post-symptom onset or post-positive PCR) of SARS-CoV-2 infection. AUTHORS' CONCLUSIONS Some antibody tests could be a useful diagnostic tool for those in whom molecular- or antigen-based tests have failed to detect the SARS-CoV-2 virus, including in those with ongoing symptoms of acute infection (from week three onwards) or those presenting with post-acute sequelae of COVID-19. However, antibody tests have an increasing likelihood of detecting an immune response to infection as time since onset of infection progresses and have demonstrated adequate performance for detection of prior infection for sero-epidemiological purposes. The applicability of results for detection of vaccination-induced antibodies is uncertain.
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Affiliation(s)
- Tilly Fox
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Julia Geppert
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jacqueline Dinnes
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Katie Scandrett
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jacob Bigio
- Research Institute of the McGill University Health Centre, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Giorgia Sulis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Dineshani Hettiarachchi
- Department of Anatomy Genetics and Biomedical Informatics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Yasith Mathangasinghe
- Department of Anatomy Genetics and Biomedical Informatics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Australian Regenerative Medicine Institute, Monash University, Clayton, Australia
| | - Praveen Weeratunga
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | | | - Brian S Buckley
- Cochrane Response, Cochrane, London, UK
- Department of Surgery, University of the Philippines, Manila, Philippines
| | | | | | - Clare Davenport
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Jane Cunningham
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Lotty Hooft
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht , Netherlands
| | - Mariska Mg Leeflang
- Epidemiology and Data Science, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Amsterdam, Netherlands
| | | | - René Spijker
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Thomas Struyf
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Ann Van den Bruel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jan Y Verbakel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Sian Taylor-Phillips
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan J Deeks
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
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7
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Qavi AJ, Wu C, Lloyd M, Zaman MMU, Luan J, Ballman C, Leung DW, Crick SL, Farnsworth CW, Amarasinghe GK. Plasmonic Fluor-Enhanced Antigen Arrays for High-Throughput, Serological Studies of SARS-CoV-2. ACS Infect Dis 2022; 8:1468-1479. [PMID: 35867632 PMCID: PMC9344907 DOI: 10.1021/acsinfecdis.2c00086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Serological testing for acute infection or prior exposure is critical for patient management and coordination of public health decisions during outbreaks. Current methods have several limitations, including variable performance, relatively low analytical and clinical sensitivity, and poor detection due to antigenic drift. Serological methods for SARS-CoV-2 detection for the ongoing COVID-19 pandemic suffer from several of these limitations and serves as a reminder of the critical need for new technologies. Here, we describe the use of ultrabright fluorescent reagents, Plasmonic Fluors, coupled with antigen arrays that address a subset of these limitations. We demonstrate its application using patient samples in SARS-CoV-2 serological assays. In our multiplexed assay, SARS-CoV-2 antigens were spotted into 48-plex arrays within a single well of a 96-well plate and used to evaluate remnant laboratory samples of SARS-CoV-2 positive patients. Signal-readout was performed with Auragent Bioscience's Empower microplate reader, and microarray analysis software. Sample volumes of 1 μL were used. High sensitivity of the Plasmonic Fluors combined with the array format enabled us to profile patient serological response to eight distinct SARS-CoV-2 antigens and evaluate responses to IgG, IgM, and IgA. Sensitivities for SARS-CoV-2 antigens during the symptomatic state ranged between 72.5 and 95.0%, specificity between 62.5 and 100%, and the resulting area under the curve values between 0.76 and 0.97. Together, these results highlight the increased sensitivity for low sample volumes and multiplex capability. These characteristics make Plasmonic Fluor-enhanced antigen arrays an attractive technology for serological studies for the COVID-19 pandemic and beyond.
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Affiliation(s)
- Abraham J. Qavi
- Department
of Pathology & Immunology, Washington
University School of Medicine, St. Louis, Missouri 63110, United States
| | - Chao Wu
- Department
of Pathology & Immunology, Washington
University School of Medicine, St. Louis, Missouri 63110, United States
| | - Matthew Lloyd
- Department
of Pathology & Immunology, Washington
University School of Medicine, St. Louis, Missouri 63110, United States
| | | | - Jingyi Luan
- Auragent
Bioscience, St. Louis, Missouri 63108, United
States
| | - Claire Ballman
- Department
of Pathology & Immunology, Washington
University School of Medicine, St. Louis, Missouri 63110, United States
| | - Daisy W. Leung
- Department
of Internal Medicine, Washington University
School of Medicine, St. Louis, Missouri 63110, United States
| | - Scott L. Crick
- Auragent
Bioscience, St. Louis, Missouri 63108, United
States
| | - Christopher W. Farnsworth
- Department
of Pathology & Immunology, Washington
University School of Medicine, St. Louis, Missouri 63110, United States
| | - Gaya K. Amarasinghe
- Department
of Pathology & Immunology, Washington
University School of Medicine, St. Louis, Missouri 63110, United States
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8
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Hu L, Calucho E, Fuentes-Chust C, Parolo C, Idili A, Álvarez-Diduk R, Rivas L, Merkoçi A. Selection and characterisation of bioreceptors to develop nanoparticle-based lateral-flow immunoassays in the context of the SARS-CoV-2 outbreak. LAB ON A CHIP 2022; 22:2938-2943. [PMID: 35903978 DOI: 10.1039/d2lc00486k] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This manuscript aims at raising the attention of the scientific community to the need for better characterised bioreceptors for fast development of point-of-care diagnostic devices able to support mass frequency testing. Particularly, we present the difficulties encountered in finding suitable antibodies for the development of a lateral flow assay for detecting the nucleoprotein of SARS-CoV-2.
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Affiliation(s)
- Liming Hu
- Nanobioelectronics & Biosensors Group, Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC, BIST, Campus UAB, 08193, Bellaterra, Barcelona, Spain.
| | - Enric Calucho
- Nanobioelectronics & Biosensors Group, Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC, BIST, Campus UAB, 08193, Bellaterra, Barcelona, Spain.
| | - Celia Fuentes-Chust
- Nanobioelectronics & Biosensors Group, Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC, BIST, Campus UAB, 08193, Bellaterra, Barcelona, Spain.
| | - Claudio Parolo
- Nanobioelectronics & Biosensors Group, Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC, BIST, Campus UAB, 08193, Bellaterra, Barcelona, Spain.
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - Andrea Idili
- Nanobioelectronics & Biosensors Group, Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC, BIST, Campus UAB, 08193, Bellaterra, Barcelona, Spain.
| | - Ruslan Álvarez-Diduk
- Nanobioelectronics & Biosensors Group, Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC, BIST, Campus UAB, 08193, Bellaterra, Barcelona, Spain.
| | - Lourdes Rivas
- Nanobioelectronics & Biosensors Group, Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC, BIST, Campus UAB, 08193, Bellaterra, Barcelona, Spain.
| | - Arben Merkoçi
- Nanobioelectronics & Biosensors Group, Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC, BIST, Campus UAB, 08193, Bellaterra, Barcelona, Spain.
- ICREA, Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
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9
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Jeong S, Hong YR, Hwang H. Performance comparison between Elecsys Anti-SARS-CoV-2 and Anti-SARS-CoV-2 S and Atellica IM SARS-CoV-2 Total and SARS-CoV-2 IgG assays. KOSIN MEDICAL JOURNAL 2022. [DOI: 10.7180/kmj.22.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Although serological severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests from several manufacturers have been introduced in South Korea and some are commercially available, the performance of these test kits has not yet been sufficiently validated. Therefore, we compared the performance of Elecsys Anti-SARS-CoV-2 (ACOV2) and Anti-SARS-CoV-2 S (ACOV2S) and Atellica IM SARS-CoV-2 Total (COV2T) and SARS-CoV-2 IgG (sCOVG) serological tests in this study.Methods: A total of 186 patient samples were used. For each test, we analyzed the positive rate of serological antibody tests, precision, linearity, and agreement among the four assays.Results: The positive rates of COV2T, sCOVG, and ACOV2S were high (81.7%–89.2%) in total, with those for ACOV2S being the highest, while those of ACOV2 were as low as 44.6%. This may be related to the high completion rate of vaccination in Korea. The repeatability and within-laboratory coefficients of variation were within the claimed allowable imprecision; however, further research is needed to establish an allowable imprecision at low concentrations. COV2T showed a linear fit, whereas sCOVG and ACOV2S were appropriately modeled with a nonlinear fit. Good agreement was found among COV2T, sCOVG, and ACOV2S; however, the agreement between ACOV2 and any one of the other methods was poor.Conclusions: Considering the different antigens used in serological SARS-CoV-2 antibody assays, the performance of the tested assays is thought to show no significant difference for the qualitative detection of antibodies to SARS-CoV-2.
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10
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Astbury S, Reynolds CJ, Butler DK, Muñoz‐Sandoval DC, Lin K, Pieper FP, Otter A, Kouraki A, Cusin L, Nightingale J, Vijay A, Craxford S, Aithal GP, Tighe PJ, Gibbons JM, Pade C, Joy G, Maini M, Chain B, Semper A, Brooks T, Ollivere BJ, McKnight Á, Noursadeghi M, Treibel TA, Manisty C, Moon JC, Valdes AM, Boyton RJ, Altmann DM. HLA-DR polymorphism in SARS-CoV-2 infection and susceptibility to symptomatic COVID-19. Immunology 2022; 166:68-77. [PMID: 35156709 PMCID: PMC9111350 DOI: 10.1111/imm.13450] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 12/15/2022] Open
Abstract
SARS-CoV-2 infection results in different outcomes ranging from asymptomatic infection to mild or severe disease and death. Reasons for this diversity of outcome include differences in challenge dose, age, gender, comorbidity and host genomic variation. Human leukocyte antigen (HLA) polymorphisms may influence immune response and disease outcome. We investigated the association of HLAII alleles with case definition symptomatic COVID-19, virus-specific antibody and T-cell immunity. A total of 1364 UK healthcare workers (HCWs) were recruited during the first UK SARS-CoV-2 wave and analysed longitudinally, encompassing regular PCR screening for infection, symptom reporting, imputation of HLAII genotype and analysis for antibody and T-cell responses to nucleoprotein (N) and spike (S). Of 272 (20%) HCW who seroconverted, the presence of HLA-DRB1*13:02 was associated with a 6·7-fold increased risk of case definition symptomatic COVID-19. In terms of immune responsiveness, HLA-DRB1*15:02 was associated with lower nucleocapsid T-cell responses. There was no association between DRB1 alleles and anti-spike antibody titres after two COVID vaccine doses. However, HLA DRB1*15:01 was associated with increased spike T-cell responses following both first and second dose vaccination. Trial registration: NCT04318314 and ISRCTN15677965.
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Affiliation(s)
- Stuart Astbury
- NIHR Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and the University of NottinghamNottinghamUK
- Nottingham Digestive Diseases CentreSchool of MedicineUniversity of NottinghamNottinghamUK
| | | | - David K. Butler
- Department of Infectious DiseaseImperial College LondonLondonUK
| | | | - Kai‐Min Lin
- Department of Infectious DiseaseImperial College LondonLondonUK
| | | | - Ashley Otter
- National Infection ServicePublic Health EnglandPorton DownUK
| | - Afroditi Kouraki
- Division of Rheumatology, Orthopaedics and DermatologySchool of MedicineUniversity of NottinghamNottinghamUK
| | - Lola Cusin
- School of Life SciencesUniversity of NottinghamNottinghamUK
| | - Jessica Nightingale
- Division of Rheumatology, Orthopaedics and DermatologySchool of MedicineUniversity of NottinghamNottinghamUK
| | - Amrita Vijay
- Division of Rheumatology, Orthopaedics and DermatologySchool of MedicineUniversity of NottinghamNottinghamUK
| | - Simon Craxford
- Division of Rheumatology, Orthopaedics and DermatologySchool of MedicineUniversity of NottinghamNottinghamUK
| | - Guruprasad P. Aithal
- NIHR Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and the University of NottinghamNottinghamUK
- Nottingham Digestive Diseases CentreSchool of MedicineUniversity of NottinghamNottinghamUK
| | | | - Joseph M. Gibbons
- Barts and the London School of Medicine and DentistryBlizard InstituteQueen Mary University of LondonLondonUK
| | - Corinna Pade
- Barts and the London School of Medicine and DentistryBlizard InstituteQueen Mary University of LondonLondonUK
| | - George Joy
- Barts Heart CentreSt. Bartholomew's HospitalLondonUK
| | - Mala Maini
- Division of Infection and ImmunityUniversity College LondonLondonUK
| | - Benny Chain
- Division of Infection and ImmunityUniversity College LondonLondonUK
| | - Amanda Semper
- National Infection ServicePublic Health EnglandPorton DownUK
| | - Timothy Brooks
- National Infection ServicePublic Health EnglandPorton DownUK
| | - Benjamin J. Ollivere
- Division of Rheumatology, Orthopaedics and DermatologySchool of MedicineUniversity of NottinghamNottinghamUK
| | - Áine McKnight
- Barts and the London School of Medicine and DentistryBlizard InstituteQueen Mary University of LondonLondonUK
| | | | - Thomas A. Treibel
- Barts Heart CentreSt. Bartholomew's HospitalLondonUK
- Institute of Cardiovascular SciencesUniversity College LondonLondonUK
| | - Charlotte Manisty
- Barts Heart CentreSt. Bartholomew's HospitalLondonUK
- Institute of Cardiovascular SciencesUniversity College LondonLondonUK
| | - James C. Moon
- Barts Heart CentreSt. Bartholomew's HospitalLondonUK
- Institute of Cardiovascular SciencesUniversity College LondonLondonUK
| | - Ana M. Valdes
- NIHR Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and the University of NottinghamNottinghamUK
- Division of Rheumatology, Orthopaedics and DermatologySchool of MedicineUniversity of NottinghamNottinghamUK
| | - Rosemary J. Boyton
- Department of Infectious DiseaseImperial College LondonLondonUK
- Lung DivisionRoyal Brompton and Harefield HospitalsGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Daniel M. Altmann
- Department of Immunology and InflammationImperial College LondonLondonUK
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11
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Van Honacker E, Coorevits L, Boelens J, Verhasselt B, Van Braeckel E, Bauters F, De Bus L, Schelstraete P, Willems J, Vandendriessche S, Padalko E. Sensitivity and specificity of 14 SARS-CoV-2 serological assays and their diagnostic potential in RT-PCR negative COVID-19 infections. Acta Clin Belg 2022; 77:315-320. [PMID: 33350362 PMCID: PMC7784824 DOI: 10.1080/17843286.2020.1861885] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Molecular detection of SARS-CoV-2 in respiratory samples is the gold standard for COVID-19 diagnosis but it has a long turnaround time and struggles to detect low viral loads. Serology could help to diagnose suspected cases which lack molecular confirmation. Two case reports are presented as illustration. Objectives: The aim of this study was to evaluate the performance of several commercial assays for COVID-19 serology. We illustrated the added value of COVID-19 serology testing in suspect COVID-19 cases with negative molecular test. Study design: Twenty-three sera from 7 patients with a confirmed molecular diagnosis of SARS-CoV-2 were tested using 14 commercial assays. Additionally, 10 pre-pandemic sera and 9 potentially cross-reactive sera were selected. We calculated sensitivity and specificity. Furthermore, we discuss the diagnostic relevance of COVID-19 serology in a retrospective cohort of 145 COVID-19 cases in which repetitive molecular and serological SARS-CoV-2 tests were applied. Results: The interpretation of the pooled sensitivity of IgM/A and IgG resulted in the highest values (range 14–71% on day 2–7; 88–94% on day 8–18). Overall, the specificity of the assays was high (range 79–100%). Among 145 retrospective cases, 3 cases (2%) remained negative after sequential molecular testing but positive on final SARS-CoV-2 serology. Conclusion: Sensitivity of COVID-19 serological diagnosis was variable but consistently increased at >7 days after symptom onset. Specificity was high. Our data suggest that serology can complement molecular testing for diagnosis of COVID-19, especially for patients presenting the 2nd week after symptom onset or later.
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Affiliation(s)
| | - Liselotte Coorevits
- Laboratory for Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - Jerina Boelens
- Laboratory for Medical Microbiology, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Bruno Verhasselt
- Laboratory for Medical Microbiology, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Eva Van Braeckel
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Fré Bauters
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Liesbet De Bus
- Deparment of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Petra Schelstraete
- Department of Pediatric Intensive Care, Belgium Ghent University Hospital, Ghent, Belgium
- Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium
| | - Jef Willems
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | | | - Elizaveta Padalko
- Laboratory for Medical Microbiology, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
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12
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Şener B, Kirbaş E, Sancak B, Gözalan A, Evren E, Karahan ZC, Zeytinoğlu A, Dinç B, Alp A, Dizman GT, Metan G, Birengel S, Gülten E, Taşbakan M, Ayhan M. PERFORMANCE EVALUATION OF SIX DIFFERENT SARS-CoV-2 ANTIBODY IMMUNOASSAYS: DISEASE SEVERITY AND SERUM SAMPLING TIME AFFECT THE SENSITIVITY. Jpn J Infect Dis 2022; 75:388-394. [PMID: 35354702 DOI: 10.7883/yoken.jjid.2021.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Comparative validation data and clinical performance data are essential for the reliable interpretation of SARS-CoV-2 antibody test results. This study aimed to assess the performance of six SARS-CoV-2 IgG immunoassays in different disease severity settings. Four automated chemiluminescence immunoassays Access (Beckman Coulter), Architect (Abbott), Atellica-IM (Siemens) and Elecsys (Roche) and two ELISA assays (SARS-CoV-2 IgG-S1-based and NCP IgG, Euroimmun) were evaluated in 143 patients and 50 pre-pandemic control sera. Accuracy and precision tests were performed for validation. Overall sensitivity differed between 73.38-88.65%, being higher in spike protein-based assays. Specificity was ≥ 98% in all immunoassays. IgG response was lower for the samples taken <20 days post-symptom onset (87.30%) than for the samples taken ≥20 days post-symptom onset (94.80%). Higher rate of antibody was detected in the clinically moderate disease group. In the asymptomatic and mild group more antibody positivity was detected with spike protein-based assays. Clinical performance of the immunoassays differs according to disease severity and antigen targeted; moderate disease leading to highest rate of IgG response. All the assays tested were eligible for the detection of SARS-CoV-2 IgG however, spike-based assays revealed relatively higher sensitivity than the nucleoprotein-based assays particularly in the asymptomatic and mild disease severity.
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Affiliation(s)
- Burçin Şener
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Turkey
| | - Ekin Kirbaş
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Turkey
| | - Banu Sancak
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Turkey
| | - Ayşegül Gözalan
- Department of Medical Microbiology, Faculty of Medicine, Alaaddin Keykubat University, Turkey
| | - Ebru Evren
- Department of Medical Microbiology, Faculty of Medicine, Ankara University, Turkey
| | - Zeynep Ceren Karahan
- Department of Medical Microbiology, Faculty of Medicine, Ankara University, Turkey
| | - Ayşın Zeytinoğlu
- Department of Medical Microbiology, Faculty of Medicine, Ege University, Turkey
| | - Bedia Dinç
- Medical Microbiology Laboratory, Ankara Bilkent City Hospital, Turkey
| | - Alpaslan Alp
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Turkey
| | - Gülçin Telli Dizman
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Hacettepe University, Turkey
| | - Gökhan Metan
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Hacettepe University, Turkey
| | - Serhat Birengel
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Ankara University, Turkey
| | - Ezgi Gülten
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Ankara University, Turkey
| | - Meltem Taşbakan
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Ege University, Turkey
| | - Müge Ayhan
- Department of Clinical Microbiology and Infectious Diseases, Ankara Bilkent City Hospital, Turkey
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13
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Saglik I, Turkkan A, Turan C, Kara A, Akalin H, Ener B, Sahin A, Yesil E, Celebi S, Kazak E, Heper Y, Yilmaz E, Korkmaz MF, Ture E, Hacimustafaoglu M. Comparison of SARS-CoV-2 Antibodies and Six Immunoassays in Pediatric and Adult Patients 12 Weeks After COVID-19. Cureus 2022; 14:e22195. [PMID: 35308741 PMCID: PMC8924986 DOI: 10.7759/cureus.22195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific humoral immune persistence has been proposed to be affected by patients’ characteristics. Moreover, available conflicting assay results are needed to be settled through comparative research with defined clinical specimens. Methods This prospective study investigated SARS-CoV-2-specific antibodies among 43 adults and 34 children at a mean of 12 weeks after the onset of COVID-19 symptoms using six serological assays and compared their performance. We used two Euroimmun (Euroimmun, Luebeck, Germany), two automated Roche Elecsys (Basel, Switzerland), and two rapid immuno-chromatographic Ecotest (Matrix Diagnostics, Assure Tech. (Hangzhou) Co., L, China) assays to investigate SARS-CoV-2 antibodies. Results The findings showed that the Roche Elecsys anti-S total test yielded the best positivity/sensitivity (children 94.1% and adults 93.0%; p = 0.877) while five immunoglobulin IgG targeting assays had similar positivity/sensitivity between children (88.2% to 94.1%) and adults (88.4% to 93.0%) (p > 0.05). Although IgM positivity was relatively low (p < 0.001), it was found in the majority of our pediatric and adult patients (67.6% and 86.0%, respectively; p = 0.098). SARS-CoV-2 S IgG titers were found to be higher among males in pediatric and adult groups compared to females (p = 0.027 and p = 0.041, respectively). Furthermore, we observed significantly higher antibody titers among pneumonia patients (p = 0.001). Conclusion Overall, we concluded SARS-CoV-2 antibody persistence over an average of 12 weeks after the onset of COVID-19 symptoms. While automated Roche Elecsys total antibody assays yielded the best sensitivity (> 90%) and five assays targeting IgG had acceptable performance. Patients with pneumonia and males have higher antibody titers. The effect of antibody persistence on re-infections should be monitored in longitudinal studies.
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14
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A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE ACCURACY OF SARS-COV-2 IGM AND IGG TESTS IN INDIVIDUALS WITH COVID-19. J Clin Virol 2022; 148:105121. [PMID: 35245882 PMCID: PMC8863416 DOI: 10.1016/j.jcv.2022.105121] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/22/2022] [Accepted: 02/21/2022] [Indexed: 01/21/2023]
Abstract
Introduction Objective Methods Results Conclusion
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15
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Wiencek JR, Bachmann LM, Dinwiddie K, Miller GW, Bazydlo LAL. Cross-Institutional Evaluation of the Abbott ARCHITECT SARS-CoV-2 IgG Immunoassay. Lab Med 2021; 52:e137-e146. [PMID: 33929022 PMCID: PMC8135851 DOI: 10.1093/labmed/lmab011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To describe a cross-institutional approach to verify the Abbott ARCHITECT SARS-CoV-2 antibody assay and to document the kinetics of the serological response. METHODS We conducted analytical performance evaluation studies using the Abbott ARCHITECT SARS-CoV-2 antibody assay on 5 Abbott ARCHITECT i2000 automated analyzers at 2 academic medical centers. RESULTS Within-run and between-run coefficients of variance (CVs) for the antibody assay did not exceed 5.6% and 8.6%, respectively, for each institution. Quantitative and qualitative results agreed for lithium heparin plasma, EDTA-plasma and serum specimen types. Results for all SARS-CoV-2 IgG-positive and -negative specimens were concordant among analyzers except for 1 specimen at 1 institution. Qualitative and quantitative agreement was observed for specimens exchanged between institutions. All patients had detectable antibodies by day 10 from symptom onset and maintained seropositivity throughout specimen procurement. CONCLUSIONS The analytical performance characteristics of the Abbott ARCHITECT SARS-CoV-2 antibody assay within and between 2 academic medical center clinical laboratories were acceptable for widespread clinical-laboratory use.
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Affiliation(s)
- Joesph R Wiencek
- Department of Pathology, University of Virginia (UVA) School of Medicine, Charlottesville, Virginia
| | - Lorin M Bachmann
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Kelly Dinwiddie
- Medical Laboratories, University of Virginia Health System, Charlottesville, Virginia
| | - Greg W Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Lindsay A L Bazydlo
- Department of Pathology, University of Virginia (UVA) School of Medicine, Charlottesville, Virginia
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16
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Assessing the Quality of Serological Testing in the COVID-19 Pandemic: Results of a European External Quality Assessment (EQA) Scheme for Anti-SARS-CoV-2 Antibody Detection. J Clin Microbiol 2021; 59:e0055921. [PMID: 34190575 PMCID: PMC8373014 DOI: 10.1128/jcm.00559-21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
External quality assessment (EQA) is a key instrument for achieving harmonization, and thus a high quality, of diagnostic procedures. As reliable test results are crucial for accurate assessment of SARS-CoV-2 infection prevalence, vaccine response, and immunity, and thus for successful management of the ongoing COVID-19 pandemic, the Reference Institute for Bioanalytics (RfB) was the first EQA provider to offer an open scheme for anti-SARS-CoV-2 antibody detection. The main objectives of this EQA were (i) to gain insights into the current diagnostic landscape and the performance of serological tests in Europe and (ii) to provide recommendations for diagnostic improvements. Within the EQA, a blinded panel of precharacterized human serum samples with variable anti-SARS-CoV-2 antibody titers was provided for detection of anti-SARS-CoV-2 IgG, IgA, and IgM antibodies. Across the three distribution rounds in 2020, 284 laboratories from 22 countries reported a total of 3,744 results for anti-SARS-CoV-2 antibody detection using more than 24 different assays for IgG. Overall, 97/3,004 results were false for anti-SARS-CoV-2 IgG, 88/248 for IgA, and 34/124 for IgM. Regarding diagnostic sensitivity and specificity, substantial differences were found between the different assays used, as well as between certified and noncertified tests. For cutoff samples, a drop in the diagnostic sensitivity to 46.3% and high interlaboratory variability were observed. In general, this EQA highlights the current variability of anti-SARS-CoV-2 antibody detection, technical limitations with respect to cutoff samples, and the lack of harmonization of testing procedures. Recommendations are provided to help laboratories and manufacturers further improve the quality of anti-SARS-CoV-2 serological diagnostics.
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17
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Hönemann M, Lück C, Maier M, Pietsch C, Dietze N, Berthold T, Encalada MVN, Grünewald T, Neumeister V, Dalpke A, Liebert UG. Comprehensive evaluation of eight commercial SARS-CoV-2 IgG assays. Diagn Microbiol Infect Dis 2021; 100:115382. [PMID: 33930691 PMCID: PMC7983330 DOI: 10.1016/j.diagmicrobio.2021.115382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 12/27/2022]
Abstract
Sensitivity and specificity of serological assays are key parameters for the accurate estimation of SARS-CoV-2 sero-prevalence. The aim of this study was to compare 8 readily available IgG antibody tests using a panel of well-defined serum samples of prepandemic and pandemic origin. A cross-reaction panel included samples of patients with recent infection with either of the endemic Coronaviruses 229E, NL63, HKU1, or OC43. Additionally, samples with high antibody levels against influenza virus, adenovirus, and during acute EBV infection were included. Previous infection with endemic coronaviruses caused a significant amount of cross-reactivity in two of the assays. In contrast, the confidence intervals for the assays of Abbott, DiaSorin, Euroimmun and Roche encompassed the value of 98% for samples with a previous endemic HCoV infection. For all assays, sensitivities were between 91.3% and 98.8%. Assay performance was independent of the usage of either nucleocapsid or spike proteins.
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Affiliation(s)
- Mario Hönemann
- Institute of Virology, Leipzig University, Leipzig, Germany.
| | - Christian Lück
- Institute of Medical Microbiology and Virology, Technische Universität Dresden, Dresden, Germany
| | - Melanie Maier
- Institute of Virology, Leipzig University, Leipzig, Germany
| | | | - Nadine Dietze
- Institute of Medical Microbiology, Leipzig University, Leipzig, Germany
| | - Tom Berthold
- Institute of Virology, Leipzig University, Leipzig, Germany
| | | | - Thomas Grünewald
- Clinic for Infectious Diseases and Tropical Medicine, Klinikum Chemnitz, Chemnitz
| | - Volker Neumeister
- Institute for Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
| | - Alexander Dalpke
- Institute of Medical Microbiology and Virology, Technische Universität Dresden, Dresden, Germany
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18
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Kanji JN, Bailey A, Fenton J, Robbin Lindsay L, Dibernardo A, Toledo NP, Waitt B, Lecocq N, Osiowy C, Giles E, Day J, Stokes W, MacDonald C, Turnbull L, Charlton C. Stability of SARS-CoV-2 IgG in multiple laboratory conditions and blood sample types. J Clin Virol 2021; 142:104933. [PMID: 34364133 PMCID: PMC8310571 DOI: 10.1016/j.jcv.2021.104933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/24/2021] [Accepted: 06/27/2021] [Indexed: 11/28/2022]
Abstract
Background : COVID-19 seroprevalence studies use serum/plasma samples to detect SARS-CoV-2 IgG. Data supporting alternate specimen types and freeze-thaw antibody stability is lacking. The stability of IgG and other immunoglobulins in multiple blood sample types stored in differing conditions and multiple freeze-thaw cycles (FTCs) was evaluated. Materials and methods : Serum, plasma, and heparinized-plasma samples were collected from COVID-19 recovered individuals. Samples underwent testing for SARS-CoV-2 antibodies upon collection, after each of 10–12 FTCs, and storage at -70°C, -20°C, 4°C, and room-temperature for 10–12 days using four high-throughput commercial assays, two rapid-test cassettes, a manual ELISA, and a surrogate neutralization assay. Results : All three specimen types were collected from 34 COVID-19 recovered seropositive individuals (≥21 days post-symptoms). Using the Architect and Liaison assays, a positive qualitative SARS-CoV-2 IgG result was detected daily up to 12 FTCs and up to 10 days of storage at different temperatures. An additional 25 plasma samples consistently demonstrated detection of SARS-CoV-2 antibodies daily after 12 FTCs and storage at -20°C using two rapid test cassette assays (SD Biosensor and Hangzhou All Test), manual (Beijing Wantai) and surrogate neutralization (GenScript) ELISAs, and two high-throughput assays (Roche Elecsys nucleocapsid and spike). IgM antibodies were less frequently detected by one of the rapid test cassette assays. Conclusions : Serum, plasma, and heparinized-plasma constitute reliable samples for SARS-CoV-2 antibody detection. In particular, the IgG response was stable and reliably detected after multiple FTCs and storage at common laboratory conditions. IgM detection was variable due to the labile nature of this antibody class.
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Affiliation(s)
- Jamil N Kanji
- Division of Infectious Diseases, Department of Medicine, University of Alberta, 8440 - 112 Street NW, Edmonton, AB, T6G 2B7, Canada; Public Health Laboratory, Alberta Precision Laboratories, University of Alberta Hospital, 8440 - 112 Street NW, Edmonton, AB, T6G 2B7, Canada; Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, 8440 - 112 Street NW, Edmonton, AB, T6G 2B7, Canada.
| | - Ashley Bailey
- Public Health Laboratory, Alberta Precision Laboratories, University of Alberta Hospital, 8440 - 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Jayne Fenton
- Public Health Laboratory, Alberta Precision Laboratories, University of Alberta Hospital, 8440 - 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - L Robbin Lindsay
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street Winnipeg, MB, R3E 3M4
| | - Antonia Dibernardo
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street Winnipeg, MB, R3E 3M4
| | - Nikki Pl Toledo
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street Winnipeg, MB, R3E 3M4
| | - Brooks Waitt
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street Winnipeg, MB, R3E 3M4
| | - Nadine Lecocq
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street Winnipeg, MB, R3E 3M4
| | - Carla Osiowy
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street Winnipeg, MB, R3E 3M4
| | - Elizabeth Giles
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street Winnipeg, MB, R3E 3M4
| | - Jacqueline Day
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street Winnipeg, MB, R3E 3M4
| | - William Stokes
- Division of Infectious Diseases, Department of Medicine, University of Alberta, 8440 - 112 Street NW, Edmonton, AB, T6G 2B7, Canada; Public Health Laboratory, Alberta Precision Laboratories, University of Alberta Hospital, 8440 - 112 Street NW, Edmonton, AB, T6G 2B7, Canada; Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, 8440 - 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Clayton MacDonald
- Public Health Laboratory, Alberta Precision Laboratories, University of Alberta Hospital, 8440 - 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - LeeAnn Turnbull
- Public Health Laboratory, Alberta Precision Laboratories, University of Alberta Hospital, 8440 - 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Carmen Charlton
- Public Health Laboratory, Alberta Precision Laboratories, University of Alberta Hospital, 8440 - 112 Street NW, Edmonton, AB, T6G 2B7, Canada; Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, 8440 - 112 Street NW, Edmonton, AB, T6G 2B7, Canada; Li Ka Shing Institute of Virology, University of Alberta, 6-010 Katz Group Centre for Pharmacy and Health Research, Edmonton, Alberta T6G 2E1, Canada
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19
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Heffernan E, Kennedy L, Hannan MM, Ramlaul N, Denieffe S, Courtney G, Watt A, Hurley J, Lynch M, Fitzgibbon M. Performance characteristics of five SARS-CoV-2 serological assays: Clinical utility in health-care workers. Ann Clin Biochem 2021; 58:496-504. [PMID: 33845592 DOI: 10.1177/00045632211012728] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVE SARS-CoV-2, which causes coronavirus disease (COVID-19), continues to cause significant morbidity and mortality. The diagnosis of acute infection relies on reverse transcription-polymerase chain reaction (RT-PCR)-based viral detection. The objective of this study was to evaluate the optimal serological testing strategy for anti-SARS-CoV-2 antibodies which provides an important indicator of prior infection and potential short-term immunity. METHODS The sensitivity and specificity of four different ELISA assays (Euroimmun IgG, Euroimmun NCP-IgG, Fortress and DIAsource) and one CLIA assay (Roche ELECSYS) were evaluated in 423 samples; 137 patients with confirmed RT-PCR COVID-19 infection (true positives), and 100 pre-pandemic samples collected prior to October 2019 (true negatives). A further 186 samples were collected from health-care staff and analysed by all five assays. RESULTS The Fortress ELISA assay demonstrated the highest sensitivity and specificity followed by the Roche ECLIA assay. The highest overall sensitivity came from the assays that measured total antibody (IgM-IgG combined) and the three assays that performed the best (Fortress, Roche, Euroimmun IgG) all have different antigens as their target proteins which suggests that antigen target does not affect assay performance. In mildly symptomatic participants with either a negative RT-PCR or no RT-PCR performed, 16.76% had detectable antibodies suggesting previous infection. CONCLUSIONS We recommend a combined testing strategy utilizing assays with different antigenic targets using the fully automated Roche ECLIA assay and confirming discordant samples with the Fortress Total Antibody ELISA assay. This study provides an important indicator of prior infection in symptomatic and asymptomatic individuals.
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Affiliation(s)
- Emma Heffernan
- Department of Immunology, Mater Private Hospital, Dublin, Ireland
| | - Lisa Kennedy
- Department of Clinical Biochemistry, Mater Private Hospital, Dublin, Ireland
| | - Margaret M Hannan
- Department of Clinical Microbiology, Mater Private Hospital, Dublin, Ireland
| | | | | | - Garry Courtney
- Department of Medicine, Luke's Hospital, Kilkenny, Ireland
| | - Alison Watt
- Department of Virology, Regional Virus Laboratory, Belfast, Ireland
| | - John Hurley
- Department of Cardiothoracic Surgery, Mater Private Hospital, Dublin, Ireland
| | - Maureen Lynch
- Department of Clinical Microbiology, Mater Private Hospital, Dublin, Ireland
| | - Maria Fitzgibbon
- Department of Clinical Biochemistry, Mater Private Hospital, Dublin, Ireland
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20
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Ibrahim EH, Ghramh HA, Kilany M. Development of in-house ELISAs for the detection of anti-SARS‑CoV‑2 RBD and N IgG and IgM antibodies in biological samples. JOURNAL OF KING SAUD UNIVERSITY. SCIENCE 2021; 33:101439. [PMID: 33879983 PMCID: PMC8049187 DOI: 10.1016/j.jksus.2021.101439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/17/2021] [Accepted: 04/06/2021] [Indexed: 05/28/2023]
Abstract
By the end of year 2019, the new virus SARS-CoV-2 appeared, causing the Coronavirus Disease 2019 (COVID-19), and spread very fast globally. A continuing need for diagnostic tools is a must to contain its spread. Till now, the gold standard method, the reverse transcription polymerase chain reaction (RT-PCR), is the precise procedure to detect the virus. However, SARS-CoV-2 may escape RT-PCR detection for several reasons. The development of well-designed, specific and sensitive serological test like enzyme immunoassay (EIA) is needed. This EIA can stand alone or work side by side with RT-PCR. In this study, we developed several EIAs including plates that are coated with either specially designed SARS-CoV-2 nucleocapsid or surface recombinant proteins. Each protein type can separately detect anti-SARS-CoV-2 IgM or IgG antibodies. For each EIAs, the cut-off value, specificity and sensitivity were determined utilizing RT-PCR confirmed Covid-19 and pre-pandemic healthy and other viruses-infected sera. Also, the receiver operator characteristic (ROC) analysis was performed to define the specificities and sensitivities of the optimized assay. The in-house EIAs were validated by comparing against commercial EIA kits. All in-house EIAs showed high specificity (98-99%) and sensitivity (97.8-98.9%) for the detection of IgG/IgM against RBD and N proteins of SARS-CoV-2. From these results, the developed Anti-RBD and anti-N IgG and IgM antibodies EIAs can be used as a specific and sensitive tool to detect SARS-CoV-2 infection, calculate the burden of disease and case fatality rates.
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Key Words
- AUC, Area under the curve
- BSA, Bovine serum albumin
- CMV, Cytomegalovirus
- CoVs, Coronaviruses
- Covid-19
- Covid-19, Coronavirus Disease-2019
- E, Envelope protein
- EIA, Enzyme immunoassay
- ELISA
- ELISA, Enzyme-linked immunosorbant assay
- HBV, Hepatitis B virus
- HCV, Hepatitis C virus
- HIV, Human immunodeficiency virus
- HTLV, Human T-lymphotropic virus
- M, Membrane protein
- N, Nucleocapsid protein
- Nucleocapsid protein
- OD, Optical density
- ORFs, Open reading frames
- RBD, Receptor-binding domain
- ROC, Receiver operating characteristic
- RT-PCR, Reverse transcription polymerase chain reaction
- S, Spike protein
- SARS-CoV-2
- SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2
- SD, Standard deviations
- Spike protein
- TMB, 3,3′,5,5′-Tetramethylbenzidine
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Affiliation(s)
- Essam H Ibrahim
- Biology Department, Faculty of Science, King Khalid University, P.O. Box 9004, Abha 61413, Saudi Arabia
- Research Center for Advanced Materials Science (RCAMS), King Khalid University, P.O. Box 9004, Abha 61413, Saudi Arabia
- Blood Products Quality Control and Research Department, National Organization for Research and Control of Biologicals, Cairo, Egypt
| | - Hamed A Ghramh
- Biology Department, Faculty of Science, King Khalid University, P.O. Box 9004, Abha 61413, Saudi Arabia
- Research Center for Advanced Materials Science (RCAMS), King Khalid University, P.O. Box 9004, Abha 61413, Saudi Arabia
- Unit of Bee Research and Honey Production, Faculty of Science, King Khalid University, P.O. Box 9004, Abha 61413, Saudi Arabia
| | - Mona Kilany
- Research Center for Advanced Materials Science (RCAMS), King Khalid University, P.O. Box 9004, Abha 61413, Saudi Arabia
- Department of Microbiology, National Organization for Drug Control and Research (NODCAR), Cairo, Egypt
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21
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Ruano‐Gallego D, García‐Villadangos M, Moreno‐Paz M, Gómez‐Elvira J, Postigo M, Simón‐Sacristán M, Reyburn HT, Carolis C, Rodrigo N, Codeseira YB, Rueda P, Zúñiga S, Enjuanes L, Parro V. A multiplex antigen microarray for simultaneous IgG and IgM detection against SARS-CoV-2 reveals higher seroprevalence than reported. Microb Biotechnol 2021; 14:1228-1236. [PMID: 33929101 PMCID: PMC8085928 DOI: 10.1111/1751-7915.13801] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 01/05/2023] Open
Abstract
The surge of SARS-CoV-2 has challenged health systems worldwide and efficient tests to detect viral particles, as well as antibodies generated against them, are needed. Specificity, sensitivity, promptness or scalability are the main parameters to estimate the final performance, but rarely all of them match in a single test. We have developed SCOVAM, a protein microarray with several viral antigens (spike, nucleocapsid, main protease Nsp5) as capturing probes in a fluorescence immunoassay for COVID-19 serological testing. SCOVAM depicts IgG and IgM antibody responses against each of these proteins of 22 individuals in a single microscope slide. It detects specific IgM (0.094 μg ml-1 ) and IgG (~0.017 μg ml-1 ) and is scalable and cost-effective. We validated SCOVAM by comparing with a widely used chemiluminescent commercial serological test (n = 742). SCOVAM showed twice the sensitivity and allowed following seroconversion in a single assay. By analysing the prevalence 4 months later in a subset of 76 positive sera, we still detected 93.42% of positives, almost doubling the detection of the commercial assay. The higher sensitivity of SCOVAM is especially relevant to screen sera for convalescent plasma-based treatments, high-throughput antibody response monitoring after vaccination or evaluation of vaccine efficiency.
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Affiliation(s)
- David Ruano‐Gallego
- Department of Molecular EvolutionCentro de Astrobiología (INTA‐CSIC)Carretera de Ajalvir km 4Torrejón de ArdozMadrid28850Spain
| | - Miriam García‐Villadangos
- Department of Molecular EvolutionCentro de Astrobiología (INTA‐CSIC)Carretera de Ajalvir km 4Torrejón de ArdozMadrid28850Spain
| | - Mercedes Moreno‐Paz
- Department of Molecular EvolutionCentro de Astrobiología (INTA‐CSIC)Carretera de Ajalvir km 4Torrejón de ArdozMadrid28850Spain
| | - Javier Gómez‐Elvira
- Space Payload DepartmentInstituto Nacional de Técnica Aeroespacial (INTA)Carretera de Ajalvir km 4Torrejón de ArdozMadrid28850Spain
| | - Marina Postigo
- Department of Molecular EvolutionCentro de Astrobiología (INTA‐CSIC)Carretera de Ajalvir km 4Torrejón de ArdozMadrid28850Spain
| | - María Simón‐Sacristán
- Microbiology and Parasitology UnitHospital Central de la Defensa ‘Gómez Ulla’Glorieta del Ejército 1Madrid28050Spain
| | - Hugh T. Reyburn
- Department of Immunology and OncologyCentro Nacional de Biotecnología (CNB‐CSIC)C/ Darwin 3Madrid28049Spain
| | - Carlo Carolis
- CRG‐Centre for Genomic RegulationDr. Aiguader 88Barcelona08003Spain
| | - Natalia Rodrigo
- CRG‐Centre for Genomic RegulationDr. Aiguader 88Barcelona08003Spain
| | - Yaiza B. Codeseira
- CIMUS Biomedical Research InstituteUniversity of Santiago de Compostela‐IDISAvenida de Barcelona s/nSantiago de Compostela15782Spain
| | - Paloma Rueda
- Eurofins‐INGENASAAvenida Institución Libre de Enseñanza 41MadridSpain
| | - Sonia Zúñiga
- Department of Molecular and Cellular BiologyCentro Nacional de Biotecnología (CNB‐CSIC)C/ Darwin 3Madrid28049Spain
| | - Luis Enjuanes
- Department of Molecular and Cellular BiologyCentro Nacional de Biotecnología (CNB‐CSIC)C/ Darwin 3Madrid28049Spain
| | - Victor Parro
- Department of Molecular EvolutionCentro de Astrobiología (INTA‐CSIC)Carretera de Ajalvir km 4Torrejón de ArdozMadrid28850Spain
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22
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Gerhards C, Thiaucourt M, Kittel M, Becker C, Ast V, Hetjens M, Neumaier M, Haselmann V. Longitudinal assessment of anti-SARS-CoV-2 antibody dynamics and clinical features following convalescence from a COVID-19 infection. Int J Infect Dis 2021; 107:221-227. [PMID: 33932604 PMCID: PMC8080496 DOI: 10.1016/j.ijid.2021.04.080] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction The longevity of antibody levels against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the duration of immunity are current topics of major scientific interest. Antibody kinetics during the acute phase are well studied, whereas the long-term kinetics are yet to be determined, with contradictory results from the studies to date. Here, we present a longitudinal analysis of the serological responses to a SARS-CoV-2 infection following convalescence and the association with post-COVID syndrome (PCS). Materials and methods A total of 237 serum samples were prospectively collected from 61 participants who had had a SARS-CoV-2 infection, which was confirmed using quantitative reverse-transcription polymerase chain reaction (qRT-PCR). For each participant, anti-nucleocapsid (N) and anti-spike subunit 1 receptor binding domain (RBD/S1) immunoglobulin (Ig) levels were regularly determined over a period of 8 months. COVID-19-associated symptoms were assessed using a standardized questionnaire at study entry and again after 6 months. Results Antibodies were detectable in 56 of the 61 participants. No substantial decline in anti-SARS-CoV-2 pan-Ig levels was observed for the duration of the follow-up period. Antibody levels correlated positively with the disease severity, body mass index, fever, and smoking status. It was found that 46.8% of the participants suffered from PCS, with olfactory and gustatory dysfunctions being the most commonly reported symptoms. Conclusion The results demonstrate stable anti-SARS-CoV-2 antibody titers and thus may indicate a long-lasting immunity. The results are in line with recently published data and provide further insight concerning asymptomatic to mildly-affected patients, the association with clinical features, and the frequency of PCS.
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Affiliation(s)
- Catharina Gerhards
- Institute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany.
| | - Margot Thiaucourt
- Institute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany
| | - Maximilian Kittel
- Institute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany
| | - Celine Becker
- Institute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany
| | - Volker Ast
- Institute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany
| | - Michael Hetjens
- Department of Biomedical Informatics, Center for Preventive Medicine and Digital Health Baden-Württemberg, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Neumaier
- Institute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany
| | - Verena Haselmann
- Institute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany
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23
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Valdes AM, Moon JC, Vijay A, Chaturvedi N, Norrish A, Ikram A, Craxford S, Cusin LM, Nightingale J, Semper A, Brooks T, McKnight A, Kurdi H, Menni C, Tighe P, Noursadeghi M, Aithal G, Treibel TA, Ollivere BJ, Manisty C. Longitudinal assessment of symptoms and risk of SARS-CoV-2 infection in healthcare workers across 5 hospitals to understand ethnic differences in infection risk. EClinicalMedicine 2021; 34:100835. [PMID: 33880438 PMCID: PMC8049191 DOI: 10.1016/j.eclinm.2021.100835] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND : Healthcare workers (HCWs) have increased rates of SARS-CoV-2 infection compared with the general population. We aimed to understand ethnic differences in SARS-CoV-2 seropositivity among hospital healthcare workers depending on their hospital role, socioeconomic status, Covid-19 symptoms and basic demographics. METHODS A prospective longitudinal observational cohort study. 1364 HCWs at five UK hospitals were studied with up to 16 weeks of symptom questionnaires and antibody testing (to both nucleocapsid and spike protein) during the first UK wave in five NHS hospitals between March 20 and July 10 2020. The main outcome measures were SARS-CoV-2 infection (seropositivity at any time-point) and symptoms. Registration number: NCT04318314. FINDINGS 272 of 1364 HCWs (mean age 40.7 years, 72% female, 74% White, ≥6 samples per participant) seroconverted, reporting predominantly mild or no symptoms. Seropositivity was lower in Intensive Therapy Unit (ITU) workers (OR=0.44 95%CI 0.24, 0.77; p=0.0035). Seropositivity was higher in Black (compared to White) participants, independent of age, sex, role and index of multiple deprivation (OR=2.61 95%CI 1.47-4.62 p=0.0009). No association was seen between White HCWs and other minority ethnic groups. INTERPRETATION In the UK first wave, Black ethnicity (but not other ethnicities) more than doubled HCWs likelihood of seropositivity, independent of age, sex, measured socio-economic factors and hospital role.
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Affiliation(s)
- Ana M. Valdes
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
- Corresponding Author: Professor Ana Valdes, University of Nottingham School of Medicine, Nottingham, United Kingdom, Tel: (+44)0115 823 1954
| | - James C. Moon
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Amrita Vijay
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, United Kingdom
| | - Alan Norrish
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Adeel Ikram
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Simon Craxford
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | | | - Jessica Nightingale
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Amanda Semper
- National Infection Service, Public Health England, Porton Down, UK
| | - Timothy Brooks
- National Infection Service, Public Health England, Porton Down, UK
| | - Aine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hibba Kurdi
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King's College London, London SE1 7EH, UK
| | - Patrick Tighe
- School of Life Sciences, University of Nottingham, NG7 2RB
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Guruprasad Aithal
- Nottingham Digestive Disease Centre, University of Nottingham School of Medicine, Nottingham, UK
| | - Thomas A. Treibel
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Benjamin J. Ollivere
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Charlotte Manisty
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
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24
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Kittel M, Findeisen P, Muth MC, Thiaucourt M, Gerhards C, Neumaier M, Haselmann V. Specificity testing by point prevalence as a simple assessment strategy using the Roche Elecsys® anti-SARS-CoV-2 immunoassay. Int J Infect Dis 2021; 105:632-638. [PMID: 33578017 PMCID: PMC7872847 DOI: 10.1016/j.ijid.2021.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The detection of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is mandatory for the diagnosis, retrospective assessment of disease progression, and correct evaluation of the current infection situation in the population. Many such assays have been launched by various manufacturers. Unfortunately, the new US Food and Drug Administration emergency use regulations have resulted in a situation where laboratories have to perform their own validation studies but many of these laboratories do not have the biobank needed to conduct the studies. METHODS We introduce a method that allows institutions to quickly perform a verification study in a low-prevalence infection situation. As proof of concept, we used the Roche Elecsys® anti-SARS-CoV-2 electrochemiluminescence immunoassay and an SAP-based hospital information system. The Shenzhen YHLO Biotech IgM and IgG assay targeting other surface patterns was used as a confirmatory test. RESULTS The Roche assay demonstrated a limit of detection of 0.069 cutoff index and successfully passed the performance validation according to Clinical and Laboratory Standards Institute EP15-A3. The study population of 627 inpatients has a median age of 64 years, and approximately 13% of the group were under intensive care at the respective time point. All patients included tested negative for SARS-CoV-2 infection by quantitative reverse transcription polymerase chain reaction (cobas® 6800, Roche, Mannheim, Germany). Only one false-positive result was obtained, resulting in a specificity for the Roche Elecsys anti-SARS-CoV-2 test of 99.84% and a negative predictive value of 99.98%. CONCLUSIONS The anonymized use of residual material enables quick evaluation of anti-SARS-CoV-2 immunoassays, as shown in this work with the Roche Elecsys assay. Comparison of the control population with economic data makes it possible to validate the sampling set and therefore to determine diagnostic specificity. By use of the approach chosen, it was shown that the Roche test achieved very good results in terms of diagnostic specificity, reproducibility, and limit of detection.
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Affiliation(s)
- Maximilian Kittel
- Department of Clinical Chemistry, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, 68167, Mannheim, Germany.
| | - Peter Findeisen
- MVZ Laboratory Dr. Limbach & Colleagues, Im Breitspiel 16, 69126, Heidelberg, Germany
| | - Maria-Christina Muth
- MVZ Laboratory Dr. Limbach & Colleagues, Im Breitspiel 16, 69126, Heidelberg, Germany
| | - Margot Thiaucourt
- Department of Clinical Chemistry, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, 68167, Mannheim, Germany
| | - Catharina Gerhards
- Department of Clinical Chemistry, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, 68167, Mannheim, Germany
| | - Michael Neumaier
- Department of Clinical Chemistry, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, 68167, Mannheim, Germany
| | - Verena Haselmann
- Department of Clinical Chemistry, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, 68167, Mannheim, Germany
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Peng T, Sui Z, Huang Z, Xie J, Wen K, Zhang Y, Huang W, Mi W, Peng K, Dai X, Fang X. Point-of-care test system for detection of immunoglobulin-G and -M against nucleocapsid protein and spike glycoprotein of SARS-CoV-2. SENSORS AND ACTUATORS. B, CHEMICAL 2021; 331:129415. [PMID: 33519091 DOI: 10.1016/j.snb.2020.129414] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/13/2020] [Accepted: 12/28/2020] [Indexed: 05/27/2023]
Abstract
The coronavirus disease 2019 (COVID-19) epidemic continues to ravage the world. In epidemic control, dealing with a large number of samples is a huge challenge. In this study, a point-of-care test (POCT) system was successfully developed and applied for rapid and accurate detection of immunoglobulin-G and -M against nucleocapsid protein (anti-N IgG/IgM) and receptor-binding domain in spike glycoprotein (anti-S-RBD IgG/IgM) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Any one of the IgG/IgM found in a sample was identified as positive. The POCT system contains colloidal gold-based lateral flow immunoassay test strips, homemade portable reader, and certified reference materials, which detected anti-N and anti-S-RBD IgG/IgM objectively in serum within 15 min. Receiver operating characteristic curve analysis was used to determine the optimal cutoff values, sensitivity, and specificity. It exhibited equal to or better performances than four approved commercial kits. Results of the system and chemiluminescence immunoassay kit detecting 108 suspicious samples had high consistency with kappa coefficient at 0.804 (P < 0.001). Besides, the levels and alterations of the IgG/IgM in an inpatient were primarily investigated by the POCT system. Those results suggested the POCT system possess the potential to contribute to rapid and accurate serological diagnosis and epidemiological survey of COVID-19.
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Affiliation(s)
- Tao Peng
- Center for Advanced Measurement Science, National Institute of Metrology, Beijing, 100029, PR China
| | - Zhiwei Sui
- Center for Advanced Measurement Science, National Institute of Metrology, Beijing, 100029, PR China
| | | | - Jie Xie
- Center for Advanced Measurement Science, National Institute of Metrology, Beijing, 100029, PR China
| | - Kai Wen
- College of Veterinary Medicine, China Agricultural University, 100193, Beijing, PR China
| | - Yongzhuo Zhang
- Center for Advanced Measurement Science, National Institute of Metrology, Beijing, 100029, PR China
| | - Wenfeng Huang
- Center for Advanced Measurement Science, National Institute of Metrology, Beijing, 100029, PR China
- Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, 430071, PR China
| | - Wei Mi
- Center for Advanced Measurement Science, National Institute of Metrology, Beijing, 100029, PR China
| | - Ke Peng
- Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, 430071, PR China
| | - Xinhua Dai
- Center for Advanced Measurement Science, National Institute of Metrology, Beijing, 100029, PR China
| | - Xiang Fang
- Center for Advanced Measurement Science, National Institute of Metrology, Beijing, 100029, PR China
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26
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Peng T, Sui Z, Huang Z, Xie J, Wen K, Zhang Y, Huang W, Mi W, Peng K, Dai X, Fang X. Point-of-care test system for detection of immunoglobulin-G and -M against nucleocapsid protein and spike glycoprotein of SARS-CoV-2. SENSORS AND ACTUATORS. B, CHEMICAL 2021; 331:129415. [PMID: 33519091 PMCID: PMC7833039 DOI: 10.1016/j.snb.2020.129415] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/13/2020] [Accepted: 12/28/2020] [Indexed: 05/02/2023]
Abstract
The coronavirus disease 2019 (COVID-19) epidemic continues to ravage the world. In epidemic control, dealing with a large number of samples is a huge challenge. In this study, a point-of-care test (POCT) system was successfully developed and applied for rapid and accurate detection of immunoglobulin-G and -M against nucleocapsid protein (anti-N IgG/IgM) and receptor-binding domain in spike glycoprotein (anti-S-RBD IgG/IgM) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Any one of the IgG/IgM found in a sample was identified as positive. The POCT system contains colloidal gold-based lateral flow immunoassay test strips, homemade portable reader, and certified reference materials, which detected anti-N and anti-S-RBD IgG/IgM objectively in serum within 15 min. Receiver operating characteristic curve analysis was used to determine the optimal cutoff values, sensitivity, and specificity. It exhibited equal to or better performances than four approved commercial kits. Results of the system and chemiluminescence immunoassay kit detecting 108 suspicious samples had high consistency with kappa coefficient at 0.804 (P < 0.001). Besides, the levels and alterations of the IgG/IgM in an inpatient were primarily investigated by the POCT system. Those results suggested the POCT system possess the potential to contribute to rapid and accurate serological diagnosis and epidemiological survey of COVID-19.
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Affiliation(s)
- Tao Peng
- Center for Advanced Measurement Science, National Institute of Metrology, Beijing, 100029, PR China
| | - Zhiwei Sui
- Center for Advanced Measurement Science, National Institute of Metrology, Beijing, 100029, PR China
| | | | - Jie Xie
- Center for Advanced Measurement Science, National Institute of Metrology, Beijing, 100029, PR China
| | - Kai Wen
- College of Veterinary Medicine, China Agricultural University, 100193, Beijing, PR China
| | - Yongzhuo Zhang
- Center for Advanced Measurement Science, National Institute of Metrology, Beijing, 100029, PR China
| | - Wenfeng Huang
- Center for Advanced Measurement Science, National Institute of Metrology, Beijing, 100029, PR China
- Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, 430071, PR China
| | - Wei Mi
- Center for Advanced Measurement Science, National Institute of Metrology, Beijing, 100029, PR China
| | - Ke Peng
- Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, 430071, PR China
| | - Xinhua Dai
- Center for Advanced Measurement Science, National Institute of Metrology, Beijing, 100029, PR China
| | - Xiang Fang
- Center for Advanced Measurement Science, National Institute of Metrology, Beijing, 100029, PR China
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27
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Føns S, Krogfelt KA. How can we interpret SARS-CoV-2 antibody test results? Pathog Dis 2021; 79:6123719. [PMID: 33512464 PMCID: PMC7858042 DOI: 10.1093/femspd/ftaa069] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022] Open
Abstract
Since the outbreak of COVID-19, the world has raced to understand and accurately diagnose infection caused by SARS-CoV-2. Today, hundreds of commercial antibody tests are on the market despite often lacking proper validation and with unsatisfactory sensitivity and/or specificity. In addition, many questions related to the humoral response remain unresolved, although research is carried out at an unprecedented speed. Despite the shortcomings, serological assays have an important part to play in combating the pandemic by aiding in diagnosis and sero-epidemiological studies. However, careful attention must be paid to the application of serology and the interpretation of serological data—especially in low prevalence regions, both at an individual and at a population level. In this article, we argue that serological results are often misinterpreted, and in the eagerness to be first, methodological rigor is often taking a backseat.
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Affiliation(s)
- Sofie Føns
- Roskilde University, Department of Science and Environment, Universitetsvej 1, Roskilde, Denmark
| | - Karen A Krogfelt
- Roskilde University, Department of Science and Environment, Universitetsvej 1, Roskilde, Denmark
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28
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Qin X, Shen J, Dai E, Li H, Tang G, Zhang L, Hou X, Lu M, Wu X, Duan S, Zhang J, Tsoi MF, Jiang P, Li Y. The seroprevalence and kinetics of IgM and IgG in the progression of COVID-19. BMC Immunol 2021; 22:14. [PMID: 33596826 PMCID: PMC7887538 DOI: 10.1186/s12865-021-00404-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/02/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND SARS-CoV-2 is a novel coronavirus first recognized in late December 2019 that causes coronavirus disease 19 (COVID-19). Due to the highly contagious nature of SARS-CoV-2, it has developed into a global pandemic in just a few months. Antibody testing is an effective method to supplement the diagnosis of COVID-19. However, multicentre studies are lacking to support the understanding of the seroprevalence and kinetics of SARS-CoV-2 antibodies in COVID-19 epidemic regions. METHOD A multicentre cross-sectional study of suspected and confirmed patients from 4 epidemic cities in China and a cohort study of consecutive follow-up patients were conducted from 29/01/2020 to 12/03/2020. IgM and IgG antibodies elicited by SARS-CoV-2 were tested by a chemiluminescence assay. Clinical information, including basic demographic data, clinical classification, and time interval from onset to sampling, was collected from each centre. RESULTS A total of 571 patients were enrolled in the cross-sectional study, including 235 COVID-19 patients and 336 suspected patients, each with 91.9%:2.1% seroprevalence of SARS-CoV-2 IgG and 92.3%:5.4% seroprevalence of SARS-CoV-2 IgM. The seroprevalence of SARS-CoV-2 IgM and IgG in COVID-19 patients was over 70% less than 7 days after symptom onset. Thirty COVID-19 patients were enrolled in the cohort study and followed up for 20 days. The peak concentrations of IgM and IgG were reached on the 10th and 20th days, respectively, after symptom onset. The seroprevalence of COVID-19 IgG and IgM increased along with the clinical classification and treatment time delay. CONCLUSION We demonstrated the kinetics of IgM and IgG SARS-CoV-2 antibodies in COVID-19 patients and the association between clinical classification and antibodies, which will contribute to the interpretation of IgM and IgG SARS-CoV-2 antibody tests and in predicting the outcomes of patients with COVID-19.
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Affiliation(s)
- Xuzhen Qin
- Department of Laboratory Medicine, Peking Union Medical College Hospital & Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jun Shen
- Department of Administrative Office, Haihe University, Tianjin, China
| | - Erhei Dai
- Division of Liver Disease, The Fifth Hospital of Shijiazhuang, Hebei Medical University, Shijiazhuang, China
| | - Haolong Li
- Department of Laboratory Medicine, Peking Union Medical College Hospital & Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Guodong Tang
- Department of Cardiology, Beijing Hospital of the Ministry of Health, Beijing, China
| | - Lixia Zhang
- Department of Clinical Laboratory, Haihe University, Tianjin, China
| | - Xin Hou
- Department of Laboratory Medicine, Peking Union Medical College Hospital & Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Minya Lu
- Department of Laboratory Medicine, Peking Union Medical College Hospital & Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xian Wu
- Department of Laboratory Medicine, Peking Union Medical College Hospital & Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Simeng Duan
- Department of Laboratory Medicine, Peking Union Medical College Hospital & Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingjia Zhang
- Department of Laboratory Medicine, Peking Union Medical College Hospital & Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Man-Fung Tsoi
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Ping Jiang
- Division of Liver Disease, The Fifth Hospital of Shijiazhuang, Hebei Medical University, Shijiazhuang, China
| | - Yongzhe Li
- Department of Laboratory Medicine, Peking Union Medical College Hospital & Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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29
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Walker GJ, Naing Z, Ospina Stella A, Yeang M, Caguicla J, Ramachandran V, Isaacs SR, Agapiou D, Bull RA, Stelzer-Braid S, Daly J, Gosbell IB, Hoad VC, Irving DO, Pink JM, Turville S, Kelleher AD, Rawlinson WD. SARS Coronavirus-2 Microneutralisation and Commercial Serological Assays Correlated Closely for Some but Not All Enzyme Immunoassays. Viruses 2021; 13:v13020247. [PMID: 33557418 PMCID: PMC7915197 DOI: 10.3390/v13020247] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 01/06/2023] Open
Abstract
Serological testing for SARS-CoV-2-specific antibodies provides important research and diagnostic information relating to COVID-19 prevalence, incidence and host immune response. A greater understanding of the relationship between functionally neutralising antibodies detected using microneutralisation assays and binding antibodies detected using scalable enzyme immunoassays (EIA) is needed in order to address protective immunity post-infection or vaccination, and assess EIA suitability as a surrogate test for screening of convalescent plasma donors. We assessed whether neutralising antibody titres correlated with signal cut-off ratios in five commercially available EIAs, and one in-house assay based on expressed spike protein targets. Sera from recovered patients or convalescent plasma donors who reported laboratory-confirmed SARS-CoV-2 infection (n = 200), and negative control sera collected prior to the COVID-19 pandemic (n = 100), were assessed in parallel. Performance was assessed by calculating EIA sensitivity and specificity with reference to microneutralisation. Neutralising antibodies were detected in 166 (83%) samples. Compared with this, the most sensitive EIAs were the Cobas Elecsys Anti-SARS-CoV-2 (98%) and Vitros Immunodiagnostic Anti-SARS-CoV-2 (100%), which detect total antibody targeting the N and S1 antigens, respectively. The assay with the best quantitative relationship with microneutralisation was the Euroimmun IgG. These results suggest the marker used (total Ab vs. IgG vs. IgA) and the target antigen are important determinants of assay performance. The strong correlation between microneutralisation and some commercially available assays demonstrates their potential for clinical and research use in assessing protection following infection or vaccination, and use as a surrogate test to assess donor suitability for convalescent plasma donation.
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Affiliation(s)
- Gregory J. Walker
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, NSW 2031, Australia; (G.J.W.); (M.Y.); (S.R.I.); (S.S.-B.)
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Zin Naing
- Serology and Virology Division (SaViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW 2031, Australia; (Z.N.); (J.C.); (V.R.)
| | - Alberto Ospina Stella
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia; (A.O.S.); (D.A.); (R.A.B.); (S.T.); (A.D.K.)
| | - Malinna Yeang
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, NSW 2031, Australia; (G.J.W.); (M.Y.); (S.R.I.); (S.S.-B.)
- Serology and Virology Division (SaViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW 2031, Australia; (Z.N.); (J.C.); (V.R.)
| | - Joanna Caguicla
- Serology and Virology Division (SaViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW 2031, Australia; (Z.N.); (J.C.); (V.R.)
| | - Vidiya Ramachandran
- Serology and Virology Division (SaViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW 2031, Australia; (Z.N.); (J.C.); (V.R.)
| | - Sonia R. Isaacs
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, NSW 2031, Australia; (G.J.W.); (M.Y.); (S.R.I.); (S.S.-B.)
| | - David Agapiou
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia; (A.O.S.); (D.A.); (R.A.B.); (S.T.); (A.D.K.)
| | - Rowena A. Bull
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia; (A.O.S.); (D.A.); (R.A.B.); (S.T.); (A.D.K.)
| | - Sacha Stelzer-Braid
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, NSW 2031, Australia; (G.J.W.); (M.Y.); (S.R.I.); (S.S.-B.)
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - James Daly
- Australian Red Cross Lifeblood, 417 St Kilda Rd, Melbourne, VIC 3004, Australia; (J.D.); (I.B.G.); (V.C.H.); (D.O.I.); (J.M.P.)
| | - Iain B. Gosbell
- Australian Red Cross Lifeblood, 417 St Kilda Rd, Melbourne, VIC 3004, Australia; (J.D.); (I.B.G.); (V.C.H.); (D.O.I.); (J.M.P.)
- School of Medicine, Western Sydney University, Penrith, NSW 2747, Australia
| | - Veronica C. Hoad
- Australian Red Cross Lifeblood, 417 St Kilda Rd, Melbourne, VIC 3004, Australia; (J.D.); (I.B.G.); (V.C.H.); (D.O.I.); (J.M.P.)
| | - David O. Irving
- Australian Red Cross Lifeblood, 417 St Kilda Rd, Melbourne, VIC 3004, Australia; (J.D.); (I.B.G.); (V.C.H.); (D.O.I.); (J.M.P.)
- Faculty of Health, University of Technology, Sydney, NSW 2007, Australia
| | - Joanne M. Pink
- Australian Red Cross Lifeblood, 417 St Kilda Rd, Melbourne, VIC 3004, Australia; (J.D.); (I.B.G.); (V.C.H.); (D.O.I.); (J.M.P.)
| | - Stuart Turville
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia; (A.O.S.); (D.A.); (R.A.B.); (S.T.); (A.D.K.)
| | - Anthony D. Kelleher
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia; (A.O.S.); (D.A.); (R.A.B.); (S.T.); (A.D.K.)
| | - William D. Rawlinson
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, NSW 2031, Australia; (G.J.W.); (M.Y.); (S.R.I.); (S.S.-B.)
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Serology and Virology Division (SaViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW 2031, Australia; (Z.N.); (J.C.); (V.R.)
- School of Biotechnology and Biomolecular Sciences, Faculty of Science, University of New South Wales, Sydney, NSW 2052, Australia
- Correspondence: ; Tel.: +61-2-9382-9188
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30
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Bouman JA, Riou J, Bonhoeffer S, Regoes RR. Estimating the cumulative incidence of SARS-CoV-2 with imperfect serological tests: Exploiting cutoff-free approaches. PLoS Comput Biol 2021; 17:e1008728. [PMID: 33635863 PMCID: PMC7946301 DOI: 10.1371/journal.pcbi.1008728] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 03/10/2021] [Accepted: 01/20/2021] [Indexed: 01/10/2023] Open
Abstract
Large-scale serological testing in the population is essential to determine the true extent of the current SARS-CoV-2 pandemic. Serological tests measure antibody responses against pathogens and use predefined cutoff levels that dichotomize the quantitative test measures into sero-positives and negatives and use this as a proxy for past infection. With the imperfect assays that are currently available to test for past SARS-CoV-2 infection, the fraction of seropositive individuals in serosurveys is a biased estimator of the cumulative incidence and is usually corrected to account for the sensitivity and specificity. Here we use an inference method-referred to as mixture-model approach-for the estimation of the cumulative incidence that does not require to define cutoffs by integrating the quantitative test measures directly into the statistical inference procedure. We confirm that the mixture model outperforms the methods based on cutoffs, leading to less bias and error in estimates of the cumulative incidence. We illustrate how the mixture model can be used to optimize the design of serosurveys with imperfect serological tests. We also provide guidance on the number of control and case sera that are required to quantify the test's ambiguity sufficiently to enable the reliable estimation of the cumulative incidence. Lastly, we show how this approach can be used to estimate the cumulative incidence of classes of infections with an unknown distribution of quantitative test measures. This is a very promising application of the mixture-model approach that could identify the elusive fraction of asymptomatic SARS-CoV-2 infections. An R-package implementing the inference methods used in this paper is provided. Our study advocates using serological tests without cutoffs, especially if they are used to determine parameters characterizing populations rather than individuals. This approach circumvents some of the shortcomings of cutoff-based methods at exactly the low cumulative incidence levels and test accuracies that we are currently facing in SARS-CoV-2 serosurveys.
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Affiliation(s)
- Judith A. Bouman
- Institute of Integrative Biology, ETH Zurich, Zurich, Switzerland
| | - Julien Riou
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | - Roland R. Regoes
- Institute of Integrative Biology, ETH Zurich, Zurich, Switzerland
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Comparison of Five Serological Assays for the Detection of SARS-CoV-2 Antibodies. Diagnostics (Basel) 2021; 11:diagnostics11010078. [PMID: 33418886 PMCID: PMC7825051 DOI: 10.3390/diagnostics11010078] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 12/11/2022] Open
Abstract
Serological assays can contribute to the estimation of population proportions with previous immunologically relevant contact with the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) virus. In this study, we compared five commercially available diagnostic assays for the diagnostic identification of SARS-CoV-2-specific antibodies. Depending on the assessed immunoglobulin subclass, recorded sensitivity ranged from 17.0% to 81.9% with best results for immunoglobulin G. Specificity with blood donor sera ranged from 90.2% to 100%, with sera from EBV patients it ranged from 84.3% to 100%. Agreement from fair to nearly perfect was recorded depending on the immunoglobulin class between the assays, the with best results being found for immunoglobulin G. Only for this immunoglobulin class was the association between later sample acquisition times (about three weeks after first positive PCR results) and positive serological results in COVID-19 patients confirmed. In conclusion, acceptable and comparable reliability for the assessed immunoglobulin G-specific assays could be shown, while there is still room for improvement regarding the reliability of the assays targeting the other immunoglobulin classes.
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Mahallawi WH. A serological assay to detect human SARS-CoV-2 antibodies. J Taibah Univ Med Sci 2020; 16:57-62. [PMID: 33424527 PMCID: PMC7775033 DOI: 10.1016/j.jtumed.2020.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/26/2020] [Accepted: 11/29/2020] [Indexed: 12/22/2022] Open
Abstract
Objectives Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), can lead to severe respiratory illness. Patients with underlying comorbidities have a high risk of contracting COVID-19. Therefore, serological assays are urgently needed to diagnose asymptomatic carriers of SARS-CoV-2, to estimate the prevalence of infection, and for disease prevention and control. This study aimed to develop an enzyme-linked immunosorbent assay (ELISA) for the detection of anti-SARS-CoV-2 antibodies in humans. Methods An ELISA test was designed and established to detect antibodies against the SARS-CoV-2 spike protein in serum samples from 41 quantitative reverse transcription polymerase chain reaction (qRT-PCR) - positive hospitalised COVID-19 patients. Forty-two convalescent patients' sera served as positive controls, while 117 pre-pandemic serum samples were used as negative controls. Results A comparison between different SARS-CoV-2 proteins was performed, which included the full-length spike (S) protein and the S1 and S2 subunits. The full-length S protein showed the strongest reactivity for anti-SARS-CoV-2 IgG antibodies in patients' serum samples. Additionally, since antibodies could be detected at very low concentrations, the assay was found to be sensitive. Conclusion The current assay was specific, since cross-reactions with other SARS coronaviruses and respiratory viruses such as influenza were not found. Additionally, it was highly sensitive, since the test was able to identify antibodies even at very low concentrations. Therefore, this assay has promise as a screening method at the population level and may be used for in future seroepidemiological studies.
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Affiliation(s)
- Waleed H Mahallawi
- Medical Laboratory Technology Department, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah, KSA
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Galipeau Y, Greig M, Liu G, Driedger M, Langlois MA. Humoral Responses and Serological Assays in SARS-CoV-2 Infections. Front Immunol 2020; 11:610688. [PMID: 33391281 PMCID: PMC7775512 DOI: 10.3389/fimmu.2020.610688] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022] Open
Abstract
In December 2019, the novel betacoronavirus Severe Acute Respiratory Disease Coronavirus 2 (SARS-CoV-2) was first detected in Wuhan, China. SARS-CoV-2 has since become a pandemic virus resulting in hundreds of thousands of deaths and deep socioeconomic implications worldwide. In recent months, efforts have been directed towards detecting, tracking, and better understanding human humoral responses to SARS-CoV-2 infection. It has become critical to develop robust and reliable serological assays to characterize the abundance, neutralization efficiency, and duration of antibodies in virus-exposed individuals. Here we review the latest knowledge on humoral immune responses to SARS-CoV-2 infection, along with the benefits and limitations of currently available commercial and laboratory-based serological assays. We also highlight important serological considerations, such as antibody expression levels, stability and neutralization dynamics, as well as cross-reactivity and possible immunological back-boosting by seasonal coronaviruses. The ability to accurately detect, measure and characterize the various antibodies specific to SARS-CoV-2 is necessary for vaccine development, manage risk and exposure for healthcare and at-risk workers, and for monitoring reinfections with genetic variants and new strains of the virus. Having a thorough understanding of the benefits and cautions of standardized serological testing at a community level remains critically important in the design and implementation of future vaccination campaigns, epidemiological models of immunity, and public health measures that rely heavily on up-to-date knowledge of transmission dynamics.
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Affiliation(s)
- Yannick Galipeau
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Matthew Greig
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - George Liu
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | | | - Marc-André Langlois
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
- uOttawa Center for Infection, Immunity and Inflammation (CI3), Ottawa, ON, Canada
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Abstract
The SARS-CoV-2 virus caused a globally growing pandemic called coronavirus disease 2019 (COVID-19) that has disrupted social, political, and medical environments around the world. Nations are assessing ways to reopen businesses while trying to balance health care risks and economic fallouts. Strategies involving antibody testing have been proposed before phased reopening of the economy. Therefore, assessing the sensitivity and specificity of antibody tests for symptomatic and asymptomatic COVID-19 patients remains paramount to prevent COVID-19 outbreaks. The antibody tests for SARS-CoV-2 detect the presence of IgA, IgM, or IgG antibodies produced by B cells. There are four major types of antibody tests: rapid diagnostic tests, enzyme-linked immunosorbent assays, neutralization assays, and chemiluminescent immunoassays. Currently, there is no standard antibody test for detecting SARS-CoV-2 antibodies during or after exposure or infection. The antibody tests for SARS-CoV-2 have a low specificity within the first week of exposure and increase in the second and third weeks. The current data on antibody tests have several limitations in quality and the presence of bias. Specifically, many antibody tests have a high false-negative rate and a high risk of bias for participant selection, application of index tests, reference standard used, and flow and timing for antibody tests that may incorrectly report the accuracy of COVID-19 antibody tests. In this review, we summarize the current methods, sensitivity/specificity, and gaps in knowledge concerning COVID-19 antibody testing.
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Affiliation(s)
- Jonathan Kopel
- Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Hemant Goyal
- The Wright Center for Graduate Medical Education, Scranton, Pennsylvania
| | - Abhilash Perisetti
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Dörschug A, Schwanbeck J, Hahn A, Hillebrecht A, Blaschke S, Groß U, Heimesaat MM, Frickmann H, Zautner AE. Evaluation of the Xiamen AmonMed Biotechnology rapid diagnostic test COVID-19 IgM/IgG test kit (Colloidal gold). Eur J Microbiol Immunol (Bp) 2020; 10:178-185. [PMID: 32979256 PMCID: PMC7592516 DOI: 10.1556/1886.2020.00029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/09/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction To efficiently monitor the COVID-19 pandemic for surveillance purposes, reliable serological rapid diagnostic tests (RDTs) are desirable for settings where well-established high-throughput bench-top solutions are not available. Here, we have evaluated such an RDT. Methods We have assessed the Xiamen AmonMed Biotechnology COVID-19 IgM/IgG test kit (Colloidal gold) and the EUROIMMUN benchtop assay with serum samples from patients with polymerase chain reaction (PCR)-confirmed COVID-19 disease. Samples from patients with Epstein-Barr-virus (EBV) infection and blood donors were used for specificity testing. Results For the colloid gold rapid test and the EUROIMMUN assay, the study indicated overall sensitivity of 15.2% and 67.4%, respectively, while specificity of 99.0% and 97.9% with the blood donor sera, as well as 100% and 96.8% with the EBV-patients, were observed, respectively. An association of the time period between positive PCR results and serum acquisition with serological test positivity could be observed for the immunologlobulin G subclass of the EUROIMMUN assay only. Conclusions In spite of acceptable specificity of the assessed RDT, the detected poor sensitivity leaves room for improvement. The test results remain difficult to interpret and therefore the RDT can currently not be recommended for routine diagnostic or surveillance use.
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Affiliation(s)
- Anja Dörschug
- 1Institute for Medical Microbiology, University Medical Center Göttingen, Göttingen, Germany
| | - Julian Schwanbeck
- 1Institute for Medical Microbiology, University Medical Center Göttingen, Göttingen, Germany
| | - Andreas Hahn
- 2Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Anke Hillebrecht
- 3Interdisciplinary Emergency Department, University Medical Center Göttingen, Göttingen, Germany
| | - Sabine Blaschke
- 3Interdisciplinary Emergency Department, University Medical Center Göttingen, Göttingen, Germany
| | - Uwe Groß
- 1Institute for Medical Microbiology, University Medical Center Göttingen, Göttingen, Germany
| | - Markus M Heimesaat
- 4Department of Microbiology and Hygiene, Charité - University Medicine Berlin, Berlin, Germany
| | - Hagen Frickmann
- 2Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany.,5Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany
| | - Andreas E Zautner
- 1Institute for Medical Microbiology, University Medical Center Göttingen, Göttingen, Germany
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Haselmann V, Özçürümez MK, Klawonn F, Ast V, Gerhards C, Eichner R, Costina V, Dobler G, Geilenkeuser WJ, Wölfel R, Neumaier M. Results of the first pilot external quality assessment (EQA) scheme for anti-SARS-CoV2-antibody testing. Clin Chem Lab Med 2020; 58:2121-2130. [PMID: 32853163 DOI: 10.1515/cclm-2020-1183] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022]
Abstract
Objectives Assessment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection prevalence and immunity is cornerstones in the fight against COVID-19 pandemic. For pandemic control, reliable assays for the detection of anti-SARS-CoV-2 antibodies are required. This pilot external quality assessment (EQA) scheme aimed to independently assess the participants' clinical performance of anti-SARS-CoV-2 testing, to identify shortcomings in clinical practice and to evaluate the suitability of the scheme format. Methods The EQA scheme consisted of eight serum samples with variable reactivity against SARS-CoV-2 intended for the analysis of anti-SARS-CoV-2 immunoglobulin (Ig)G, IgA, and IgM antibodies. Laboratories reported: (1) results for each sample and the respective method, (2) raw data from replicate testing of each sample. Results The 16 selected pilot EQA participants reported 294 interpreted results and 796 raw data results from replicate testing. The overall error rate for the anti-SARS-CoV-2 IgG, IgA, and IgM tests was 2.7, 6.9, and 16.7%, respectively. While the overall diagnostic specificity was rated as very high, sensitivity rates between 67 and 98% indicate considerable quality differences between the manufacturers, especially for IgA and IgM. Conclusions Even the results reported by the small number of participants indicate a very heterogeneous landscape of anti-SARS-CoV-2 serological testing. Differences of available tests and the individual performance of laboratories result in a success rate of 57.1% with one laboratory succeeding for all three antibody-classes. These results are an incentive for laboratories to participate in upcoming open EQA schemes that are needed to achieve a harmonization of test results and to improve serological testing.
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Affiliation(s)
- Verena Haselmann
- Department of Clinical Chemistry, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Mustafa K Özçürümez
- Department of Laboratory Medicine of the Medical Clinic at the University Medical Center Knappschaftskrankenhaus Bochum, Ruhr University, Bochum, Germany
| | - Frank Klawonn
- Biostatistics, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Department of Computer Science, Ostfalia University of Applied Sciences, Wolfenbuttel, Germany
| | - Volker Ast
- Department of Clinical Chemistry, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Catharina Gerhards
- Department of Clinical Chemistry, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Romy Eichner
- Department of Clinical Chemistry, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Victor Costina
- Department of Clinical Chemistry, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Gerhard Dobler
- Bundeswehr Institute of Microbiology, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Wolf-Jochen Geilenkeuser
- Reference-Institute for Bioanalytics, German Society for Clinical Chemistry and Laboratory Medicine (DGKL), Bonn, Germany
| | - Roman Wölfel
- Bundeswehr Institute of Microbiology, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Michael Neumaier
- Department of Clinical Chemistry, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
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Abstract
Introduction IgG immunoassays have been developed and used widely for clinical samples and serosurveys for SARS-CoV2, with most detecting antibodies against the spike/receptor-binding-domain or nucleocapsid. Limited information is available on comparative evaluation of IgG immunoassays against a clinical reference standard, i.e., RT-PCR positivity with >20 days of illness. This study addresses the need for comparing clinical performance of IgG immunoassays with respect to this alternate reference standard. Methods We compared the performance of three immunoassays, an in-house RBD assay, and two commercial assays, the Diasorin LIAISON SARS-CoV-2 S1/S1 IgG CLIA which detects antibodies against S1/S2 domains of the Spike protein and the Zydus Kavach assay based on inactivated virus using a well-characterized panel of sera. 379 sera and plasma samples from RTPCR positive individuals >20 days of illness in symptomatic or RT-PCR positivity in asymptomatic individuals and 184 samples collected prior to 2019 were used for assay evaluation. Results The sensitivity of the assays were 84.7 (95 %CI 80.6–88.1), 82.6 (95 %CI 78.3–86.2) and 75.7 (95 %CI 71.0–79.9) respectively for RBD, LIAISON and Kavach. Kavach and the in-house RBD ELISA showed a specificity of 99.5 % and 100 %, respectively. The RBD and LIAISON (S1/S2) assays showed high agreement (94.7 %; 95 %CI: 92.0, 96.6) and were able to correctly identify more positive sera/plasma than Kavach. Conclusion Independent comparisons support the evaluation of performance characteristics of immunoassays. All three assays are suitable for serosurveillance studies, but in low prevalence sites, estimation of exposure may require adjustment based on our findings.
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