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Association of Lower Antispike Antibody Levels with Mortality in ICU Patients with COVID-19 Disease. Crit Care Res Pract 2023; 2023:4174241. [PMID: 36761157 PMCID: PMC9904915 DOI: 10.1155/2023/4174241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 11/23/2022] [Accepted: 12/21/2022] [Indexed: 02/04/2023] Open
Abstract
Background Though vaccines have been reported as highly efficacious in preventing severe COVID-19 disease, there is emerging data of severe infections, albeit a small number, in vaccinated individuals. We have conducted a retrospective observational study to assess the clinical characteristics, immunological response, and disease outcomes among the vaccinated and unvaccinated patients admitted to the ICU with severe COVID-19 disease. Methods Study Design and Participants. We conducted a retrospective observational study in COVID ICU of a tertiary care hospital. Data were collected from the month of 1 April 2021 to 31 November 2021. All adult patients admitted to the ICU having severe COVID-19 disease were included in the study. Data were collected from the medical records database which included demographics, a clinical course in the ICU, laboratory and radiological parameters, and disease outcomes. In a subset of patients, cell-mediated immunity and S1S2-neutralising antibody assessment was done. Results A total of 419 patients with severe COVID-19 were included in the study. Of the 419 patients, 90 (21.5%) were vaccinated, and 329 (78.5%) were unvaccinated. There was a significantly higher mortality in unvaccinated severe COVID 19 patients as compared to vaccinated severe COVID patients (46.2% vs 34.4%; P < 0.0455). The neutralizing antibody titre was significantly higher in survivors as compared to nonsurvivors (2139.8, SE ± 713.3 vs 471, SE ± 154.4); P < 0.026. Conclusion Our study suggests the association of lower neutralizing antibody levels with mortality in ICU patients admitted with COVID-19 breakthrough infections.
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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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Proinflammatory Innate Cytokines and Distinct Metabolomic Signatures Shape the T Cell Response in Active COVID-19. Vaccines (Basel) 2022; 10:vaccines10101762. [PMID: 36298628 PMCID: PMC9609972 DOI: 10.3390/vaccines10101762] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/07/2022] [Accepted: 10/14/2022] [Indexed: 11/26/2022] Open
Abstract
The underlying factors contributing to the evolution of SARS-CoV-2-specific T cell responses during COVID-19 infection remain unidentified. To address this, we characterized innate and adaptive immune responses with metabolomic profiling longitudinally at three different time points (0–3, 7–9, and 14–16 days post-COVID-19 positivity) from young, mildly symptomatic, active COVID-19 patients infected during the first wave in mid-2020. We observed that anti-RBD IgG and viral neutralization are significantly reduced against the delta variant, compared to the ancestral strain. In contrast, compared to the ancestral strain, T cell responses remain preserved against the delta and omicron variants. We determined innate immune responses during the early stage of active infection, in response to TLR 3/7/8-mediated activation in PBMCs and serum metabolomic profiling. Correlation analysis indicated PBMCs-derived proinflammatory cytokines, IL-18, IL-1β, and IL-23, and the abundance of plasma metabolites involved in arginine biosynthesis were predictive of a robust SARS-CoV-2-specific Th1 response at a later stage (two weeks after PCR positivity). These observations may contribute to designing effective vaccines and adjuvants that promote innate immune responses and metabolites to induce a long-lasting anti-SARS-CoV-2-specific T cell response.
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Patnaik AP, Rout NK, Ahmed S, Dash KA, Praharaj AK, Patro ARK. Correlation of Breakthrough Infection During the Omicron Wave With Seropositivity of Vaccinated Patients Undergoing Hemodialysis. Cureus 2022; 14:e29296. [PMID: 36277581 PMCID: PMC9578564 DOI: 10.7759/cureus.29296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Patients with chronic kidney disease and undergoing hemodialysis are at greater risk of developing COVID-19. In spite of vaccine efficacy, SARS-CoV-2 breakthrough infection has been reported in several studies. This study was carried out to assess if seroconversion could predict SARS-CoV-2 breakthrough infection in a cohort of vaccinated patients undergoing hemodialysis. Methodology Patients undergoing maintenance hemodialysis for at least three months and who had received two doses of BBV152 or AZD1222 vaccine were included in the study. Their baseline IgG antibodies to SARS-CoV-2 were measured and followed up for a median of three months during the third wave of COVID-19 in India with SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) to detect breakthrough infections. Results Of 80 patients enrolled, seroconversion was seen in 81% of the cases, and SARS-CoV-2 breakthrough cases have been detected in 16% (13/80; 95% CI 8.95-26.18) patients undergoing hemodialysis. Of the 13 patients, seven patients required hospitalization and others had a mild outcome. There was no correlation of baseline seropositivity with breakthrough infections or hospitalization. Conclusions A majority of patients who underwent hemodialysis are seropositive post-vaccination. The breakthrough infection did not correlate with baseline seroconversion. Thus, there would be other predictors of breakthrough COVID-19 infections that need to be recognized in this susceptible population.
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Yadav AK, Ghosh S, Faujdar DS, Rajmohan KS, Bhalla S, Shekhawat VS, Jindamwar P, Dubey S, Sahai A, Rakesh CR, Chand S, Rawat MS, Gupta S, Dhawan R, Kotwal A, Bobdey S, Teli P, Kaushik SK, Vaidya R. Findings of second multicentric follow-up serosurvey among Health Care Workers in government hospitals. Med J Armed Forces India 2022:S0377-1237(22)00082-X. [PMID: 35910399 PMCID: PMC9322976 DOI: 10.1016/j.mjafi.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/27/2022] [Indexed: 11/24/2022] Open
Abstract
Background The change in serological status of community may be used as input for guiding the public health policy. Hence, the present study was conducted to determine change in seroprevalence of COVID-19 among healthcare workers (HCWs). Methods From the baseline multicentric study sample, a subsample was followed up, and a seroepidemiological study was conducted among them between 6 and 22 weeks after the second dose of the vaccination. Multistage population proportion to size sampling was performed for the selection of subsample of HCWs. The serosurvey was conducted using the enzyme-linked immunosorbent assay-based IgG antibody test (COVID KAVACH). Results Follow-up serological testing was done in subsample of 1122 participants of original 3253 participants. The mean age of the participants was 34.6 (8.13) years. A total of 300 (26.7%) participants were females. The seroprevalence was 78.52, (95%CI:76-80.1). Among those who were seronegative at initial test, 708 (77.04%) were seroconverted. Those who were not seroconverted (241 (21.5%)) have longer duration from the second dose of the vaccination (93 (31.4) vs. 56 (38.4); p value < 0.001). The COVID-19 infection was significantly associated with seropositive status and being a medical staff was associated with remaining seronegative on follow-up. The higher age (≥50 years) was found to be significantly associated with seroreversion. Conclusion Four in five HCWs had detectable antibodies. Seroepidemiological studies carry vital information to control the public health response in the course of the pandemic. The study can also further help as a platform to study the seroconversion and effect of vaccination among HCWs for newer variants of SARS-CoV-2.
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Affiliation(s)
- Arun Kumar Yadav
- Associate Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - S Ghosh
- Col AFMS (Health), O/o DGAFMS, New Delhi, India
| | - D S Faujdar
- Associate Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - K S Rajmohan
- Professor (Pathology) & Neuropathologist, ACMS, Delhi, India
| | - Sharad Bhalla
- Professor (Microbiology), Command Hospital (Eastern Command), Kolkatta, India
| | - V S Shekhawat
- Classified Specialist (Medicine & Endocrinologist), INHS Asvini, Colaba, Mumbai, India
| | - Prashant Jindamwar
- Classified Specialist (Microbiology), Army Institute of Cardio-Thoracic Sciences (AICTS), Pune, India
| | - Sudhir Dubey
- Classified Specialist (Microbiology), ACMS, Delhi, India
| | - Atul Sahai
- Classified Specialist (Pathology), Jammu, India
| | - C R Rakesh
- Classified Specialist (Surgery), Command Hospital (Air Force), Bengaluru, India
| | - Satish Chand
- Assistant Professor (Dermatology), Command Hospital (Air Force), Bengaluru, India
| | - M S Rawat
- Graded Specialist (Pathology), Military Hospital, Ahmedabad, India
| | - Shilpi Gupta
- Graded Specialist (Microbiology), Military Hospital, Jaipur, India
| | - Rakhi Dhawan
- Senior Registrar, Military Hospital, Jaipur, India
| | | | - Saurabh Bobdey
- Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Prabhakar Teli
- Associate Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - S K Kaushik
- Professor & Head, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Rajesh Vaidya
- Dean & Deputy Commandant, Armed Forces Medical College, Pune, India
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Anantharaj A, Gujjar S, Verma N, Khan NA, Shaman H, Sharanabasava P, Das A, Pandey R, Pandey AK, Medigeshi GR. Resolution of viral load in mild COVID-19 patients is associated with both innate and adaptive immune responses. J Clin Virol 2021; 146:105060. [PMID: 34971849 PMCID: PMC8687718 DOI: 10.1016/j.jcv.2021.105060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 12/08/2021] [Accepted: 12/19/2021] [Indexed: 12/29/2022]
Abstract
Over 90% of the COVID-19 patients manifest mild/moderate symptoms or are asymptomatic. Although comorbidities and dysregulation of immune response have been implicated in severe COVID-19, the host factors that associate with asymptomatic or mild infections have not been characterized. We have collected serial samples from 23 hospitalized COVID-19 patients with mild symptoms and measured the kinetics of SARS-CoV-2 viral load in respiratory samples and markers of inflammation in serum samples. We monitored seroconversion during the acute phase of illness and quantitated the amount of total IgG against the receptor-binding domain of SARS-CoV-2 and estimated the virus neutralization potential of these antibodies. Viral load decreased by day 8 in all the patients but the detection of viral RNA in saliva samples did not correlate well with viral RNA detection in nasopharyngeal/oropharyngeal swab samples. 25% of the virus-positive patients had no detectable neutralizing antibodies in the serum and in other cases, the efficiency of antibodies to neutralize SARS-CoV-2 B1.1.7 strain was lower as compared to the circulating virus isolate. Decrease in viral load coincided with increase in neutralizing antibodies and interferon levels in serum. Most patients showed no increase in inflammatory cytokines such as IL-1β or IL-6, however, elevated levels of IL-7 and other inflammatory mediators such as TNF-α and IL-8 was observed. These data suggest that most mild infections are associated with absence of inflammation coupled with an active innate immune response, T-cell activation and neutralizing antibodies.
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Affiliation(s)
- Anbalagan Anantharaj
- Bioassay Laboratory, Translational Health Science and Technology Institute, Faridabad, Haryana. India
| | - Sunil Gujjar
- Clinical and Cellular Virology lab, Translational Health Science and Technology Institute, Faridabad, Haryana. India
| | - Nikhil Verma
- Employees State Insurance Corporation Medical College and Hospital, Faridabad, Haryana, India
| | - Naseem Ahmed Khan
- Bioassay Laboratory, Translational Health Science and Technology Institute, Faridabad, Haryana. India
| | - Heena Shaman
- Bioassay Laboratory, Translational Health Science and Technology Institute, Faridabad, Haryana. India
| | - Patil Sharanabasava
- Bioassay Laboratory, Translational Health Science and Technology Institute, Faridabad, Haryana. India
| | - Asim Das
- Employees State Insurance Corporation Medical College and Hospital, Faridabad, Haryana, India
| | - Rajesh Pandey
- CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Anil Kumar Pandey
- Employees State Insurance Corporation Medical College and Hospital, Faridabad, Haryana, India
| | - Guruprasad R Medigeshi
- Bioassay Laboratory, Translational Health Science and Technology Institute, Faridabad, Haryana. India; Clinical and Cellular Virology lab, Translational Health Science and Technology Institute, Faridabad, Haryana. India.
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Makoah NA, Tipih T, Litabe MM, Brink M, Sempa JB, Goedhals D, Burt FJ. A systematic review and meta-analysis of the sensitivity of antibody tests for the laboratory confirmation of COVID-19. Future Virol 2021; 17:10.2217/fvl-2021-0211. [PMID: 34950219 PMCID: PMC8686841 DOI: 10.2217/fvl-2021-0211] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/19/2021] [Indexed: 12/14/2022]
Abstract
Aim: The aim of this study was to investigate the utility of serological tests for the diagnosis of COVID-19 during the first week of symptom onset in patients confirmed with the real-time RT-PCR. Materials & methods: A systematic review and meta-analysis of 58 publications were performed using data obtained from Academic Search Ultimate, Africa-wide, Scopus, Web of Science and MEDLINE. Results: We found that the highest pooled sensitivities were obtained with ELISA IgM-IgG and chemiluminescence immunoassay IgM tests. Conclusion: Serological tests have low sensitivity within the first week of symptom onset and cannot replace nucleic acid amplification tests. However, serological assays can be used to support nucleic acid amplification tests.
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Affiliation(s)
- Nigel A Makoah
- Division of Virology, Faculty of Health Sciences, University of The Free State, Bloemfontein, 9301, South Africa
| | - Thomas Tipih
- Division of Virology, Faculty of Health Sciences, University of The Free State, Bloemfontein, 9301, South Africa
| | - Matefo M Litabe
- Division of Virology, Faculty of Health Sciences, University of The Free State, Bloemfontein, 9301, South Africa
| | - Mareza Brink
- Free State Department of Health, Bloemfontein, 9301, South Africa
| | - Joseph B Sempa
- Department of Biostatistics, Faculty of Health Sciences, University of The Free State, Bloemfontein, 9301, South Africa
- DST-NRF Centre of Excellence in Epidemiological Modelling & Analysis (SACEMA), Stellenbosch University, Stellenbosch, 7600, South Africa
| | - Dominique Goedhals
- Division of Virology, Faculty of Health Sciences, University of The Free State, Bloemfontein, 9301, South Africa
- Division of Virology, National Health Laboratory Service, Bloemfontein, 9301, South Africa
| | - Felicity J Burt
- Division of Virology, Faculty of Health Sciences, University of The Free State, Bloemfontein, 9301, South Africa
- Division of Virology, National Health Laboratory Service, Bloemfontein, 9301, South Africa
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Menon V, Shariff MA, Perez Gutierrez V, Carreño JM, Yu B, Jawed M, Gossai M, Valdez E, Pillai A, Venugopal U, Kasubhai M, Dimitrov V, Krammer F. Longitudinal humoral antibody response to SARS-CoV-2 infection among healthcare workers in a New York City hospital. BMJ Open 2021; 11:e051045. [PMID: 34702729 PMCID: PMC8550870 DOI: 10.1136/bmjopen-2021-051045] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/22/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Dynamics of humoral immune responses to SARS-CoV-2 antigens following infection suggest an initial decay of antibody followed by subsequent stabilisation. We aim to understand the longitudinal humoral responses to SARS-CoV-2 nucleocapsid (N) protein and spike (S) protein and to evaluate their correlation to clinical symptoms among healthcare workers (HCWs). DESIGN A prospective longitudinal study. SETTING This study was conducted in a New York City public hospital in the South Bronx, New York. PARTICIPANTS HCWs participated in phase 1 (N=500) and were followed up 4 months later in phase 2 (N=178) of the study. They underwent SARS-CoV-2 PCR and serology testing for N and S protein antibodies, in addition to completion of an online survey in both phases. Analysis was performed on the 178 participants who participated in both phases of the study. PRIMARY OUTCOME MEASURE Evaluate longitudinal humoral responses to viral N (qualitative serology testing) and S protein (quantitative Mount Sinai Health System ELISA to detect receptor-binding domain and full-length S reactive antibodies) by measuring rate of decay. RESULTS Anti-N antibody positivity was 27% and anti-S positivity was 28% in phase 1. In phase 1, anti-S titres were higher in symptomatic (6754 (5177-8812)) than in asymptomatic positive subjects (5803 (2825-11 920)). Marginally higher titres (2382 (1494-3797)) were seen in asymptomatic compared with the symptomatic positive subgroup (2198 (1753-2755)) in phase 2. A positive correlation was noted between age (R=0.269, p<0.01), number (R=0.310, p<0.01) and duration of symptoms (R=0.434, p<0.01), and phase 1 anti-S antibody titre. A strong correlation (R=0.898, p<0.001) was observed between phase 1 titres and decay of anti-S antibody titres between the two phases. Significant correlation with rate of decay was also noted with fever (R=0.428, p<0.001), gastrointestinal symptoms (R=0.340, p<0.05), and total number (R=0.357, p<0.01) and duration of COVID-19 symptoms (R=0.469, p<0.001). CONCLUSIONS Higher initial anti-S antibody titres were associated with larger number and longer duration of symptoms as well as a faster decay between the two time points.
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Affiliation(s)
- Vidya Menon
- Department of Medicine, New York City Health and Hospitals/ Lincoln, New York City, New York, USA
| | - Masood A Shariff
- Department of Medicine, New York City Health and Hospitals/ Lincoln, New York City, New York, USA
| | - Victor Perez Gutierrez
- Department of Medicine, New York City Health and Hospitals/ Lincoln, New York City, New York, USA
| | - Juan M Carreño
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Bo Yu
- Department of Medicine, New York City Health and Hospitals/ Lincoln, New York City, New York, USA
| | - Muzamil Jawed
- Department of Medicine, New York City Health and Hospitals/ Lincoln, New York City, New York, USA
| | - Marcia Gossai
- Department of Medicine, New York City Health and Hospitals/ Lincoln, New York City, New York, USA
| | - Elisenda Valdez
- Department of Medicine, New York City Health and Hospitals/ Lincoln, New York City, New York, USA
| | - Anjana Pillai
- Department of Medicine, New York City Health and Hospitals/ Lincoln, New York City, New York, USA
| | - Usha Venugopal
- Department of Medicine, New York City Health and Hospitals/ Lincoln, New York City, New York, USA
| | - Moiz Kasubhai
- Department of Medicine, New York City Health and Hospitals/ Lincoln, New York City, New York, USA
| | - Vihren Dimitrov
- Department of Medicine, New York City Health and Hospitals/ Lincoln, New York City, New York, USA
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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9
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Cai R, Novosad P, Tandel V, Asher S, Malani A. Representative estimates of COVID-19 infection fatality rates from four locations in India: cross-sectional study. BMJ Open 2021. [PMID: 34610940 DOI: 10.1101/2021.01.05.21249264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES To estimate age-specific and sex-specific mortality risk among all SARS-CoV-2 infections in four settings in India, a major lower-middle-income country and to compare age trends in mortality with similar estimates in high-income countries. DESIGN Cross-sectional study. SETTING India, multiple regions representing combined population >150 million. PARTICIPANTS Aggregate infection counts were drawn from four large population-representative prevalence/seroprevalence surveys. Data on corresponding number of deaths were drawn from official government reports of confirmed SARS-CoV-2 deaths. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was age-specific and sex-specific infection fatality rate (IFR), estimated as the number of confirmed deaths per infection. The secondary outcome was the slope of the IFR-by-age function, representing increased risk associated with age. RESULTS Among males aged 50-89, measured IFR was 0.12% in Karnataka (95% CI 0.09% to 0.15%), 0.42% in Tamil Nadu (95% CI 0.39% to 0.45%), 0.53% in Mumbai (95% CI 0.52% to 0.54%) and an imprecise 5.64% (95% CI 0% to 11.16%) among migrants returning to Bihar. Estimated IFR was approximately twice as high for males as for females, heterogeneous across contexts and rose less dramatically at older ages compared with similar studies in high-income countries. CONCLUSIONS Estimated age-specific IFRs during the first wave varied substantially across India. While estimated IFRs in Mumbai, Karnataka and Tamil Nadu were considerably lower than comparable estimates from high-income countries, adjustment for under-reporting based on crude estimates of excess mortality puts them almost exactly equal with higher-income country benchmarks. In a marginalised migrant population, estimated IFRs were much higher than in other contexts around the world. Estimated IFRs suggest that the elderly in India are at an advantage relative to peers in high-income countries. Our findings suggest that the standard estimation approach may substantially underestimate IFR in low-income settings due to under-reporting of COVID-19 deaths, and that COVID-19 IFRs may be similar in low-income and high-income settings.
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Affiliation(s)
- Rebecca Cai
- Development Data Lab, Washington, District of Columbia, USA
| | - Paul Novosad
- Economics, Dartmouth College, Hanover, New Hampshire, USA
| | - Vaidehi Tandel
- Real Estate and Planning Henley Business School, University of Reading, Reading, UK
| | - Sam Asher
- Economics, Johns Hopkins University School of Advanced International Studies, Washington, District of Columbia, USA
| | - Anup Malani
- University of Chicago Law School, Chicago, Illinois, USA
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10
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Kumar V, Ghosh K, Chandran A, Panwar S, Bhat A, Konaje S, Das S, Srikanta S, Jaganathan L, Prasad S, Venkatesh DB, Shivaram C, Krishnaswamy PR, Bhat N. Multicentric evaluation of a novel point of care electrochemical ELISA platform for SARS-CoV-2 specific IgG and IgM antibody assay. J Virol Methods 2021; 298:114275. [PMID: 34530010 PMCID: PMC8436431 DOI: 10.1016/j.jviromet.2021.114275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022]
Abstract
New diagnostics technologies for the efficient detection and quantification of SARS-CoV-2 antibodies are very crucial to manage the COVID-19 pandemic, especially in the context of emerging vaccination paradigms. Herein, we report on a novel point-of-care Electrochemical ELISA platform with disposable screen printed electrodes functionalized with SARS-CoV-2 Spike Glycoprotein S1, to enable fast and accurate quantitative estimation of total antibody concentration (IgG and IgM) in clinical samples. The quantification is performed with a comparison of electrochemical redox current against the current produced by the spiked monoclonal antibodies with known concentration. The assay is validated through multicentric evaluation against 3 different FDA authorized Laboratory standard techniques, using both EDTA whole blood and serum samples. We demonstrate that the proposed assay has excellent sensitivity and specificity, making it a suitable candidate for epidemiological surveys and quantification of antibodies in COVID-19 vaccination programs.
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Affiliation(s)
- Vinay Kumar
- PathShodh Healthcare Pvt. Ltd., Kamakshi Complex, 1st Floor, No 1 Sanjaynagar Main Road, Sanjaynagar, Bengaluru, 560094, India.
| | - Kanad Ghosh
- PathShodh Healthcare Pvt. Ltd., Kamakshi Complex, 1st Floor, No 1 Sanjaynagar Main Road, Sanjaynagar, Bengaluru, 560094, India
| | - Anagha Chandran
- PathShodh Healthcare Pvt. Ltd., Kamakshi Complex, 1st Floor, No 1 Sanjaynagar Main Road, Sanjaynagar, Bengaluru, 560094, India
| | - Sachin Panwar
- PathShodh Healthcare Pvt. Ltd., Kamakshi Complex, 1st Floor, No 1 Sanjaynagar Main Road, Sanjaynagar, Bengaluru, 560094, India
| | - Ananthram Bhat
- PathShodh Healthcare Pvt. Ltd., Kamakshi Complex, 1st Floor, No 1 Sanjaynagar Main Road, Sanjaynagar, Bengaluru, 560094, India
| | - Shreenivas Konaje
- PathShodh Healthcare Pvt. Ltd., Kamakshi Complex, 1st Floor, No 1 Sanjaynagar Main Road, Sanjaynagar, Bengaluru, 560094, India
| | - Saroj Das
- Centre for Nano Science and Engineering, Indian Institute of Science, Bengaluru, India
| | - S Srikanta
- Samatvam Endocrinology Diabetes Center, 313, 17th Main, Jayanagar, Bengaluru, India
| | - Latha Jaganathan
- Bangalore Medical Services Trust, New Tippasandra, Bengaluru, India
| | - Sujay Prasad
- Neuberg Anand Diagnostics Laboratory, Bengaluru, India
| | - D B Venkatesh
- Neuberg Anand Diagnostics Laboratory, Bengaluru, India
| | | | - P R Krishnaswamy
- Centre for Nano Science and Engineering, Indian Institute of Science, Bengaluru, India
| | - Navakanta Bhat
- PathShodh Healthcare Pvt. Ltd., Kamakshi Complex, 1st Floor, No 1 Sanjaynagar Main Road, Sanjaynagar, Bengaluru, 560094, India; Centre for Nano Science and Engineering, Indian Institute of Science, Bengaluru, India
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11
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Kulkarni R, Shrivastava S, Patil HP, Kore P, Rane P, Palkar S, Lalwani S, Mishra AC, Arankalle VA. Performance assessment of SARS-CoV-2 IgM & IgG ELISAs in comparison with plaque reduction neutralization test. Indian J Med Res 2021; 153:658-664. [PMID: 34145085 PMCID: PMC8555602 DOI: 10.4103/ijmr.ijmr_3806_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) continues to be a devastating pandemic. This study was aimed at performance assessment of SARS-CoV-2 IgM and IgG ELISAs, and investigation of their utility for patient diagnosis and sero-epidemiologic investigations. Methods Serum/plasma samples from COVID-19 patients or asymptomatic contacts (n=180) and healthy donors (n=90) were tested in parallel using two commercial IgM ELISAs (Erbalisa and Inbios), and four IgG ELISAs (Kavach, Euroimmun, Erbalisa and Inbios) along with an indigenous β-propiolactone inactivated virus-based ELISA (IRSHA-IgG-ELISA). Plaque reduction neutralization test (PRNT) was used as reference test. Results Among 180 COVID-19 patients, 125 tested positive by PRNT. Inbios-IgM-ELISA showed sensitivity (Se)/specificity (Sp)/positive predictive value (PPV)/negative predictive value (NPV) of 93.6/97.8/98.4/94.4 per cent in relation to PRNT, and performed better than Erbalisa-IgM-ELISA (Se: 48%, Sp: 95.6%, PPV: 95.2%, NPV: 65.2%). During the first week of disease, only 47.4 per cent of the COVID-19 patients tested IgM positive by Inbios-IgM-ELISA, detection improving at two weeks and beyond (~86-100%). Among IgG tests, Inbios-IgG-ELISA ranked first in terms of sensitivity (83.2%), followed by IRSHA (64.8%), Euroimmun (64%), Erbalisa (57.6%) and Kavach (56%) tests. For all IgG tests, sensitivity improved during the third (73.9-95.7%) and fourth week (100%) of illness. The specificity (96.7-100%) and PPV (96.2-100%) of all IgG tests were high; NPV ranged between 71.9 and 87.1 per cent with Inbios-IgG-ELISA scoring highest. Interpretation & conclusions Our results show that IgM detection by the current, most sensitive ELISAs cannot replace molecular diagnosis, but may aid as a supplement test. The available IgG tests are suitable for serosurveys for the assessment of previous virus exposure.
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Affiliation(s)
- Ruta Kulkarni
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Pune, Maharashtra, India
| | - Shubham Shrivastava
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Pune, Maharashtra, India
| | - Harshad P Patil
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Pune, Maharashtra, India
| | - Pravin Kore
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Pune, Maharashtra, India
| | - Prajakta Rane
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Pune, Maharashtra, India
| | - Sonali Palkar
- Department of Pediatrics, Bharati Vidyapeeth Medical College, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Sanjay Lalwani
- Bharati Vidyapeeth Medical College, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | | | - Vidya A Arankalle
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Pune, Maharashtra, India
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12
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Abstract
In the context of large numbers of workers moving from urban to rural areas with less strict lockdown policies in low- and middle-income countries, this study describes community-based severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prevalence in urban vs rural areas of Karnataka state, India.
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Affiliation(s)
- Manoj Mohanan
- Sanford School of Public Policy, Duke University, Durham, North Carolina
| | - Anup Malani
- Law School, University of Chicago, Chicago, Illinois
| | - Kaushik Krishnan
- Center for Monitoring Indian Economy, Mumbai, Maharashtra, India
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13
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Al-Jighefee HT, Yassine HM, Al-Nesf MA, Hssain AA, Taleb S, Mohamed AS, Maatoug H, Mohamedali M, Nasrallah GK. Evaluation of Antibody Response in Symptomatic and Asymptomatic COVID-19 Patients and Diagnostic Assessment of New IgM/IgG ELISA Kits. Pathogens 2021; 10:161. [PMID: 33546341 PMCID: PMC7913500 DOI: 10.3390/pathogens10020161] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 01/01/2023] Open
Abstract
This study aims to study the immune response and evaluate the performances of four new IgM and five IgG enzyme-linked immunosorbent assay (ELISA) kits for detecting anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies against different antigens in symptomatic and asymptomatic coronavirus disease 2019 (COVID-19) patients. A total of 291 samples collected from symptomatic and asymptomatic RT-PCR-confirmed patients were used to evaluate the ELISA kits' performance (EDI, AnshLabs, DiaPro, NovaLisa, and Lionex). The sensitivity was measured at three different time-intervals post symptoms onset or positive SARS-CoV-2 RT-PCR test (≤14, 14-30, >30 days). The specificity was investigated using 119 pre-pandemic serum samples. The sensitivity of all IgM kits gradually decreased with time, ranging from 48.7% (EDI)-66.4% (Lionex) at ≤14 days, 29.1% (NovaLisa)-61.8% (Lionex) at 14-30 days, and 6.0% (AnshLabs)-47.9% (Lionex) at >30 days. The sensitivity of IgG kits increased with time, peaking in the latest interval (>30 days) at 96.6% (Lionex). Specificity of IgM ranged from 88.2% (Lionex)-99.2% (EDI), while IgG ranged from 75.6% (DiaPro)-98.3% (Lionex). Among all RT-PCR-positive patients, 23 samples (7.9%) were seronegative by all IgG kits, of which only seven samples (30.4%) had detectable IgM antibodies. IgM assays have variable and low sensitivity, thus considered a poor marker for COVID-19 diagnosis. IgG assays can miss at least 8% of RT-PCR-positive cases.
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Affiliation(s)
- Hadeel T. Al-Jighefee
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; (H.T.A.-J.); (H.M.Y.)
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha 2713, Qatar
| | - Hadi M. Yassine
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; (H.T.A.-J.); (H.M.Y.)
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha 2713, Qatar
| | - Maryam A. Al-Nesf
- Adult Allergy and Immunology Section, Department of Medicine, Hamad Medical Corporation, Doha 2713, Qatar;
| | - Ali A. Hssain
- Medical Intensive Care Unit, Hamad Medical Corporation, Doha 2713, Qatar;
| | - Sara Taleb
- Division of Genomics and Translational Biomedicine, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha 2713, Qatar;
| | - Ahmed S. Mohamed
- Criticl Care Nursing Department, Hazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation, Doha 2713, Qatar;
| | - Hassen Maatoug
- Nursing Deaprtment, Hamad Medical Corporation, Doha 2713, Qatar;
| | - Mohamed Mohamedali
- Department of Medicine, Hazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation, Doha 2713, Qatar;
| | - Gheyath K. Nasrallah
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; (H.T.A.-J.); (H.M.Y.)
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha 2713, Qatar
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14
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Nag DS, Chaudhry R, Mishra M, Rai S, Gupta M. A Prospective Study on Rapidly Declining SARS-CoV-2 IgG Antibodies Within One to Three Months of Testing IgG Positive: Can It Lead to Potential Reinfections? Cureus 2020; 12:e11845. [PMID: 33282604 PMCID: PMC7714733 DOI: 10.7759/cureus.11845] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background COVID-19 immunoglobulin G (IgG) antibodies have been considered to provide protective immunity and its immunoassays have been widely used for serosurveillance. In our serosurveillance on an industrial workforce of randomly selected 3296 subjects, COVID-19 IgG antibody positivity was reported in 7.37% (243) subjects. However, when 30 days later, eight of the 243 COVID-19 IgG antibody-positive individuals complained of symptoms suggestive of COVID-19 infection and were confirmed as COVID-19 infection by reverse transcription-polymerase chain reaction (RT-PCR), their COVID-19 IgG antibodies were retested. Seven of the eight previously IgG positive individuals had lost their protective antibodies. Methods Subsequently, a prospective clinical trial was planned by repeating the test for IgG antibodies on the remaining earlier positive 235 individuals at 45-65 days after their initial test. Only 201 of the 235 individuals consented and participated in the non-randomized single-arm observational trial. Results Only 28.36% (57/201) retained their IgG antibodies and 70.15% (141/201) had lost their IgG antibodies. Three cases reported equivocal results on retesting. Conclusions Our findings show that the protective COVID-19 IgG antibodies rapidly decline over one to three months. Further studies are needed with a quantitative assay over a period with neutralizing antibodies to establish if its decay can potentially lead to reinfections. Rapidly decaying protective IgG antibodies would impact herd immunity and vaccine durability. It is critical for the potential vaccines to generate both protective T- and B-cell immune responses in a sustained manner.
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Affiliation(s)
| | | | | | - Sudhir Rai
- Medical Services, Tata Main Hospital, Jamshedpur, IND
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