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Binder RA, Matta AM, Forconi CS, Oduor CI, Bedekar P, Patrone PN, Kearsley AJ, Odwar B, Batista J, Forrester SN, Leftwich HK, Cavacini LA, Moormann AM. Minding the margins: Evaluating the impact of COVID-19 among Latinx and Black communities with optimal qualitative serological assessment tools. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.23.24307817. [PMID: 38826359 PMCID: PMC11142299 DOI: 10.1101/2024.05.23.24307817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
COVID-19 disproportionately affected minorities, while research barriers to engage underserved communities persist. Serological studies reveal infection and vaccination histories within these communities, however lack of consensus on downstream evaluation methods impede meta-analyses and dampen the broader public health impact. To reveal the impact of COVID-19 and vaccine uptake among diverse communities and to develop rigorous serological downstream evaluation methods, we engaged racial and ethnic minorities in Massachusetts in a cross-sectional study (April - July 2022), screened blood and saliva for SARS-CoV-2 and human endemic coronavirus (hCoV) antibodies by bead-based multiplex assay and point-of-care (POC) test and developed across-plate normalization and classification boundary methods for optimal qualitative serological assessments. Among 290 participants, 91.4 % reported receiving at least one dose of a COVID-19 vaccine, while 41.7 % reported past SARS-CoV-2 infections, which was confirmed by POC- and multiplex-based saliva and blood IgG seroprevalences. We found significant differences in antigen-specific IgA and IgG antibody outcomes and indication of cross-reactivity with hCoV OC43. Finally, 26.5 % of participants reported lingering COVID-19 symptoms, mostly middle-aged Latinas. Hence, prolonged COVID-19 symptoms were common among our underserved population and require public health attention, despite high COVID-19 vaccine uptake. Saliva served as a less-invasive sample-type for IgG-based serosurveys and hCoV cross-reactivity needed to be evaluated for reliable SARS-CoV-2 serosurvey results. Using the developed rigorous downstream qualitative serological assessment methods will help standardize serosurvey outcomes and meta-analyses for future serosurveys beyond SARS-CoV-2.
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Tolan NV, DeSimone MS, Fernandes MD, Lewis JE, Simmons DP, Schur PH, Brigl M, Tanasijevic MJ, Desjardins M, Sherman AC, Baden LR, Snyder M, Melanson SE. Lessons learned: A look back at the performance of nine COVID-19 serologic assays and their proposed utility. Clin Biochem 2023; 117:60-68. [PMID: 36878344 PMCID: PMC9985916 DOI: 10.1016/j.clinbiochem.2023.03.003] [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: 10/11/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Serologic assays for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been proposed to assist with the acute diagnosis of infection, support epidemiological studies, identify convalescent plasma donors, and evaluate vaccine response. METHODS We report an evaluation of nine serologic assays: Abbott (AB) and Epitope (EP) IgG and IgM, EUROIMMUN (EU) IgG and IgA, Roche anti-N (RN TOT) and anti-S (RS TOT) total antibody, and DiaSorin (DS) IgG. We evaluated 291 negative controls (NEG CTRL), 91 PCR positive (PCR POS) patients (179 samples), 126 convalescent plasma donors (CPD), 27 healthy vaccinated donors (VD), and 20 allogeneic hematopoietic stem cell transplant (HSCT) recipients (45 samples). RESULTS We observed good agreement with the method performance claims for specificity (93-100%) in NEG CTRL but only 85% for EU IgA. The sensitivity claims in the first 2 weeks of symptom onset was lower (26-61%) than performance claims based on > 2 weeks since PCR positivity. We observed high sensitivities (94-100%) in CPD except for AB IgM (77%), EP IgM (0%). Significantly higher RS TOT was observed for Moderna vaccine recipients then Pfizer (p-values < 0.0001). A sustained RS TOT response was observed for the five months following vaccination. HSCT recipients demonstrated significantly lower RS TOT than healthy VD (p < 0.0001) at dose 2 and 4 weeks after. CONCLUSIONS Our data suggests against the use of anti-SARS-CoV-2 assays to aid in acute diagnosis. RN TOT and RS TOT can readily identify past-resolved infection and vaccine response in the absence of native infection. We provide an estimate of expected antibody response in healthy VD over the time course of vaccination for which to compare antibody responses in immunosuppressed patients.
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Affiliation(s)
- Nicole V Tolan
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Mia S DeSimone
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Maria D Fernandes
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, United States
| | - Joshua E Lewis
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Daimon P Simmons
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Peter H Schur
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Manfred Brigl
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Milenko J Tanasijevic
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Michaël Desjardins
- Harvard Medical School, Boston, MA, United States; Brigham and Women's Hospital, Department of Medicine, Division of Infectious Diseases, Boston, MA, United States
| | - Amy C Sherman
- Harvard Medical School, Boston, MA, United States; Brigham and Women's Hospital, Department of Medicine, Division of Infectious Diseases, Boston, MA, United States
| | - Lindsey R Baden
- Harvard Medical School, Boston, MA, United States; Brigham and Women's Hospital, Department of Medicine, Division of Infectious Diseases, Boston, MA, United States
| | | | - Stacy Ef Melanson
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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Cai MJ, Lin J, Zhu JH, Dai Z, Lin YQ, Liang XM. Unspecific reactivity must be excluded in COVID-19 epidemiological analyses or virus tracing based on serologic testing: Analysis of 46,777 post-pandemic samples and 1,114 pre-pandemic samples. Front Med (Lausanne) 2022; 9:1018578. [DOI: 10.3389/fmed.2022.1018578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). Serologic testing is complementary to nucleic acid screening to identify SARS-CoV-2. This study aimed to evaluate unspecific reactivity in SARS-CoV-2 serologic tests.Materials and methodsTotal anti-SARS-CoV-2 antibodies from 46,777 subjects who were screened for SARS-CoV-2 were retrospectively studied to evaluate the incidence and characteristics of the unspecific reactivity. A total of 1,114 pre-pandemic samples were also analysed to compare unspecific reactivity.ResultsThe incidence of unspecific reactivity in anti-SARS-CoV-2 total antibody testing was 0.361% in 46,777 post-pandemic samples, similar to the incidence of 0.359% (4/1,114) in 1,114 pre-pandemic samples (p = 0.990). Subjects ≥ 19 years old had a 2.753-fold [95% confidence interval (CI), 1.130–6.706] higher probability of unspecific reactivity than subjects < 19 years old (p = 0.026). There was no significant difference between the sexes. The unspecific reactivity was associated with 14 categories within the disease spectrum, with three tops being the skin and subcutaneous tissue diseases (0.93%), respiratory system diseases (0.78%) and neoplasms diseases (0.76%). The percentage of patients with a titer ≥ 13.87 cut-off index (COI) in the unspecific reactivity was 7.69%.ConclusionOur results suggest a unspecific reactivity incidence rate of 0.361% involving 14 categories on the disease spectrum. Unspecific reactivity needs to be excluded when performing serologic antibody testing in COVID-19 epidemiological analyses or virus tracing.
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Binder RA, Fujimori GF, Forconi CS, Reed GW, Silva LS, Lakshmi PS, Higgins A, Cincotta L, Dutta P, Salive MC, Mangolds V, Anya O, Calvo Calle JM, Nixon T, Tang Q, Wessolossky M, Wang Y, Ritacco DA, Bly CS, Fischinger S, Atyeo C, Oluoch PO, Odwar B, Bailey JA, Maldonado-Contreras A, Haran JP, Schmidt AG, Cavacini L, Alter G, Moormann AM. SARS-CoV-2 Serosurveys: How Antigen, Isotype and Threshold Choices Affect the Outcome. J Infect Dis 2022; 227:371-380. [PMID: 36314635 PMCID: PMC9891417 DOI: 10.1093/infdis/jiac431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Evaluating the performance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological assays and clearly articulating the utility of selected antigens, isotypes, and thresholds is crucial to understanding the prevalence of infection within selected communities. METHODS This cross-sectional study, implemented in 2020, screened PCRconfirmed coronavirus disease 2019 patients (n 86), banked prepandemic and negative samples (n 96), healthcare workers and family members (n 552), and university employees (n 327) for antiSARS-CoV-2 receptor-binding domain, trimeric spike protein, and nucleocapsid protein immunoglobulin (Ig)G and IgA antibodies with a laboratory-developed enzyme-linked immunosorbent assay and tested how antigen, isotype and threshold choices affected the seroprevalence outcomes. The following threshold methods were evaluated: (i) mean 3 standard deviations of the negative controls; (ii) 100 specificity for each antigen-isotype combination; and (iii) the maximal Youden index. RESULTS We found vastly different seroprevalence estimates depending on selected antigens and isotypes and the applied threshold method, ranging from 0.0 to 85.4. Subsequently, we maximized specificity and reported a seroprevalence, based on more than one antigen, ranging from 9.3 to 25.9. CONCLUSIONS This study revealed the importance of evaluating serosurvey tools for antigen-, isotype-, and threshold-specific sensitivity and specificity, to interpret qualitative serosurvey outcomes reliably and consistently across studies.
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Affiliation(s)
- Raquel A Binder
- Correspondence: Raquel A. Binder, University of Massachusetts Chan Medical School, Worcester, MA 01605 ()
| | | | | | - George W Reed
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Leandro S Silva
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Priya Saikumar Lakshmi
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Amanda Higgins
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Lindsey Cincotta
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Protiva Dutta
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Marie-Claire Salive
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Virginia Mangolds
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Otuwe Anya
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - J Mauricio Calvo Calle
- Department of Pathology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Thomas Nixon
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Qiushi Tang
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Mireya Wessolossky
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Yang Wang
- MassBiologics, University of Massachusetts Medical School, Boston, Massachusetts, USA
| | - Dominic A Ritacco
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Courtney S Bly
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | - Caroline Atyeo
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Peter O Oluoch
- Department of Microbiology and Physiological Systems, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Boaz Odwar
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Jeffrey A Bailey
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Ana Maldonado-Contreras
- Department of Microbiology and Physiological Systems, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA,Department of Microbiology and Physiological Systems, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Aaron G Schmidt
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA,Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Lisa Cavacini
- MassBiologics, University of Massachusetts Medical School, Boston, Massachusetts, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
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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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Jolobe OMP. Towards a deeper understanding of the dynamics of COVID-19-associated Guillain-Barre syndrome. QJM 2022; 115:342-343. [PMID: 34240216 PMCID: PMC8344536 DOI: 10.1093/qjmed/hcab186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Oscar M P Jolobe
- Flat 6 Souchay Court, 1 Clothorn Road, Manchester, 6BR M20
- Corresponding. Emial: Telephone: 44 161 900 6887
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7
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Slev PR. Severe Acute Respiratory Syndrome Coronavirus 2 Serology Testing - A Laboratory Primer. Clin Lab Med 2022; 42:1-13. [PMID: 35153044 PMCID: PMC8563364 DOI: 10.1016/j.cll.2021.10.003] [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] [Indexed: 11/30/2022]
Abstract
In 2019, an emerging coronavirus, SARS-COV-2, was first identified. In the months since, SARS-CoV-2 has become a global pandemic of unimaginable scale. In 2021, SARS-CoV-2 continues to be a huge public health burden and a dominating issue in health care. In addition, SARS-CoV-2 has placed a spotlight on laboratory medicine and its key role in infectious disease management. The SARS-CoV-2 antibody testing landscape is vast and consists of dozens of antibody tests that have received EUA. The laboratory is faced with choosing the right test, staying current with the rapidly evolving recommendations, and updating test information for clients and clinicians. This review addresses what we know about the humoral response in SARS-CoV-2 infection and how this knowledge translates into appropriate serology test choice, utility, and interpretation.
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Affiliation(s)
- Patricia R. Slev
- Immunology Division, ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT 80108, USA,Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA,ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT 80108, USA
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Chamkhi S, Dhaouadi T, Sfar I, Mokni S, Jebri A, Mansouri D, Ghedira S, Ben Jemia E, Ben Boujemaa S, Houissa M, Aouina H, Ben Abdallah T, Gorgi Y. Comparative study of six SARS-CoV-2 serology assays: Diagnostic performance and antibody dynamics in a cohort of hospitalized patients for moderate to critical COVID-19. Int J Immunopathol Pharmacol 2022; 36:20587384211073232. [PMID: 35113728 PMCID: PMC8819577 DOI: 10.1177/20587384211073232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To overcome the COVID-19 pandemic, serology assays are needed to identify past and ongoing infections. In this context, we evaluated the diagnostic performance of 6 immunoassays on samples from hospitalized patients for moderate to critical COVID-19. METHODS 701 serum samples obtained from 443 COVID-19 patients (G1: 356 positive RT-PCR patients and G2: 87 negative RT-PCR cases) and 108 pre-pandemic sera from blood donors were tested with 6 commercial immunoassays: (1) Elecsys Anti-SARS-CoV-2, Roche (Nucleocapsid, N), (2) Elecsys Anti-SARS-CoV-2 S, Roche (Spike, S), (3) Vidas SARS-COV-2 IgM/IgG, BioMérieux (S), (4) SARS-CoV-2 IgG, Abbott (N), (5) Access SARS-CoV-2 IgG, Beckman Coulter (Receptor Binding Domain), and (6) Standard F COVID-19 IgM/IgG Combo FIA, SD Biosensor (N). RESULTS Global sensitivities of the evaluated assays were as follows: (1) Roche anti-N = 74.5% [69.6-79.3], (2) Roche anti-S = 92.7% [84.7-100], (3) Vidas IgM = 74.9% [68.6-81.2], (4) Vidas IgG = 73.9% [67.6-80.1], (5) Abbott = 78.6% [63.4-93.8], (6) Beckman Coulter = 74.5% [62-86.9], (7) SD Biosensor IgM = 73.1% [61-85.1], and (8) SD Biosensor IgG = 76.9% [65.4-88.4]. Sensitivities increased gradually from week 1 to week 3 as follow: (1) Roche anti-N: 63.3%, 81% and 82.1%; (2) Vidas IgM: 68.2%, 83.2% and 85.9%; and (3) Vidas IgG: 66.7%, 79.1% and 86.6%. All immunoassays showed a specificity of 100%. Seropositivity was significantly associated with a higher frequency of critical COVID-19 (50.8% vs. 38.2%), p = 0.018, OR [95% CI] = 1.668 [1.09-2.553]. Inversely, death occurred more frequently in seronegative patients (28.7% vs. 13.6%), p=3.02 E-4, OR [95% CI] = 0.392 [0.233-0.658]. CONCLUSION Evaluated serology assays exhibited good sensitivities and excellent specificities. Sensitivities increased gradually after symptoms onset. Even if seropositivity is more frequent in patients with critical COVID-19, it may predict a recovery outcome.
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Affiliation(s)
- Sameh Chamkhi
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Tarak Dhaouadi
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Imen Sfar
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Salma Mokni
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Alia Jebri
- Intensive care unit, Charles Nicolle Hospital, Tunis, Tunisia
| | - Dhouha Mansouri
- Intensive care unit, Charles Nicolle Hospital, Tunis, Tunisia
| | - Salma Ghedira
- Intensive care unit, Charles Nicolle Hospital, Tunis, Tunisia
| | - Emna Ben Jemia
- Pneumonology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Samia Ben Boujemaa
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed Houissa
- Intensive care unit, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hichem Aouina
- Pneumonology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Taïeb Ben Abdallah
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Yousr Gorgi
- Research Laboratory in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
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Qualitative and quantitative detection of SARS-CoV-2 antibodies from dried blood spots. Clin Biochem 2022; 117:16-22. [PMID: 34990593 PMCID: PMC8721924 DOI: 10.1016/j.clinbiochem.2021.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/20/2021] [Accepted: 12/30/2021] [Indexed: 01/13/2023]
Abstract
Introduction Dried blood spot (DBS) sampling is a minimally invasive method for specimen collection with potential multifaceted uses, particularly for serosurveillance of previous SARS-CoV-2 infection. In this study, we assessed DBS as a potential specimen type for assessing IgG and total (including IgG and IgM) antibodies to SARS-CoV-2 in vaccinated and naturally infected patients. Methods Six candidate buffers were assessed for eluting blood from DBS cards. The study utilized one hundred and five paired plasma specimens and DBS specimens from prospectively collected SARS-CoV-2 vaccinated individuals, remnants from those with PCR confirmed SARS-CoV-2 infections, or remnants from those without history of infection or vaccination. All specimens were tested with the Siemens SARS-CoV-2 total assay (COV2T) or IgG assay (sCOVG). Results The lowest backgrounds were observed with water and PBS, and water was used for elution. Relative to plasma samples, DBS samples had a positive percent agreement (PPA) of 94.4% (95% CI: 94.9–100%) for COV2T and 79.2 (68.4–87.0) for sCOVG using the manufacturer’s cutoff. The NPA was 100 % (87.1–100.0 and 85.13–100) for both assays. Dilution studies revealed 100% (95% CI: 90.8–100%) qualitative agreement between specimen types on the COV2T assay and 98.0% (88.0–99.9%) with the sCOVG using study defined cutoffs. Conclusion DBS specimens demonstrated high PPA and NPA relative to plasma for SARS-CoV-2 serological testing. Our data support feasibility of DBS sampling for SARS-CoV-2 serological testing.
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10
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Cobb BL, Lloyd M, Hock KG, Farnsworth CW. OUP accepted manuscript. J Appl Lab Med 2022; 7:827-833. [PMID: 35296885 PMCID: PMC8992344 DOI: 10.1093/jalm/jfac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/13/2021] [Indexed: 11/27/2022]
Abstract
Background Serological assays for SARS-CoV-2 are important tools for diagnosis in patients with negative RT-PCR testing, pediatric patients with multisystem inflammatory syndrome, and serosurveillance studies. However, lateral flow-based serological assays have previously demonstrated poor analytical and clinical performance, limiting their utility. Methods We assessed the ADEXUSDx COVID-19 lateral flow assay for agreement with diagnostic RT-PCR testing using 120 specimens from RT-PCR–positive patients, 77 specimens from symptomatic RT-PCR–negative patients, and 47 specimens obtained prepandemic. Specimens collected <14 days from symptom onset in RT-PCR–positive patients were compared relative to the Abbott SARS-CoV-2 IgG assay. Results The ADEXUSDx COVID-19 Test yielded an overall positive percent agreement (PPA) of 92.5% (95%CI 85.8 to 96.3) and negative percent agreement of 99.2% (95% CI 94.9–100.0) relative to RT-PCR and in prepandemic specimens. Relative to days from symptom onset, the PPA after 13 days was 100% (95% CI 94.2–100); from 7 to 13 days, 89.7 (95% CI 71.5–97.2); and from 0 to 7 days, 53.8 (95% CI 26.1–79.6). The overall agreement between the Abbott and ADEXUSDx assays was 80.9%. Twenty-five specimens were positive by both assays, 9 specimens were negative by both assays, and 8 specimens were positive by only the ADEXUSDx assay. Conclusions We demonstrate high PPA and negative percent agreement of the ADEXUSDx COVID-19 assay and diagnostic testing by RT-PCR, with PPA approximately 90% by 7 days following symptom onset. The use of waived testing for antibodies to SARS-CoV-2 with high sensitivity and specificity provide a further tool for combatting the COVID-19 pandemic.
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Affiliation(s)
| | - Matthew Lloyd
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Karl G Hock
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Christopher W Farnsworth
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
- Address correspondence to this author at: Department of Pathology & Immunology, Washington University in St. Louis, 660 S. Euclid Ave., Campus Box 8118, St. Louis, MO 63110, USA. Fax 314 362-1461; e-mail
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Billa V, Kothari J, Bichu S, Kumar R, Usulumarty D, Tilve P, Hariharan S. From Infection to Immunity - Impact of COVID-19 Across Nine Hemodialysis Centres in Mumbai. Indian J Nephrol 2021; 31:544-549. [PMID: 35068761 PMCID: PMC8722561 DOI: 10.4103/ijn.ijn_361_20] [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: 07/28/2020] [Revised: 08/29/2020] [Accepted: 10/18/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There are several studies of symptomatic hemodialysis patients with proven COVID-19 infection. However, there is paucity of data on asymptomatic COVID-19 infection in the outpatient hemodialysis population. The true prevalence and transmission of this infection in hemodialysis centres is unknown. This study was conducted across hemodialysis centers by testing all patients and staff for COVID-19 PCR and later for IgG antibody, irrespective of their symptoms. METHODS All 705 hemodialysis patients and 103 dialysis staff across nine centres, were tested for COVID-19 over a period of 54 days of the pandemic, and for COVID IgG antibody of available enrolled staff and patients, after 8 weeks of study termination. RESULTS The period prevalence of infection in patients and staff was 7.1% and 14.6% respectively. Mortality in patients was 18%, and all staff recovered. Clustering of patients and staff occurred at 3 of 9 centers. Of 26 HIV positive patients, only one contracted the COVID-19 infection and has recovered. Of those infected, seroconversion occurred in 80% of patients and 83% of staff. Seroconversion also occurred in 16% of patients and 37% of staff, who were asymptomatic and COVID PCR negative during the study period. CONCLUSIONS Testing a patient only when symptomatic, identified only 26% (13/50) of infected patients. For every single symptomatic patient who tested positive, there were 3 other asymptomatic infected ones. There was a high seroconversion rates in infected subjects. But antibodies also developed in asymptomatic subjects, indicating silent transmission and antibody generation in this population.
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Affiliation(s)
- Viswanath Billa
- Apex Kidney Care, Mumbai, Maharashtra, India
- Apex Kidney Foundation, Mumbai, Maharashtra, India
- Sushrut Hospital and Research Centre, Mumbai, Maharashtra, India
- Bombay Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Jatin Kothari
- Apex Kidney Care, Mumbai, Maharashtra, India
- Apex Kidney Foundation, Mumbai, Maharashtra, India
- PD Hinduja Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Shrirang Bichu
- Apex Kidney Care, Mumbai, Maharashtra, India
- Apex Kidney Foundation, Mumbai, Maharashtra, India
- Bombay Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Rajesh Kumar
- Apex Kidney Care, Mumbai, Maharashtra, India
- Apex Kidney Foundation, Mumbai, Maharashtra, India
- LH Hiranandani Hospital, Mumbai, Maharashtra, India
| | - Deepa Usulumarty
- Apex Kidney Care, Mumbai, Maharashtra, India
- Apex Kidney Foundation, Mumbai, Maharashtra, India
- Sushrut Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Parag Tilve
- Apex Kidney Care, Mumbai, Maharashtra, India
- Apex Kidney Foundation, Mumbai, Maharashtra, India
- Bombay Hospital and Research Centre, Mumbai, Maharashtra, India
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12
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Afzal A, Iqbal N, Feroz S, Ali A, Ehsan MA, Khan SA, Rehman A. Rapid antibody diagnostics for SARS-CoV-2 adaptive immune response. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2021; 13:4019-4037. [PMID: 34555136 DOI: 10.1039/d1ay00888a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The emergence of a pandemic scale respiratory illness (COVID-19: coronavirus disease 2019) and the lack of the world's readiness to prevent its spread resulted in an unprecedented rise of biomedical diagnostic industries, as they took lead to provide efficient diagnostic solutions for COVID-19. However, these circumstances also led to numerous emergency use authorizations without appropriate evaluation that compromised standards, which could result in a larger than usual number of false-positive or false-negative results, leading to unwanted ambiguity in already confusing realities of the pandemic-hit closures of the world economy. This review is aimed at comparing the claimed or reported clinical sensitivity and clinical specificity of commercially available rapid antibody diagnostics with independently evaluated clinical performance results of the tests. Thereby, we not only present the types of modern antibody diagnostics and their working principles but summarize their experimental evaluations and observed clinical efficiencies to highlight the research, development, and commercialization issues with future challenges. Still, it must be emphasized that the serological or antibody tests do not serve the purpose of early diagnosis but are more suitable for epidemiology and screening populaces with an active immune response, recognizing convalescent plasma donors, and determining vaccine efficacy.
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Affiliation(s)
- Adeel Afzal
- Department of Chemistry, College of Science, University of Hafr Al Batin, PO Box 1803, Hafr Al Batin, 39524, Saudi Arabia
| | - Naseer Iqbal
- Department of Chemistry, College of Science, University of Hafr Al Batin, PO Box 1803, Hafr Al Batin, 39524, Saudi Arabia
| | - Saima Feroz
- Department of Biosciences, College of Science, University of Hafr Al Batin, PO Box 1803, Hafr Al Batin, 39524, Saudi Arabia
| | - Asghar Ali
- Department of Chemistry, College of Science, University of Hafr Al Batin, PO Box 1803, Hafr Al Batin, 39524, Saudi Arabia
| | - Muhammad Ali Ehsan
- Center of Excellence in Nanotechnology (CENT), King Fahd University of Petroleum and Minerals, Dhahran, 31261, Saudi Arabia
| | - Safyan Akram Khan
- Center of Excellence in Nanotechnology (CENT), King Fahd University of Petroleum and Minerals, Dhahran, 31261, Saudi Arabia
| | - Abdul Rehman
- Department of Chemistry, King Fahd University of Petroleum and Minerals, Dhahran, 31261, Saudi Arabia.
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Farnsworth CW, Case JB, Hock K, Chen RE, O'Halloran JA, Presti R, Goss CW, Rauseo AM, Ellebedy A, Theel ES, Diamond MS, Henderson JP. Assessment of serological assays for identifying high titer convalescent plasma. Transfusion 2021; 61:2658-2667. [PMID: 34216156 PMCID: PMC8440373 DOI: 10.1111/trf.16580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The COVID-19 pandemic has been accompanied by the largest mobilization of therapeutic convalescent plasma (CCP) in over a century. Initial identification of high titer units was based on dose-response data using the Ortho VITROS IgG assay. The proliferation of severe acute respiratory syndrome coronavirus 2 serological assays and non-uniform application has led to uncertainty about their interrelationships. The purpose of this study was to establish correlations and analogous cutoffs between multiple serological assays. METHODS We compared the Ortho, Abbott, Roche, an anti-spike (S) ELISA, and a virus neutralization assay. Relationships relative to FDA-approved cutoffs under the CCP emergency use authorization were identified in convalescent plasma from a cohort of 79 donors from April 2020. RESULTS Relative to the neutralization assay, the spearman r value of the Ortho Clinical, Abbott, Roche, anti-S ELISA assays was 0.65, 0.59, 0.45, and 0.76, respectively. The best correlative index for establishing high-titer units was 3.87 signal-to-cutoff (S/C) for the Abbott, 13.82 cutoff index for the Roche, 1:1412 for the anti-S ELISA, 1:219 by the neutralization assay, and 15.9 S/C by the Ortho Clinical assay. The overall agreement using derived cutoffs compared to a neutralizing titer of 1:250 was 78.5% for Abbott, 74.7% for Roche, 83.5% for the anti-S ELISA, and 78.5% for Ortho Clinical. DISCUSSION Assays based on antibodies against the nucleoprotein were positively associated with neutralizing titers and the Ortho assay, although their ability to distinguish FDA high-titer specimens was imperfect. The resulting relationships help reconcile results from the large body of serological data generated during the COVID-19 pandemic.
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Affiliation(s)
| | - James B. Case
- Division of Infectious Diseases, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Karl Hock
- Department of Pathology and ImmunologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Rita E. Chen
- Department of Pathology and ImmunologyWashington University School of MedicineSt. LouisMissouriUSA
- Division of Infectious Diseases, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Jane A. O'Halloran
- Division of Infectious Diseases, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Rachel Presti
- Division of Infectious Diseases, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Charles W. Goss
- Division of Biostatistics, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Adriana M. Rauseo
- Division of Infectious Diseases, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Ali Ellebedy
- Department of Pathology and ImmunologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Elitza S. Theel
- Division of Clinical Microbiology, Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
| | - Michael S. Diamond
- Department of Pathology and ImmunologyWashington University School of MedicineSt. LouisMissouriUSA
- Division of Infectious Diseases, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
- Department of Molecular MicrobiologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Jeffrey P. Henderson
- Division of Infectious Diseases, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
- Department of Molecular MicrobiologyWashington University School of MedicineSt. LouisMissouriUSA
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14
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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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15
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Riester E, Findeisen P, Hegel JK, Kabesch M, Ambrosch A, Rank CM, Pessl F, Laengin T, Niederhauser C. Performance evaluation of the Roche Elecsys Anti-SARS-CoV-2 S immunoassay. J Virol Methods 2021; 297:114271. [PMID: 34461153 PMCID: PMC8393518 DOI: 10.1016/j.jviromet.2021.114271] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 12/23/2022]
Abstract
The Elecsys® Anti-SARS-CoV-2 S immunoassay (Roche Diagnostics International Ltd, Rotkreuz, Switzerland) has been developed for the detection of antibodies to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike (S) protein. We evaluated the assay performance using samples from seven sites in Germany, Austria, and Switzerland. For specificity and sensitivity analyses, 7880 presumed negative pre-pandemic samples and 827 SARS-CoV-2 PCR-confirmed single or sequential samples from 272 different patients were tested, respectively. The overall specificity and sensitivity (≥14 days post-PCR) for the Elecsys Anti-SARS-CoV-2 S immunoassay were 99.95% (95% confidence interval [CI]: 99.87–99.99; 7876/7880) and 97.92% (95% CI: 95.21–99.32; 235/240), respectively. The Elecsys Anti-SARS-CoV-2 S immunoassay had significantly higher specificity compared with the LIAISON® SARS-CoV-2 S1/S2 IgG (99.95% [2032/2033] vs 98.82% [2009/2033]), ADVIA Centaur® SARS-CoV-2 Total (100% [928/928] vs 86.96% [807/928]), ARCHITECT SARS-CoV-2 IgG (99.97% [2931/2932] vs 99.69% [2923/2932]), iFlash-SARS-CoV-2 IgM (100.00% [928/928] vs 99.57% [924/928]), and EUROIMMUN Anti-SARS-CoV-2 IgG (100.00% [903/903] vs 97.45% [880/903]) and IgA (100.00% [895/895] vs 95.75% [857/895]) assays. The Elecsys Anti-SARS-CoV-2 S immunoassay had significantly higher sensitivity (≥14 days post-PCR) compared with the ARCHITECT SARS-CoV-2 IgG (98.70% [76/77] vs 87.01% [67/77]), iFlash-SARS-CoV-2 IgG (100.00% [76/76] vs 93.42% [71/76]) and IgM (100.00% [76/76] vs 35.53% [27/76]), and EUROIMMUN Anti-SARS-CoV-2 IgG (98.26% [113/115] vs 93.91% [108/115]) assays. Therefore, the Elecsys Anti-SARS-CoV-2 S assay demonstrated a reliable performance across various sample populations for the detection of anti-S antibodies.
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Affiliation(s)
| | | | - J Kolja Hegel
- Labor Berlin, Charité Vivantes Services GmbH, Berlin, Germany
| | - Michael Kabesch
- University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John and the University Hospital, University of Regensburg, Germany
| | - Andreas Ambrosch
- Institute for Laboratory Medicine, Microbiology and Hygiene, Barmherzige Brüder Hospital, Regensburg, Germany
| | | | | | | | - Christoph Niederhauser
- Interregionale Blood Transfusion Swiss Red Cross, Bern, Switzerland; Institute for Infectious Diseases (IFIK), University of Bern, Bern, Switzerland.
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16
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Plaga A, Wei R, Olson E, Payto D, Harrington J, Nwe-Kissig PT, Strizzi M, Zilka S, Ko J, Colón-Franco JM. Evaluation of the Clinical Performance of 7 Serological Assays for SARS-CoV-2 for Use in Clinical Laboratories. J Appl Lab Med 2021; 6:998-1004. [PMID: 33825844 PMCID: PMC8083591 DOI: 10.1093/jalm/jfab038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/29/2021] [Indexed: 12/21/2022]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological assays have emerged as a response to the global pandemic, warranting studies evaluating their clinical performance. This study investigated seven commercially available SARS-CoV-2 serological assays in samples from non-infected individuals and hospitalized patients. Methods SARS-CoV-2 qualitative serological assays by Abbott (IgG), Beckman (IgG), DiaSorin (IgG), EUROIMMUN (IgG and IgA), Roche and Bio-Rad (Total) were evaluated using specimens collected pre-December 2019 (n=393), from nucleic acid amplification testing (NAAT) negative patients (n=40), and from 53 patients with COVID-19 by NAAT collected 3-21 days post-onset of symptoms (POS) (N=83). Negative agreement (NA), positive agreement (PA), and positive and negative predictive values (PPV and NPV) at prevalences of 5% and 10% were calculated. Results The overall %NA;95% CI in the negative samples were: Roche 99.8%; 99.3-100.2, Beckman 99.8%; 98.7-100.0, Abbott and Bio-Rad 99.3%; 98.0-99.9, DiaSorin 98.4; 97.2-99.6, EUROIMMUN IgG 97.5%; 95.5-98.7, and EUROIMMUN IgA 79.7%; 75.9-83.5), accounting for positive/equivocal results as false positives. The %PA; 95% CI in samples collected 14+days POS (n=24) were: Bio-Rad 83.3%; 68.4-98.2, Abbott and Roche 79.2%; 62.9-95.4, EUROIMMUN IgA 70.8%; 52.6-89.0, Beckman 58.3%; 38.6-78.1, DiaSorin 54.2; 34.2-74.1, and EUROIMMUN IgG 50.0%; 30.0-70.0, accounting for negative/equivocal results as false negatives. NPVs ranged from 97.4-98.9% and 94.7-97.7% for prevalences 5% and 10%, respectively. PPVs ranged from 15.5-94.8% and 27.9-97.4% for prevalences 5% and 10%, respectively. Conclusions The Roche and Beckman assays resulted in fewer false positives followed by the Bio-Rad and Abbott assays. While the Bio-Rad assay demonstrated higher antibody detection in COVID-19-positive patients, PA claims cannot be established with a high level of confidence in our sample population.
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Affiliation(s)
- Alexis Plaga
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, OH, USA
| | - Ruhan Wei
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, OH, USA
| | - Elizabeth Olson
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, OH, USA
| | - Drew Payto
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, OH, USA
| | - John Harrington
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, OH, USA
| | | | - Michelle Strizzi
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, OH, USA
| | - Sarah Zilka
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, OH, USA
| | - Jennifer Ko
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, OH, USA
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17
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Tang MS, Case JB, Franks CE, Chen RE, Anderson NW, Henderson JP, Diamond MS, Gronowski AM, Farnsworth CW. Association between SARS-CoV-2 Neutralizing Antibodies and Commercial Serological Assays. Clin Chem 2021; 66:1538-1547. [PMID: 32894750 PMCID: PMC7499494 DOI: 10.1093/clinchem/hvaa211] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022]
Abstract
Introduction Commercially available SARS-CoV-2 serological assays based on different viral antigens have been approved for the qualitative determination of anti-SARS-CoV-2 antibodies. However, there are limited published data associating the results from commercial assays with neutralizing antibodies. Methods 67 specimens from 48 patients with PCR-confirmed COVID-19 and a positive result by the Roche Elecsys Anti-SARS-CoV-2, Abbott SARS-CoV-2 IgG, or EUROIMMUN SARS-CoV-2 IgG assays and 5 control specimens were analyzed for the presence of neutralizing antibodies to SARS-CoV-2. Correlation, concordance, positive percent agreement (PPA), and negative percent agreement (NPA) were calculated at several cutoffs. Results were compared in patients categorized by clinical outcomes. Results The correlation between SARS-CoV-2 neutralizing titer (EC50) and the Roche, Abbott, and EUROIMMUN assays was 0.29, 0.47, and 0.46 respectively. At an EC50 of 1:32, the concordance kappa with Roche was 0.49 (95% CI; 0.23-0.75), with Abbott was 0.52 (0.28-0.77), and with EUROIMMUN was 0.61 (0.4-0.82). At the same neutralizing titer, the PPA and NPA for the Roche was 100% (94-100) & 56% (30-80); Abbott was 96% (88-99) & 69% (44-86); and EUROIMMUN was 91% (80-96) & 81% (57-93) for distinguishing neutralizing antibodies. Patients who were intubated, had cardiac injury, or acute kidney injury from COVID-19 infection had higher neutralizing titers relative to those with mild symptoms. Conclusion COVID-19 patients generate an antibody response to multiple viral proteins such that the calibrator ratios on the Roche, Abbott, and EUROIMMUN assays are all associated with SARS-CoV-2 neutralization. Nevertheless, commercial serological assays have poor NPA for SARS-CoV-2 neutralization, making them imperfect proxies for neutralization.
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Affiliation(s)
- Mei San Tang
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - James Brett Case
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Caroline E Franks
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Rita E Chen
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Neil W Anderson
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey P Henderson
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Michael S Diamond
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO.,Department of Medicine, Washington University School of Medicine, St. Louis, MO.,Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO
| | - Ann M Gronowski
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
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18
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Geisler D, Freeman MC, Rapsinski GJ, Wheeler SE. Unexpected False-Positive Rates in Pediatric SARS-CoV-2 Serology Using the EUROIMMUN Anti-SARS-CoV-2 ELISA IgG Assay. Am J Clin Pathol 2021; 155:773-775. [PMID: 33899091 PMCID: PMC8130881 DOI: 10.1093/ajcp/aqab033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Serologic assay performance studies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pediatric populations are lacking, and few seroprevalence studies have routinely incorporated orthogonal testing to improve accuracy. METHODS Remnant serum samples for routine bloodwork from 2,338 pediatric patients at UPMC Children's Hospital of Pittsburgh were assessed using the EUROIMMUN Anti-SARS-CoV-2 ELISA IgG (EuroIGG) assay. Reactive cases with sufficient volume were also tested using 3 additional commercial assays. RESULTS Eighty-five specimens were reactive according to the EuroIGG, yielding 3.64% (95% confidence interval [CI], 2.91%-4.48%) seropositivity, of which 73 specimens had sufficient remaining volume for confirmation by orthogonal testing. Overall, 19.18% (95% CI, 10.18%-28.18%) of samples were positive on a second and/or third orthogonal assay. This 80.82% false positivity rate is disproportionate to the expected false positivity rate of 50% given our pediatric population prevalence and assay performance. CONCLUSIONS In pediatric populations, false-positive SARS-CoV-2 serology may be more common than assay and prevalence parameters would predict, and further studies are needed to establish the performance of SARS-CoV-2 serology in children.
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Affiliation(s)
- Daniel Geisler
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Megan Culler Freeman
- Department of Pediatrics, Division of Infectious Diseases, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Glenn J Rapsinski
- Department of Pediatrics, Division of Infectious Diseases, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sarah E Wheeler
- Department of Pathology, Division of Clinical Immunopathology and Clinical Chemistry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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19
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Buchholtz ML, Arend FM, Eichhorn P, Weigand M, Kleinhempel A, Häusler K, Bruegel M, Holdt LM, Teupser D. SARS-CoV-2 antibody immunoassays in serial samples reveal earlier seroconversion in acutely ill COVID-19 patients developing ARDS. PLoS One 2021; 16:e0251587. [PMID: 33984048 PMCID: PMC8118560 DOI: 10.1371/journal.pone.0251587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/28/2021] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES During the COVID-19 pandemic, SARS-CoV-2 antibody testing has been suggested for (1) screening populations for disease prevalence, (2) diagnostics, and (3) guiding therapeutic applications. Here, we conducted a detailed clinical evaluation of four Anti-SARS-CoV-2 immunoassays in samples from acutely ill COVID-19 patients and in two negative cohorts. METHODS 443 serum specimens from serial sampling of 29 COVID-19 patients were used to determine clinical sensitivities. Patients were stratified for the presence of acute respiratory distress syndrome (ARDS). Individual serum specimens from a pre-COVID-19 cohort of 238 healthy subjects and from a PCR-negative clinical cohort of 257 patients were used to determine clinical specificities. All samples were measured side-by-side with the Anti-SARS-CoV-2-ELISA (IgG), Anti-SARS-CoV-2-ELISA (IgA) and Anti-SARS-CoV-2-NCP-ELISA (IgG) (Euroimmun AG, Lübeck, Germany) and the Elecsys Anti-SARS-CoV-2 ECLIA (Roche Diagnostics International, Rotkreuz, Switzerland). RESULTS Median seroconversion occurred earlier in ARDS patients (8-9 days) than in non-ARDS patients (11-17 days), except for EUR N-IgG. Rates of positivity and mean signal ratios in the ARDS group were significantly higher than in the non-ARDS group. Sensitivities between the four tested immunoassays were equivalent. In the set of negative samples, the specificity of the Anti-SARS-CoV-2-ELISA (IgA) was lower (93.9%) compared to all other assays (≥98.8%) and the specificity of Anti-SARS-CoV-2-NCP-ELISA (IgG) was lower (98.8%) than that of Elecsys Anti-SARS-CoV-2 (100%). CONCLUSIONS Serial sampling in COVID-19 patients revealed earlier seroconversion and higher signal ratios of SARS-CoV-2 antibodies as a potential risk marker for the development of ARDS, suggesting a utility for antibody testing in acutely diseased patients.
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Affiliation(s)
| | - Florian M. Arend
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Peter Eichhorn
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Michael Weigand
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Alisa Kleinhempel
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Kurt Häusler
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Mathias Bruegel
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Lesca M. Holdt
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Teupser
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
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20
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Abstract
The landscape of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic testing is rapidly evolving. While serology testing has limited diagnostic capacity for acute infection, its role in providing population-based information on positivity rates and informing evidence-based decision making for public health recommendations is increasing. With the global availability of vaccines, there is increasing pressure on clinical laboratories to provide antibody screening and result interpretation for vaccinated and non-vaccinated individuals. Here we present the most up-to-date data on SARS-CoV-2 antibody timelines, including the longevity of antibodies, and the production and detection of neutralizing antibodies. Additionally, we provide practical guidance for clinical microbiology laboratories to both verify commercial serology assays and choose appropriate testing algorithms for their local populations.
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21
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Choudhry N, Drysdale K, Usai C, Leighton D, Sonagara V, Buchanan R, Nijjar M, Thomas S, Hopkins M, Cutino-Moguel T, Gill US, Foster GR, Kennedy PT. Disparities of SARS-CoV-2 Nucleoprotein-Specific IgG in Healthcare Workers in East London, UK. Front Med (Lausanne) 2021; 8:642723. [PMID: 33987193 PMCID: PMC8111172 DOI: 10.3389/fmed.2021.642723] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/19/2021] [Indexed: 01/17/2023] Open
Abstract
Introduction: SARS-CoV-2 antibody detection serves as an important diagnostic marker for past SARS-CoV-2 infection and is essential to determine the spread of COVID-19, monitor potential COVID-19 long-term effects, and to evaluate possible protection from reinfection. A study was conducted across three hospital sites in a large central London NHS Trust in the UK, to evaluate the prevalence and duration of SARS-CoV-2 IgG antibody positivity in healthcare workers. Methods: A matrix equivalence study consisting of 228 participants was undertaken to evaluate the Abbott Panbio™ COVID-19 IgG/IgM rapid test device. Subsequently, 2001 evaluable healthcare workers (HCW), representing a diverse population, were enrolled in a HCW study between June and August 2020. A plasma sample from each HCW was evaluated using the Abbott Panbio™ COVID-19 IgG/IgM rapid test device, with confirmation of IgG-positive results by the Abbott ArchitectTM SARS-CoV-2 IgG assay. 545 participants, of whom 399 were antibody positive at enrolment, were followed up at 3 months. Results: The Panbio™ COVID-19 IgG/IgM rapid test device demonstrated a high concordance with laboratory tests. SARS-CoV-2 antibodies were detected in 506 participants (25.3%) at enrolment, with a higher prevalence in COVID-19 frontline (28.3%) than non-frontline (19.9%) staff. At follow-up, 274/399 antibody positive participants (68.7%) retained antibodies; 4/146 participants negative at enrolment (2.7%) had seroconverted. Non-white ethnicity, older age, hypertension and COVID-19 symptoms were independent predictors of higher antibody levels (OR 1.881, 2.422-3.034, 2.128, and 1.869 respectively), based on Architect™ index quartiles; participants in the first three categories also showed a greater antibody persistence at 3 months. Conclusion: The SARS-CoV-2 anti-nucleocapsid IgG positivity rate among healthcare staff was high, declining by 31.3% during the 3-month follow-up interval. Interestingly, the IgG-positive participants with certain risk factors for severe COVID-19 illness (older age, Black or Asian Ethnicity hypertension) demonstrated greater persistence over time when compared to the IgG-positive participants without these risk factors.
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Affiliation(s)
- Naheed Choudhry
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Kate Drysdale
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
| | - Carla Usai
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Dean Leighton
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Vinay Sonagara
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
| | - Ruaridh Buchanan
- Barts Health NHS Trust, Newham General Hospital, London, United Kingdom
| | - Manreet Nijjar
- Barts Health NHS Trust, Whipps Cross Hospital, London, United Kingdom
| | - Sherine Thomas
- Barts Health NHS Trust, Whipps Cross Hospital, London, United Kingdom
| | - Mark Hopkins
- Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
| | | | - Upkar S. Gill
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
| | - Graham R. Foster
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
| | - Patrick T. Kennedy
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
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22
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Orner EP, Rodgers MA, Hock K, Tang MS, Taylor R, Gardiner M, Olivo A, Fox A, Prostko J, Cloherty G, Farnsworth CW. Comparison of SARS-CoV-2 IgM and IgG seroconversion profiles among hospitalized patients in two US cities. Diagn Microbiol Infect Dis 2021; 99:115300. [PMID: 33388575 PMCID: PMC7759125 DOI: 10.1016/j.diagmicrobio.2020.115300] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 01/05/2023]
Abstract
The clinical and public health utility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serologic testing requires a better understanding of the dynamics of the humoral response to infection. To track seroconversion of IgG and IgM antibodies in patients with SARS-CoV-2 infection and its association with patient and clinical factors and outcomes. Residual patient specimens were analyzed on the Abbott ARCHITECT i2000 instrument using the Abbott SARS-CoV-2 IgG assay and prototype SARS-CoV-2 IgM assay. Age, sex, comorbidities, symptom onset date, mortality, and specimen collection date were obtained from electronic medical records. Three hundred fifty-nine longitudinal samples were collected from 89 hospitalized patients 0 to 82 days postsymptom onset. Of all, 51.7% of the patients developed IgG and IgM antibodies simultaneously; 32.8% seroconverted for IgM before IgG. On average, patients seroconverted for IgG by 8 days and for IgM by 7 days postsymptom onset. All patients achieved IgG seropositivity by 19 days and IgM seropositivity by 17 days. Median time to IgG and IgM seroconversion was prolonged and initial levels of IgG were lower in immunocompromised patients and patients <65 years of age compared to immune competent patients and those ≥65 years of age. Immunocompromised patients also had persistently lower levels of IgM that peaked on day 17.6 and decreased thereafter compared to immune competent patients. IgM seroconversion in patients who died reached significantly higher levels later after symptom onset than in those who recovered. SARS-CoV-2 infected patients have similar time to seroconversion for IgG and IgM. However, differences in immune status and age alter time to seroconversion. These results may help guide serologic testing application in COVID-19 management.
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Affiliation(s)
- Erika P Orner
- Department of Pathology, Montefiore Medical Center, Bronx, NY, USA
| | | | - Karl Hock
- Department of Pathology and Immunology, Washington University Medical School, St. Louis, MO, USA
| | - Mei San Tang
- Department of Pathology and Immunology, Washington University Medical School, St. Louis, MO, USA
| | | | | | | | - Amy Fox
- Department of Pathology, Montefiore Medical Center, Bronx, NY, USA
| | | | | | - Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University Medical School, St. Louis, MO, USA.
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23
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Farnsworth CW, Case JB, Hock K, Chen RE, O’Halloran JA, Presti R, Goss CW, Rauseo AM, Ellebedy A, Theel ES, Diamond MS, Henderson JP. Assessment of serological assays for identifying high titer convalescent plasma. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.03.26.21254427. [PMID: 33791711 PMCID: PMC8010743 DOI: 10.1101/2021.03.26.21254427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The COVID-19 pandemic has been accompanied by the largest mobilization of therapeutic convalescent plasma (CCP) in over a century. Initial identification of high titer units was based on dose-response data using the Ortho VITROS IgG assay. The proliferation of SARS-CoV-2 serological assays and non-uniform application has led to uncertainty about their interrelationships. The purpose of this study was to establish correlations and analogous cutoffs between commercially available serological tests (Ortho, Abbott, Roche), a spike ELISA, and a virus neutralization assay using convalescent plasma from a cohort of 79 donors from April 2020. Relationships relative to FDA-approved cutoffs under the CCP EUA were identified by linear regression and receiver operator characteristic curves. Relative to the Ortho VITROS assay, the r2 of the Abbott, Roche, the anti-Spike ELISA and the neutralizing assay were 0.58, 0.5, 0.82, and 0.44, respectively. The best correlative index for establishing high-titer units was 3.82 S/C for the Abbott, 10.89 COI for the Roche, 1:1,202 for the anti-Spike ELISA, and 1:200 by the neutralization assay. The overall agreement using derived cutoffs compared to the CCP EUA Ortho VITROS cutoff of 9.5 was 92.4% for Abbott, 84.8% for Roche, 87.3% for the anti-S ELISA and 78.5% for the neutralization assay. Assays based on antibodies against the nucleoprotein (Roche, Abbott) and neutralizing antibody tests were positively associated with the Ortho assay, although their ability to distinguish FDA high-titer specimens was imperfect. The resulting relationships help reconcile results from the large body of serological data generated during the COVID-19 pandemic.
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Affiliation(s)
| | - James Brett Case
- Department of Medicine, Division of Infectious Diseases. Washington University School of Medicine. St. Louis, MO
| | - Karl Hock
- Department of Pathology & Immunology. Washington University School of Medicine. St. Louis, MO
| | - Rita E. Chen
- Department of Pathology & Immunology. Washington University School of Medicine. St. Louis, MO
- Department of Medicine, Division of Infectious Diseases. Washington University School of Medicine. St. Louis, MO
| | - Jane A. O’Halloran
- Department of Medicine, Division of Infectious Diseases. Washington University School of Medicine. St. Louis, MO
| | - Rachel Presti
- Department of Medicine, Division of Infectious Diseases. Washington University School of Medicine. St. Louis, MO
| | - Charles W. Goss
- Department of Medicine, Division of Biostatistics. Washington University School of Medicine. St. Louis, MO
| | - Adriana M. Rauseo
- Department of Medicine, Division of Infectious Diseases. Washington University School of Medicine. St. Louis, MO
| | - Ali Ellebedy
- Department of Pathology & Immunology. Washington University School of Medicine. St. Louis, MO
| | - Elitza S. Theel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Michael S. Diamond
- Department of Pathology & Immunology. Washington University School of Medicine. St. Louis, MO
- Department of Medicine, Division of Infectious Diseases. Washington University School of Medicine. St. Louis, MO
- Department of Molecular Microbiology. Washington University School of Medicine. St. Louis, MO
| | - Jeffrey P. Henderson
- Department of Pathology & Immunology. Washington University School of Medicine. St. Louis, MO
- Department of Molecular Microbiology. Washington University School of Medicine. St. Louis, MO
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24
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Zhang YV, Wiencek J, Meng QH, Theel ES, Babic N, Sepiashvili L, Pecora ND, Slev P, Cameron A, Konforte D. AACC Practical Recommendations for Implementing and Interpreting SARS-CoV-2 EUA and LDT Serologic Testing in Clinical Laboratories. Clin Chem 2021; 67:1188-1200. [PMID: 34470034 PMCID: PMC8083777 DOI: 10.1093/clinchem/hvab051] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/12/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The clinical laboratory continues to play a critical role in managing the coronavirus pandemic. Numerous FDA emergency use authorization (EUA) and laboratory developed test (LDT) serologic assays have become available. The performance characteristics of these assays and their clinical utility continue to be defined in real-time during this pandemic. The American Association for Clinical Chemistry (AACC) convened a panel of experts from clinical chemistry, microbiology, and immunology laboratories, the in vitro diagnostics (IVD) industry, and regulatory agencies to provide practical recommendations for implementation and interpretation of these serologic tests in clinical laboratories. CONTENT The currently available EUA serologic tests and platforms, information on assay design, antibody classes including neutralizing antibodies, and the humoral immune responses to SARS-CoV-2 are discussed. Verification and validation of EUA and LDTs are described along with quality management approach. Four indications for serologic testing are outlined. Result interpretation, reporting comments, and the role of orthogonal testing are also recommended. SUMMARY This document aims to provide a comprehensive reference for laboratory professionals and healthcare workers to appropriately implement SARS-CoV-2 serologic assays in the clinical laboratory and interpret test results during this pandemic. Given the more frequent occurrence of outbreaks associated with either vector-borne or respiratory pathogens, this document will be a useful resource in planning for similar scenarios in the future.
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Affiliation(s)
- Y Victoria Zhang
- Department of Pathology and Lab Medicine, University of Rochester Medical Center
| | - Joesph Wiencek
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center
| | - Qing H Meng
- Department of Laboratory Medicine, Division of Pathology and Laboratory Medicine, The University of Texas/MD Anderson Cancer Center
| | - Elitza S Theel
- Department of Laboratory Medicine and Pathology, Mayo Clinic
| | - Nikolina Babic
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina
| | - Lusia Sepiashvili
- Departments of Biochemistry and Laboratory Medicine & Pathobiology The Hospital for Sick Children/University of Toronto
| | - Nicole D Pecora
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center
| | - Patricia Slev
- Department of Pathology, University of Utah, ARUP Laboratories
| | - Andrew Cameron
- Department of Clinical Microbiology, University of Rochester Medical Center
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25
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Renard N, Daniel S, Cayet N, Pecquet M, Raymond F, Pons S, Lupo J, Tourneur C, Pretis C, Gerez G, Blasco P, Combe M, Canova I, Lesénéchal M, Berthier F. Performance Characteristics of the Vidas SARS-CoV-2 IgM and IgG Serological Assays. J Clin Microbiol 2021; 59:e02292-20. [PMID: 33419947 PMCID: PMC8092742 DOI: 10.1128/jcm.02292-20] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/06/2021] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic, caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to spread worldwide. Serological testing for SARS-CoV-2-specific antibodies plays an important role in understanding and controlling the pandemic, notably through epidemiological surveillance. Well-validated and highly specific SARS-CoV-2 serological assays are urgently needed. We describe here the analytical and clinical performance of Vidas SARS-CoV-2 IgM and Vidas SARS-CoV-2 IgG, two CE-marked, emergency use authorization (EUA)-authorized, automated, qualitative assays for the detection of SARS-CoV-2-specific IgM and IgG, respectively. Both assays showed high within-run and within-laboratory precision (coefficients of variation < 11.0%) and very low cross-reactivity toward sera of patients with a past common coronavirus or respiratory virus infection. Clinical specificity determined on up to 989 prepandemic healthy donors was ≥99% with a narrow 95% confidence interval for both IgM and IgG assays. Clinical sensitivity was determined on up to 232 samples from 130 reverse transcriptase PCR (RT-PCR)-confirmed SARS-CoV-2 patients. The positive percent agreement (PPA) with SARS-CoV-2 PCR reached 100% at ≥16 days (Vidas SARS-CoV-2 IgM) and ≥32 days (Vidas SARS-CoV-2 IgG) of symptom onset. Combined IgM/IgG test results improved the PPA compared to each test alone. SARS-CoV-2 IgG seroconversion followed closely that of SARS-CoV-2 IgM and remained stable over time, while SARS-CoV-2 IgM levels rapidly declined. Interestingly, SARS-CoV-2-specific IgM and IgG responses were significantly higher in COVID-19 hospitalized versus nonhospitalized patients. Altogether, the Vidas SARS-CoV-2 IgM and IgG assays are highly specific and sensitive serological tests suitable for the reliable detection of past acute SARS-CoV-2 infections.
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Affiliation(s)
| | | | | | - Matthieu Pecquet
- Laboratoire de Biologie, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | | | - Sylvie Pons
- Laboratoire Commun de Recherche Hospices Civils de Lyon-bioMérieux, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Julien Lupo
- Institut de Biologie Structurale (IBS), CEA, CNRS, Université Grenoble-Alpes; Laboratoire de Virologie, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
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26
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Brownstein NC, Chen YA. Predictive values, uncertainty, and interpretation of serology tests for the novel coronavirus. Sci Rep 2021; 11:5491. [PMID: 33750810 PMCID: PMC7943825 DOI: 10.1038/s41598-021-84173-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 01/21/2021] [Indexed: 12/23/2022] Open
Abstract
Antibodies testing in the coronavirus era is frequently promoted, but the underlying statistics behind their validation has come under more scrutiny in recent weeks. We provide calculations, interpretations, and plots of positive and negative predictive values under a variety of scenarios. Prevalence, sensitivity, and specificity are estimated within ranges of values from researchers and antibodies manufacturers. Illustrative examples are highlighted, and interactive plots are provided in the Supplementary Information. Implications are discussed for society overall and across diverse locations with different levels of disease burden. Specifically, the proportion of positive serology tests that are false can differ drastically from up to 3%-88% for people from different places with different proportions of infected people in the populations while the false negative rate is typically under 10%.
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Affiliation(s)
- Naomi C Brownstein
- Moffitt Cancer Center, Department of Biostatistics and Bioinformatics, Tampa, FL, USA.
| | - Yian Ann Chen
- Moffitt Cancer Center, Department of Biostatistics and Bioinformatics, Tampa, FL, USA
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27
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Favresse J, Eucher C, Elsen M, Gillot C, Van Eeckhoudt S, Dogné JM, Douxfils J. Persistence of Anti-SARS-CoV-2 Antibodies Depends on the Analytical Kit: A Report for Up to 10 Months after Infection. Microorganisms 2021; 9:556. [PMID: 33800489 PMCID: PMC8001517 DOI: 10.3390/microorganisms9030556] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/20/2021] [Accepted: 03/05/2021] [Indexed: 12/27/2022] Open
Abstract
Several studies have described the long-term kinetics of anti-SARS-CoV-2 antibodies but long-term follow-up data, i.e., >6 months, are still sparse. Additionally, the literature is inconsistent regarding the waning effect of the serological response. The aim of this study was to explore the temporal dynamic changes of the immune response after SARS-CoV-2 infection in hospitalized and non-hospitalized symptomatic patients over a period of 10 months. Six different analytical kits for SARS-CoV-2 antibody detection were used. Positivity rates, inter-assay agreement and kinetic models were determined. A high inter-individual and an inter-methodology variability was observed. Assays targeting total antibodies presented higher positivity rates and reached the highest positivity rates sooner compared with assays directed against IgG. The inter-assay agreement was also higher between these assays. The stratification by disease severity showed a much-elevated serological response in hospitalized versus non-hospitalized patients in all assays. In this 10-month follow-up study, serological assays showed a clinically significant difference to detect past SARS-CoV-2 infection with total antibody assays presenting the highest positivity rates. The waning effect reported in several studies should be interpreted with caution because it could depend on the assay considered.
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Affiliation(s)
- Julien Favresse
- Department of Laboratory Medicine, Clinique St-Luc Bouge, 5004 Namur, Belgium; (C.E.); (M.E.)
- Department of Pharmacy, Namur Research Institute for Life Sciences, University of Namur, 5000 Namur, Belgium; (C.G.); (J.-M.D.); (J.D.)
| | - Christine Eucher
- Department of Laboratory Medicine, Clinique St-Luc Bouge, 5004 Namur, Belgium; (C.E.); (M.E.)
| | - Marc Elsen
- Department of Laboratory Medicine, Clinique St-Luc Bouge, 5004 Namur, Belgium; (C.E.); (M.E.)
| | - Constant Gillot
- Department of Pharmacy, Namur Research Institute for Life Sciences, University of Namur, 5000 Namur, Belgium; (C.G.); (J.-M.D.); (J.D.)
| | | | - Jean-Michel Dogné
- Department of Pharmacy, Namur Research Institute for Life Sciences, University of Namur, 5000 Namur, Belgium; (C.G.); (J.-M.D.); (J.D.)
| | - Jonathan Douxfils
- Department of Pharmacy, Namur Research Institute for Life Sciences, University of Namur, 5000 Namur, Belgium; (C.G.); (J.-M.D.); (J.D.)
- Qualiblood s.a., 5000 Namur, Belgium
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28
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Moat SJ, Zelek WM, Carne E, Ponsford MJ, Bramhall K, Jones S, El-Shanawany T, Wise MP, Thomas A, George C, Fegan C, Steven R, Webb R, Weeks I, Morgan BP, Jolles S. Development of a high-throughput SARS-CoV-2 antibody testing pathway using dried blood spot specimens. Ann Clin Biochem 2021; 58:123-131. [PMID: 33269949 PMCID: PMC7844389 DOI: 10.1177/0004563220981106] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Serological assays for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) have roles in seroepidemiology, convalescent plasma-testing, antibody durability and vaccine studies. Currently, SARS-CoV-2 serology is performed using serum/plasma collected by venepuncture. Dried blood spot (DBS) testing offers significant advantages as it is minimally invasive, avoids venepuncture with specimens being mailed to the laboratory. METHODS A pathway utilizing a newborn screening laboratory infrastructure was developed using an enzyme-linked immunosorbent assay to detect IgG antibodies against the receptor-binding domain of the SARS-CoV-2 spike protein in DBS specimens. Paired plasma and DBS specimens from SARS-CoV-2 antibody-positive and -negative subjects and polymerase chain reaction positive subjects were tested. DBS specimen stability, effect of blood volume and punch location were also evaluated. RESULTS DBS specimens from antibody-negative (n = 85) and -positive (n = 35) subjects and polymerase chain reaction positive subjects (n = 11) had a mean (SD; range) optical density (OD) of 0.14 (0.046; 0.03-0.27), 0.98 (0.41; 0.31-1.64) and 1.12 (0.37; 0.49-1.54), respectively. An action value OD >0.28 correctly assigned all cases. The weighted Deming regression for comparison of the DBS and the plasma assay yielded: y = 0.004041 + 1.005x, r = 0.991, Sy/x 0.171, n = 82. Extraction efficiency of antibodies from DBS specimens was >99%. DBS specimens were stable for at least 28 days at ambient room temperature and humidity. CONCLUSIONS SARS-CoV-2 IgG receptor-binding domain antibodies can be reliably detected in DBS specimens. DBS serological testing offers lower costs than either point of care or serum/plasma assays that require patient travel, phlebotomy and hospital/clinic resources; the development of a DBS assay may be particularly important for resource poor settings.
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Affiliation(s)
- Stuart J Moat
- Wales Newborn Screening Laboratory, Department of Medical Biochemistry, Immunology and Toxicology, University Hospital of Wales, Cardiff, Wales, UK
- School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Wioleta M Zelek
- Systems Immunity University Research Institute and Dementia Research Institute, Cardiff University, Cardiff, UK
| | - Emily Carne
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Mark J Ponsford
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
- Division of Infection, Inflammation and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Kathryn Bramhall
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Sara Jones
- Weqas, Cardiff and Vale University Health Board, Cardiff, UK
| | - Tariq El-Shanawany
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, UK
| | - Annette Thomas
- Weqas, Cardiff and Vale University Health Board, Cardiff, UK
| | - Chloe George
- Welsh Blood Service, Ely Valley Road, Talbot Green, Pontyclun, UK
| | - Christopher Fegan
- Department of Haematology, University Hospital of Wales, Cardiff, Wales, UK
| | - Rachael Steven
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Russell Webb
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Ian Weeks
- College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - B Paul Morgan
- Systems Immunity University Research Institute and Dementia Research Institute, Cardiff University, Cardiff, UK
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
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29
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Abstract
Laboratory evaluation of SARS-CoV-2 involves the detection of viral nucleic acid, viral protein antigens, and the antibody response. Molecular detection of SARS-CoV-2 is the only diagnostic test currently available in acutely or recently infected individuals. In contrast, serological testing is typically performed once viral RNA has been cleared and symptoms have resolved. This leads to some confusion among clinicians as to which test to order and when each is appropriate. While SARS-CoV-2 assays can suffer from poor sensitivity, all FDA authorized assays to date are intended to be qualitative. Serological tests have multiple assay formats, detect various classes of immunoglobulins, and have a distinct role in seroprevalence studies; however, the association with long-term protection remains unclear. Both molecular and serological testing for SARS-CoV-2 have complementary roles in patient management, and we highlight the challenges faced by clinicians and laboratorians alike in the evaluation and interpretation of the currently available laboratory assays.
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Affiliation(s)
- Bijal A. Parikh
- Corresponding author. 660 South Euclid Ave., Campus Box 8118, St. Louis, MO, 63110, United States
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30
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Jassam N, Barth JH, Allgar V, Glover S, Stevenson F, Lauber N, Houghton V, Hanif Z, Child J, Clark B. Evaluation of the MP Rapid 2019-NCOV IgM/IgG combo POCT test vs. an established platform-based method. Ann Clin Biochem 2021; 58:305-310. [PMID: 33554608 DOI: 10.1177/0004563221995551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Accurate and rapid testing for SARS-COV-2 antibodies could improve the diagnosis and management of COVID-19. In this study, we aim to evaluate the diagnostic accuracy of a commercially available point-of-care lateral flow kit independently and in comparison to an established platform-based system. METHOD Samples from 144 PCR-confirmed COVID-19 cases and 130 pre-pandemic negative controls were tested in parallel by MP Rapid 2019-NCOV IgM/IgG Combo test and Roche Elecsys. Comparison of results based on serum and capillary blood testing was undertaken. RESULTS Sensitivity at day 15 onwards was 100% for both methods. Between days 1 and 7 post admission, the IgM/IgG Combo test and Roche Elecsys shown sensitivity of 74% (95%CI: 62%-85%) vs. 67% (95% CI: 55%-79%, P = 0.3947). Combo test specificities were 100% for IgG, 98.5% for IgM vs. Roche Elecsys specificity of 100%. Concordance analysis showed 98.5% agreement to the Roche Elecsys method (Cohen's Kappa 0.96 95% CI [0.92-0.99]). Capillary blood results showed complete agreement with serum samples using the Combo test. CONCLUSION In comparison to Roche Elecsys, our data show that the MP Rapid 2019-NCOV IgM/IgG Combo test provides a high-confidence assay system for the detection of previous exposure to SARS-COV-2 infection with advantage of affording near-patient testing.
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Affiliation(s)
- N Jassam
- Department of Clinical Biochemistry, Harrogate Foundation Trust, Harrogate, UK
| | - J H Barth
- Department of Clinical Biochemistry, Leeds Teaching Hospitals Trust, Leeds, UK
| | - V Allgar
- Department of Health Sciences, Hull York Medical School, University of York, York, UK
| | - S Glover
- Department of Clinical Biochemistry, Harrogate Foundation Trust, Harrogate, UK
| | - F Stevenson
- Department of Clinical Biochemistry, Harrogate Foundation Trust, Harrogate, UK
| | - N Lauber
- Department of Clinical Biochemistry, Harrogate Foundation Trust, Harrogate, UK
| | - V Houghton
- Department of Clinical Biochemistry, Harrogate Foundation Trust, Harrogate, UK
| | - Z Hanif
- Department of Clinical Biochemistry, Harrogate Foundation Trust, Harrogate, UK
| | - J Child
- Department of Microbiology, Harrogate Foundation Trust, Harrogate, UK
| | - B Clark
- Department of Transplant Immunology, Leeds Teaching Hospitals Trust, Leeds, UK
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Wakita M, Idei M, Saito K, Horiuchi Y, Yamatani K, Ishikawa S, Yamamoto T, Igawa G, Hinata M, Kadota K, Kurosawa T, Takahashi S, Saito T, Misawa S, Akazawa C, Naito T, Miida T, Takahashi K, Ai T, Tabe Y. Comparison of the clinical performance and usefulness of five SARS-CoV-2 antibody tests. PLoS One 2021; 16:e0246536. [PMID: 33556086 PMCID: PMC7870088 DOI: 10.1371/journal.pone.0246536] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/21/2021] [Indexed: 12/23/2022] Open
Abstract
We examined the usefulness of five COVID-19 antibody detection tests using 114 serum samples at various time points from 34 Japanese COVID-19 patients. We examined Elecsys Anti-SARS-CoV-2 from Roche, and four immunochromatography tests from Hangzhou Laihe Biotech, Artron Laboratories, Chil, and Nadal. In the first week after onset, Elecsys had 40% positivity in Group S (severe cases) but was negative in Group M (mild-moderate cases). The immunochromatography kits showed 40–60% and 0–8% positivity in Groups S and M, respectively. In the second week, Elecsys showed 75% and 50% positivity, and the immunochromatography tests showed 5–80% and 50–75% positivity in Groups S and M, respectively. After the third week, Elecsys showed 100% positivity in both groups. The immunochromatography kits showed 100% positivity in Group S. In Group M, positivity decreased to 50% for Chil and 75–89% for Artron and Lyher. Elecsys and immunochromatography kits had 91–100% specificity. Elecsys had comparable chronological change of cut-off index values in the two groups from the second week to the sixth week. The current SARS-CoV-2 antibody detection tests do not provide meaningful interpretation of severity and infection status. Its use might be limited to short-term epidemiological studies.
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Affiliation(s)
- Mitsuru Wakita
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Mayumi Idei
- Department of Clinical Laboratory Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
- Medical Technology Innovation Center, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kaori Saito
- Department of Clinical Laboratory Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuki Horiuchi
- Department of Clinical Laboratory Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kotoko Yamatani
- Department of Clinical Laboratory Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Suzuka Ishikawa
- Tokyo Medical and Dental University School of Health Care Sciences, Tokyo, Japan
| | - Takamasa Yamamoto
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Gene Igawa
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Masanobu Hinata
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Katsuhiko Kadota
- Emergency and Disaster Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Taro Kurosawa
- Department of Gastroenterology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Sho Takahashi
- Department of Gastroenterology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takumi Saito
- Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shigeki Misawa
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Chihiro Akazawa
- Intractable Disease Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Tomohiko Ai
- Department of Clinical Laboratory Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- * E-mail: ,
| | - Yoko Tabe
- Department of Clinical Laboratory Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Next Generation Hematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Ocmant A, Roisin S, De Meuter R, Brauner J. Clinical performance of the Advia Centaur anti-SARS-CoV-2 chemiluminescent immunoassay related to antibody kinetics. J Med Virol 2021; 93:2583-2584. [PMID: 33448403 PMCID: PMC8014508 DOI: 10.1002/jmv.26800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/07/2020] [Accepted: 01/05/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Annick Ocmant
- Department of Laboratory Medicine, Centre Hospitalier Universitaire (CHU) de Tivoli, La Louvière, Belgium
| | - Sandrine Roisin
- Department of Laboratory Medicine, Centre Hospitalier Universitaire (CHU) de Tivoli, La Louvière, Belgium
| | - Régis De Meuter
- Department of Laboratory Medicine, Centre Hospitalier Universitaire (CHU) de Tivoli, La Louvière, Belgium
| | - Jonathan Brauner
- Department of Laboratory Medicine, Centre Hospitalier Universitaire (CHU) de Tivoli, La Louvière, Belgium
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Mehdi F, Chattopadhyay S, Thiruvengadam R, Yadav S, Kumar M, Sinha SK, Goswami S, Kshetrapal P, Wadhwa N, Chandramouli Natchu U, Sopory S, Koundinya Desiraju B, Pandey AK, Das A, Verma N, Sharma N, Sharma P, Bhartia V, Gosain M, Lodha R, Lamminmäki U, Shrivastava T, Bhatnagar S, Batra G. Development of a Fast SARS-CoV-2 IgG ELISA, Based on Receptor-Binding Domain, and Its Comparative Evaluation Using Temporally Segregated Samples From RT-PCR Positive Individuals. Front Microbiol 2021; 11:618097. [PMID: 33552028 PMCID: PMC7854536 DOI: 10.3389/fmicb.2020.618097] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022] Open
Abstract
SARS-CoV-2 antibody detection assays are crucial for gathering seroepidemiological information and monitoring the sustainability of antibody response against the virus. The SARS-CoV-2 Spike protein's receptor-binding domain (RBD) is a very specific target for anti-SARS-CoV-2 antibodies detection. Moreover, many neutralizing antibodies are mapped to this domain, linking antibody response to RBD with neutralizing potential. Detection of IgG antibodies, rather than IgM or total antibodies, against RBD is likely to play a larger role in understanding antibody-mediated protection and vaccine response. Here we describe a rapid and stable RBD-based IgG ELISA test obtained through extensive optimization of the assay components and conditions. The test showed a specificity of 99.79% (95% CI: 98.82-99.99%) in a panel of pre-pandemic samples (n = 470) from different groups, i.e., pregnancy, fever, HCV, HBV, and autoantibodies positive. Test sensitivity was evaluated using sera from SARS-CoV-2 RT-PCR positive individuals (n = 312) and found to be 53.33% (95% CI: 37.87-68.34%), 80.47% (95% CI: 72.53-86.94%), and 88.24% (95% CI: 82.05-92.88%) in panel 1 (days 0-13), panel 2 (days 14-20) and panel 3 (days 21-27), respectively. Higher sensitivity was achieved in symptomatic individuals and reached 92.14% (95% CI: 86.38-96.01%) for panel 3. Our test, with a shorter runtime, showed higher sensitivity than parallelly tested commercial ELISAs for SARS-CoV-2-IgG, i.e., Euroimmun and Zydus, even when equivocal results in the commercial ELISAs were considered positive. None of the tests, which are using different antigens, could detect anti-SARS-CoV-2 IgGs in 10.5% RT-PCR positive individuals by the fourth week, suggesting the lack of IgG response.
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Affiliation(s)
- Farha Mehdi
- Translational Health Science and Technology Institute, Faridabad, India
| | | | | | - Sarla Yadav
- Translational Health Science and Technology Institute, Faridabad, India
| | - Manjit Kumar
- Translational Health Science and Technology Institute, Faridabad, India
| | | | - Sandeep Goswami
- Translational Health Science and Technology Institute, Faridabad, India
| | | | - Nitya Wadhwa
- Translational Health Science and Technology Institute, Faridabad, India
| | | | - Shailaja Sopory
- Translational Health Science and Technology Institute, Faridabad, India
| | | | | | - Asim Das
- ESIC Medical College and Hospital, Faridabad, India
| | - Nikhil Verma
- ESIC Medical College and Hospital, Faridabad, India
| | - Nandini Sharma
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Pragya Sharma
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Vandita Bhartia
- Translational Health Science and Technology Institute, Faridabad, India
| | - Mudita Gosain
- Translational Health Science and Technology Institute, Faridabad, India
| | - Rakesh Lodha
- All India Institute of Medical Sciences, New Delhi, India
| | - Urpo Lamminmäki
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | | | | | - Gaurav Batra
- Translational Health Science and Technology Institute, Faridabad, India
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Péré H, Mboumba Bouassa RS, Tonen-Wolyec S, Podglajen I, Veyer D, Bélec L. Analytical performances of five SARS-CoV-2 whole-blood finger-stick IgG-IgM combined antibody rapid tests. J Virol Methods 2021; 290:114067. [PMID: 33476707 PMCID: PMC7813505 DOI: 10.1016/j.jviromet.2021.114067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/12/2020] [Accepted: 01/12/2021] [Indexed: 12/18/2022]
Abstract
Facing the ongoing pandemic caused by SARS-CoV-2, there is an urgent need for serological assays identifying individuals previously infected by coronavirus disease 2019 (COVID-19), including rapid diagnostic tests (RDTs). We herein compared five new CE-IVD-labeled commercially available SARS-CoV-2 whole-blood finger-stick IgG/IgM combined RDTs, in parallel according to the manufacturers’ instructions, with two serum panels obtained from 48 patients with confirmed COVID-19 (panel I) and from a group of 52 patients randomly selected, for whom serum samples collected before the COVID-19 epidemic (from October 1 to November 30, 2019) were negative for SARS-CoV-2 IgG (panel II). We found a sensitivity of 95.8 %, 91.6 %, 92.3 %, 97.9 % and 91.4 %, and a specificity of 98.1 %, 86.5 %, 100 %, 98.1 % and 84.6 %, for BIOSYNEX COVID-19 BSS (IgG/IgM) (Biosynex Swiss SA, Freiburg, Switzerland), Humasis COVID-19 IgG/IgM Test (Humasis Co., Ltd., Gyneonggi, Republic of Korea), LYHER COVID-19 IgM/IgG Rapid Test (Medakit Ltd, Hong Kong, China), SIENNA™ COVID-19 (IgG/IgM) Rapid Test Cassette (Salofa Oy, Salo, Finland) and NG-BIOTECH COVID-19 (IgG/IgM) (NG-Biotech, Guipry, France), respectively. Commercially available SARS-CoV-2 IgG/IgM combined RDTs have a sufficient sensitivity for identifying individuals with past SARS-CoV-2 infection, but some RDTs may lack of specificity, with risk of false positivity mainly for the IgM band.
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Affiliation(s)
- Hélène Péré
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U970, PARCC, Hôpital Européen Georges Pompidou, Faculté de Médecine, Centre Université de Paris, Paris, France; Service de Microbiologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Ralph-Sydney Mboumba Bouassa
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Ecole Doctorale Régionale D'Afrique Centrale en Infectiologie Tropicale, Franceville, Gabon
| | - Serge Tonen-Wolyec
- Ecole Doctorale Régionale D'Afrique Centrale en Infectiologie Tropicale, Franceville, Gabon; Faculty of Medicine and Pharmacy, University of Kisangani, Kisangani, the Democratic Republic of the Congo
| | - Isabelle Podglajen
- Service de Microbiologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Sorbonne Paris Cité, Paris, France
| | - David Veyer
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Service de Microbiologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Bélec
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Service de Microbiologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Sorbonne Paris Cité, Paris, France.
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35
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Choy KW. SARS-CoV-2 serological cross-reactivity with autoantibodies. THE LANCET RHEUMATOLOGY 2021; 3:e15. [PMID: 33392517 PMCID: PMC7758714 DOI: 10.1016/s2665-9913(20)30358-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Humble RM, Merrill AE, Ford BA, Diekema DJ, Krasowski MD. Practical Considerations for Implementation of SARS-CoV-2 Serological Testing in the Clinical Laboratory: Experience at an Academic Medical Center. Acad Pathol 2021; 8:23742895211002802. [PMID: 33889715 PMCID: PMC8040556 DOI: 10.1177/23742895211002802] [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] [Received: 01/16/2021] [Revised: 01/16/2021] [Accepted: 02/06/2021] [Indexed: 12/19/2022] Open
Abstract
Molecular techniques, especially reverse transcriptase polymerase chain reaction (RT-PCR), have been the gold standard for the diagnosis of acute severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Serological tests for SARS-CoV-2 have been widely used for serosurveys, epidemiology, and identification of potential convalescent plasma donors. However, the clinical role of serologic testing is still limited and evolving. In this report, we describe the experience of selecting, validating, and implementing SARS-CoV-2 serologic testing for clinical purposes at an academic medical center in a rural state. Successful implementation involved close collaboration between pathology, infectious diseases, and outpatient clinics. The most common clinician concerns were appropriateness/utility of testing, patient charges/insurance coverage, and assay specificity. In analyzing test utilization, serologic testing in the first month after go-live was almost entirely outpatient and appeared to be strongly driven by patient interest (including health care workers and others in high-risk occupations for exposure to SARS-CoV-2), with little evidence that the results impacted clinical decision-making. Test volumes for serology declined steadily through October 31, 2020, with inpatient ordering assuming a steadily higher percentage of the total. In a 5-month period, SARS-CoV-2 serology test volumes amounted to only 1.3% of that of reverse transcriptase polymerase chain reaction. Unlike reverse transcriptase polymerase chain reaction, supply chain challenges and reagent availability were not major issues for serology testing. We also discuss the most recent challenge of requirements for SARS-CoV-2 testing in international travel protocols. Overall, our experience at an academic medical center shows that SARS-CoV-2 serology testing assumed a limited clinical role.
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Affiliation(s)
- Robert M. Humble
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Anna E. Merrill
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Bradley A. Ford
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Daniel J. Diekema
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Matthew D. Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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SARS-CoV-2 serological cross-reactivity with autoantibodies – Authors' reply. THE LANCET RHEUMATOLOGY 2021; 3:e16. [PMID: 33392518 PMCID: PMC7758717 DOI: 10.1016/s2665-9913(20)30359-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Giri B, Pandey S, Shrestha R, Pokharel K, Ligler FS, Neupane BB. Review of analytical performance of COVID-19 detection methods. Anal Bioanal Chem 2021; 413:35-48. [PMID: 32944809 PMCID: PMC7498299 DOI: 10.1007/s00216-020-02889-x] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 12/18/2022]
Abstract
In the recent SARS-CoV-2 pandemic, public health experts have emphasized testing, tracking infected people, and tracing their contacts as an effective strategy to reduce the spread of the virus. Several diagnostic methods are reported for detecting the coronavirus in clinical, research, and public health laboratories. Some tests detect the infection directly by detecting the viral RNA and other tests detect the infection indirectly by detecting the host antibodies. A diagnostic test during the pandemic should help make an appropriate clinical decision in a short period of time. Recently reported diagnostic methods for SARS-CoV-2 have varying throughput, batching capacity, requirement of infrastructure setting, analytical performance, and turnaround times ranging from a few minutes to several hours. These factors should be considered while selecting a reliable and rapid diagnostic method to help make an appropriate decision and prompt public health interventions. This paper reviews recent SARS-CoV-2 diagnostic methods published in journals and reports released by regulatory agencies. We compared the analytical efficiency including limit of detection, sensitivity, specificity, and throughput. In addition, we also looked into ease of use, affordability, and availability of accessories. Finally, we discuss the limitations of the methods and provide our perspectives on priorities for future test development.
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Affiliation(s)
- Basant Giri
- Center for Analytical Sciences, Kathmandu Institute of Applied Sciences, Kathmandu, 44600, Nepal
| | - Shishir Pandey
- Center for Analytical Sciences, Kathmandu Institute of Applied Sciences, Kathmandu, 44600, Nepal
| | - Retina Shrestha
- Center for Analytical Sciences, Kathmandu Institute of Applied Sciences, Kathmandu, 44600, Nepal
| | - Krisha Pokharel
- Center for Analytical Sciences, Kathmandu Institute of Applied Sciences, Kathmandu, 44600, Nepal
| | - Frances S Ligler
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, 27695, USA.
| | - Bhanu B Neupane
- Center for Analytical Sciences, Kathmandu Institute of Applied Sciences, Kathmandu, 44600, Nepal
- Central Department of Chemistry, Tribhuvan University, Kathmandu, 44618, Nepal
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Catry E, Jacqmin H, Dodemont M, Saad Albichr I, Lardinois B, de Fays B, Delaere B, Closset M, Laurent T, Denis O, Galanti L, Mullier F, Huang TD. Analytical and clinical evaluation of four commercial SARS-CoV-2 serological immunoassays in hospitalized patients and ambulatory individuals. J Virol Methods 2020; 289:114060. [PMID: 33359614 PMCID: PMC7834313 DOI: 10.1016/j.jviromet.2020.114060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 12/30/2022]
Abstract
Hospitalized patients seroconverted at ≥ 3 weeks pso. Ambulatory symptomatic individuals seroconverted at 14 days pso. Illness’ severity degree and infection phase impacted the longitudinal Ab changes. Five “severe-to-critically” ill patients have positive Ab levels up to 16 weeks pso. Total Ab immunoassay, compared to IgG, present a better sensitivity and specificity.
Background This study aimed to compare four anti-SARS-CoV-2 immunoassays in populations presenting different clinical severity levels. Methods Three populations were included: “severe-to-critical” ICU-hospitalized patients (n = 18), “mild-to-moderate” hospitalized patients (n = 16) and non-hospitalized symptomatic patients (n = 24). Four commercial immunoassays were analyzed and validated: anti-IgG ARCHITECT® (Abbott), anti-Total antibodies (Ab) VITROS® (Ortho Clinical Diagnostics), anti-IgG NovaLisa® (NovaTec Immundiagnostica) and Healgen® IgM and IgG (Zhejiang Orient Gene Biotech). Sensitivities were evaluated according to days post-symptoms onset (pso). Specificities were evaluated on SARS-CoV-2-negative control sera collected before January 2020. Results A majority of severe-to-critically ill patients showed detectable Ab already at day 14 and sensitivities reached 100 % after 22 days pso. For patients with “mild-to-moderate” illness, sensitivities increased by at least 5-fold from day 0 to day 14 pso. Non-hospitalized symptomatic individuals already seroconverted at day 14 days pso with 100 % sensitivities for Total Ab VITROS®. Specificities were evaluated at 97 % for ARCHITECT® and NovaLisa®, 98 % for VITROS® and at 94 % for Healgen® combined IgM and IgG. Five “severe-to-critically” ill patients presented high positive Ab levels for at least 16 weeks pso. Conclusion The Ab levels and the evaluated sensitivities, representing the true positive rate, increased overtime and were related to the COVID-19 severity. Automated Total Ab immunoassay showed better sensitivities and specificity for immunological surveillance and vaccine evaluation.
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Affiliation(s)
- E Catry
- Université catholique de Louvain, CHU UCL Namur, Department of Laboratory Medicine, Yvoir, Belgium.
| | - H Jacqmin
- Université catholique de Louvain, CHU UCL Namur, Department of Laboratory Medicine, Yvoir, Belgium
| | - M Dodemont
- Université catholique de Louvain, CHU UCL Namur, Department of Laboratory Medicine, Yvoir, Belgium
| | - I Saad Albichr
- Université catholique de Louvain, CHU UCL Namur, Department of Laboratory Medicine, Yvoir, Belgium
| | - B Lardinois
- Université catholique de Louvain, CHU UCL Namur, Department of Laboratory Medicine, Yvoir, Belgium
| | - B de Fays
- Université catholique de Louvain, CHU UCL Namur, Department of Infectious Diseases, Yvoir, Belgium
| | - B Delaere
- Université catholique de Louvain, CHU UCL Namur, Department of Infectious Diseases, Yvoir, Belgium
| | - M Closset
- Université catholique de Louvain, CHU UCL Namur, Department of Laboratory Medicine, Yvoir, Belgium
| | - T Laurent
- Université catholique de Louvain, CHU UCL Namur, Department of Laboratory Medicine, Namur, Belgium
| | - O Denis
- Université catholique de Louvain, CHU UCL Namur, Department of Laboratory Medicine, Yvoir, Belgium; Université catholique de Louvain, CHU UCL Namur, Infection Control and Prevention Unit, Yvoir, Belgium
| | - L Galanti
- Université catholique de Louvain, CHU UCL Namur, Department of Laboratory Medicine, Yvoir, Belgium
| | - F Mullier
- Université catholique de Louvain, CHU UCL Namur, Department of Laboratory Medicine, Yvoir, Belgium
| | - T D Huang
- Université catholique de Louvain, CHU UCL Namur, Department of Laboratory Medicine, Yvoir, Belgium
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40
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Favresse J, Brauner J, Bodart N, Vigneron A, Roisin S, Melchionda S, Douxfils J, Ocmant A. An original multiplex method to assess five different SARS-CoV-2 antibodies. Clin Chem Lab Med 2020; 59:971-978. [PMID: 33554567 DOI: 10.1515/cclm-2020-1652] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/01/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Accurate SARS-CoV-2 serological assays are urgently needed to help diagnose infection, determine past exposure of populations and assess the response to future vaccines. The study aims at assessing the performance of the multiplex D-tek COVIDOT 5 IgG assay for the detection of SARS-CoV-2 IgG antibodies (N, S1+S2, S1, S2 and RBD). METHODS Sensitivity and dynamic trend to seropositivity were evaluated in 218 samples obtained from 46 rRT-PCR confirmed COVID-19 patients. Non-SARS-CoV-2 sera (n=118) collected before the COVID-19 pandemic with a potential cross-reaction to the SARS-CoV-2 immunoassay were included in the specificity analysis. RESULTS A gradual dynamic trend since symptom onset was observed for all IgG antibodies. Sensitivities before day 14 were suboptimal. At ≥21 days, sensitivities reached 100% (93.4-100%) for N, S1+S2, S2 and RBD-directed IgG and 96.3% (87.3-99.6%) for S1-directed IgG. In 42 out of 46 patients (91.3%), all five antibodies were detected at ≥14 days. The four remaining patients had between 2 and 4 positive antibodies at their respective maximal follow-up period. The specificity was 100 % for S1+S2, S2 and RBD, 98.3% for N and 92.4% (86.0-96.5%) for S1-directed IgG. The combined use of antigens increases the early sensitivity whilst enforcing high specificity. CONCLUSIONS Sensitivities at ≥21 days and specificities were excellent, especially for N, S1+S2, S2 and RBD-directed IgG. Caution is however required when interpreting single S1-directed reactivities. Using a multiplex assay complies with the orthogonal testing algorithm of the CDC and allows a better and critical interpretation of the serological status of a patient.
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Affiliation(s)
- Julien Favresse
- Department of Laboratory Medicine, Clinique Saint-Luc Bouge, Namur, Belgium
- Department of Pharmacy, Namur Research Institute for Lifes Sciences, University of Namur, Namur, Belgium
| | - Jonathan Brauner
- Department of Laboratory Medicine, CHU Tivoli, La Louvière, Belgium
| | | | | | - Sandrine Roisin
- Department of Laboratory Medicine, CHU Tivoli, La Louvière, Belgium
| | | | - Jonathan Douxfils
- Department of Pharmacy, Namur Research Institute for Lifes Sciences, University of Namur, Namur, Belgium
- Qualiblood sa, Namur, Belgium
| | - Annick Ocmant
- Department of Laboratory Medicine, CHU Tivoli, La Louvière, Belgium
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41
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Comparison of the Clinical Performances of the Abbott Alinity IgG, Abbott Architect IgM, and Roche Elecsys Total SARS-CoV-2 Antibody Assays. J Clin Microbiol 2020; 59:JCM.02104-20. [PMID: 33106364 DOI: 10.1128/jcm.02104-20] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/22/2020] [Indexed: 01/29/2023] Open
Abstract
Critical evaluation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serologic assays is needed to guide clinical decision-making and ensure that these assays provide optimal benefit to patients and the public. Here, three commercially available assays with widespread distribution capabilities are compared. A total of 667 specimens, 103 from patients with confirmed SARS-CoV-2 infections and 564 collected prior to the emergence of SARS-CoV-2, were analyzed in parallel using the Roche Elecsys SARS-CoV-2 total antibody and Abbott Alinity SARS-CoV-2 IgG assays; a subset of 55 samples from patients with confirmed SARS-CoV-2 infections was additionally evaluated using the Abbott Architect SARS-CoV-2 IgM assay. Qualitative agreement between the Abbott IgG and Roche total antibody assays was 98.7% (658/667), with Cohen's kappa value of 0.919 (95% confidence interval [CI], 0.867 to 0.972). Qualitative agreements with the Abbott IgM assay were 92.7% (51/55, Abbott IgG) and 85.5% (47/55, Roche total antibody). Diagnostic specificities determined using pre-COVID-19 samples for the Abbott IgG and Roche total antibody assays were 99.65% (95% CI, 98.72 to 99.90%) and 100.00% (95% CI, 99.32 to 100.00%), respectively, spanning claims made by each manufacturer. Diagnostic sensitivities increased for all three assays with increasing time since the onset of symptoms. Among 51 patients with confirmed SARS-CoV-2 infections, 23 (45.1%), 24 (47.1%), and 22 (43.1%) were reactive by the Abbott IgG, Roche total antibody, and Abbott IgM assays, respectively, with sampling times 0 to 56 days post-positive PCR (median/mean, 2/6.2 days). Combining IgG and IgM screening identified 4/55 additional samples with detectable antibodies that would not have been observed using the assays independently. Notably, one immunocompromised patient with confirmed SARS-CoV-2 infection showed no detectable antibodies using any of the three assays 43 days after onset of symptoms.
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42
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Predictive values, uncertainty, and interpretation of serology tests for the novel coronavirus. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 32577683 DOI: 10.1101/2020.06.04.20122358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Antibodies testing in the coronavirus era is frequently promoted, but the underlying statistics behind their validation has come under more scrutiny in recent weeks. We provide calculations, interpretations, and plots of positive and negative predictive values under a variety of scenarios. Prevalence, sensitivity, and specificity are estimated within ranges of values from researchers and antibodies manufacturers. Illustrative examples are highlighted, and interactive plots are provided in the Supplementary Material. Implications are discussed for society overall and across diverse locations with different levels of disease burden. Specifically, the proportion of positive serology tests that are false can differ drastically from up to 3% to 88% for people from different places with different proportions of infected people in the populations while the false negative rate is typically under 10%.
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Kittel M, Muth MC, Zahn I, Roth HJ, Thiaucourt M, Gerhards C, Haselmann V, Neumaier M, Findeisen P. Clinical evaluation of commercial automated SARS-CoV-2 immunoassays. Int J Infect Dis 2020; 103:590-596. [PMID: 33310108 PMCID: PMC7725057 DOI: 10.1016/j.ijid.2020.12.003] [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: 09/09/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Numerous immunoassays for detecting antibodies directed against SARS-CoV-2 have been rapidly developed and released. Validations of these have been performed with a limited number of samples. The lack of standardisation might lead to significantly different results. This study compared ten automated assays from six vendors in terms of sensitivity, specificity and reproducibility. METHODS This study compared ten fully automated immunoassays from the following vendors: Diasorin, Epitope Diagnostics, Euroimmun, Roche, YHLO, and Snibe. The retrospective part of the study included patients with a laboratory-confirmed COVID-19 infection, and controls comprised patients with a suspected infection, in whom the disease was excluded. Furthermore, biobanked sera were taken as negative controls (n = 97). The retrospective part involved four groups: (1) laboratory-confirmed COVID-19 infection (n = 183); (1B) suspected COVID-19 infection (n = 167) without a qRT-PCR result but positive serological results from at least two different assays, and suspected COVID-19 infection due to a positive serological result from the Roche assay (n = 295); (2) biobanked sera obtained from patients before the emergence of SARS-CoV-2 (n = 97) as negative controls; and (2A) probably COVID-19-negative sera with negative serological results from at least two different assays (n = 152). RESULTS Overall diagnostic sensitivities were: Euroimmun (IgA) 87%; Epitope Diagnostics (IgG) 83%; YHLO (IgG) 77%; Roche (IgM/IgG) 77%; Euroimmun (IgG) 75%; Diasorin (IgG) 53%; Epitope Diagnostics (IgM) 52%; Snibe (IgG) 47%; YHLO (IgM) 35%; and Snibe (IgM) 26%. Diagnostic specificities were: YHLO (IgG) 100%; Roche, 100%; Snibe (IgM/IgG) 100%; Diasorin (IgG) 97%; Euroimmun (IgG) 94%; YHLO (IgM) 94%; Euroimmun (IgA) 83%. CONCLUSION Assays from different vendors substantially varied in terms of their performance. These findings might facilitate selection of appropriate serological assays.
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Affiliation(s)
- Maximilian Kittel
- Institute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany.
| | | | - Ingrid Zahn
- MVZ Laboratory Dr. Limbach & Colleagues, Heidelberg, Germany
| | | | - Margot Thiaucourt
- Institute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Catharina Gerhards
- Institute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Verena Haselmann
- Institute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Michael Neumaier
- Institute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Peter Findeisen
- MVZ Laboratory Dr. Limbach & Colleagues, Heidelberg, Germany
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44
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Aloisio E, Falvella FS, Carnevale A, Panteghini M. SARS-CoV-2 serologic tests: do not forget the good laboratory practice. Clin Chem Lab Med 2020; 59:e175-e177. [DOI: 10.1515/cclm-2020-1554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Elena Aloisio
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco , Milan , Italy
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan , Milan , Italy
| | | | - Assunta Carnevale
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco , Milan , Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco , Milan , Italy
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan , Milan , Italy
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45
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Merrill AE, Jackson JB, Ehlers A, Voss D, Krasowski MD. Head-to-Head Comparison of Two SARS-CoV-2 Serology Assays. J Appl Lab Med 2020; 5:1351-1357. [PMID: 32717056 PMCID: PMC7454580 DOI: 10.1093/jalm/jfaa125] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/06/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND While molecular techniques remain the gold standard for diagnosis of acute SARS-CoV-2 infection, serological tests have the unique potential to ascertain how much of the population has been exposed to the COVID-19 pathogen. There have been limited published studies to date documenting the performance of SARS-CoV-2 antibody assays. METHODS We compared the DiaSorin Liaison SARS-CoV-2 S1/S2 IgG and Roche Diagnostics Elecsys Anti-SARS-CoV-2 assays using 228 samples spanning patients with positive PCR for SARS-CoV-2, patients with compatible symptoms but negative PCR, pre-COVID specimens, and potential cross-reactives. RESULTS Both assays detected antibodies in 18/19 samples collected at least one week after a positive PCR result. Neither method consistently detected antibodies in specimens collected within one week of a positive PCR result (sensitivity < 50%), but antibodies were detected by only Roche in four samples in this time frame. Using 139 pre-COVID and 35 PCR-negative samples, the Roche and DiaSorin assays demonstrated specificities of 100.0% and 98.9%, respectively. Neither assay demonstrated cross-reactivity from other coronaviruses (229E, HKU1, NL63, OC43), respiratory pathogens (adenovirus, metapneumovirus, rhinovirus/enterovirus), or antibodies to other viruses (HIV, EBV, CMV, HBV, HCV, HAV). DISCUSSION Overall, the qualitative interpretations afforded by the Roche and DiaSorin assays agreed for 97% of samples evaluated. Minor discrepancies in sensitivity and specificity were observed between methods, with the differences in specificity more clinically significant for our low-prevalence population. For the DiaSorin assay, all disagreements with the Roche assay occurred in samples with quantitative signals near the cut-off determining positivity.
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Affiliation(s)
- Anna E Merrill
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - J Brooks Jackson
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Alexandra Ehlers
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Dena Voss
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
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46
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Xu G, Emanuel AJ, Nadig S, Mehrotra S, Caddell BA, Curry SR, Nolte FS, Babic N. Evaluation of Orthogonal Testing Algorithm for Detection of SARS-CoV-2 IgG Antibodies. Clin Chem 2020; 66:1531-1537. [PMID: 32894753 PMCID: PMC7499512 DOI: 10.1093/clinchem/hvaa210] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/27/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody testing is an important tool in assessment of pandemic progress, contact tracing, and identification of recovered coronavirus disease 2019 (COVID-19) patients. We evaluated an orthogonal testing algorithm (OTA) to improve test specificity in these use cases. METHODS A two-step OTA was applied where individuals who initially tested positive were tested with a second test. The first-line test, detecting IgG antibodies to the viral nucleocapsid protein, was validated in 130 samples and the second-line test, detecting IgG antibodies to the viral spike protein in 148 samples. The OTA was evaluated in 4333 clinical patient specimens. The seropositivity rates relative to the SARS-CoV-2 PCR positivity rates were evaluated from our entire patient population data (n = 5102). RESULTS The first-line test resulted in a clinical sensitivity of 96.4% (95% CI; 82.3% to 99.4%), and specificity of 99.0% (95% CI; 94.7% to 99.8%), whereas the second-line test had a sensitivity of 100% (95% CI; 87.1% to 100%) and specificity of 98.4% (95% CI; 94.2% to 99.5%). Using the OTA, 78/98 (80%) of initially positive SARS-CoV-2 IgG results were confirmed with a second-line test, while 11/42 (26%) of previously diagnosed COVID-19 patients had no detectable antibodies as long as 94 days post PCR diagnosis. CONCLUSION Our results show that an OTA can be used to identify patients who require further follow-up due to potential SARS CoV-2 IgG false positive results. In addition, serological testing may not be sufficiently sensitive to reliably detect prior COVID-19 infection.
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Affiliation(s)
- Gang Xu
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - Anthony J Emanuel
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - Satish Nadig
- Department of Surgery, Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Shikhar Mehrotra
- Department of Surgery, Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Brittany A Caddell
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - Scott R Curry
- Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Frederick S Nolte
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - Nikolina Babic
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
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47
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Favresse J, Cadrobbi J, Eucher C, Elsen M, Laffineur K, Dogné JM, Douxfils J. Clinical performance of three fully automated anti-SARS-CoV-2 immunoassays targeting the nucleocapsid or spike proteins. J Med Virol 2020; 93:2262-2269. [PMID: 33200836 PMCID: PMC7753716 DOI: 10.1002/jmv.26669] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/26/2020] [Accepted: 11/10/2020] [Indexed: 02/02/2023]
Abstract
This study assesses the clinical performance of three anti‐SARS‐CoV‐2 assays, namely EUROIMMUN anti‐SARS‐CoV‐2 nucleocapsid (IgG) ELISA, Elecsys anti‐SARS‐CoV‐2 nucleocapsid (total antibodies) assay, and LIAISON anti‐SARS‐CoV‐2 spike proteins S1 and S2 (IgG) assay. One hundred and thirty‐seven coronavirus disease 2019 (COVID‐19) samples from 96 reverse‐transcription polymerase chain reaction confirmed patients were chosen to perform the sensitivity analysis. Non‐SARS‐CoV‐2 sera (n = 141) with a potential cross‐reaction to SARS‐CoV‐2 immunoassays were included in the specificity analysis. None of these tests demonstrated a sufficiently high clinical sensitivity to diagnose acute infection. Fourteen days since symptom onset, we did not find any significant difference between the three techniques in terms of sensitivities. However, Elecsys performed better in terms of specificity. All three anti‐SARS‐CoV‐2 assays had equivalent sensitivities 14 days from symptom onset to diagnose past‐COVID‐19 infection. We also confirmed that anti‐SARS‐CoV‐2 determination before Day 14 is of less clinical interest.
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Affiliation(s)
- Julien Favresse
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium.,Department of Pharmacy, Namur Research Institute for Life Sciences, University of Namur, Namur, Belgium
| | - Julie Cadrobbi
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
| | - Christine Eucher
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
| | - Marc Elsen
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
| | - Kim Laffineur
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
| | - Jean-Michel Dogné
- Department of Pharmacy, Namur Research Institute for Life Sciences, University of Namur, Namur, Belgium
| | - Jonathan Douxfils
- Department of Pharmacy, Namur Research Institute for Life Sciences, University of Namur, Namur, Belgium.,Qualiblood sa, Namur, Belgium
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48
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Drouot L, Hantz S, Jouen F, Velay A, Lamia B, Veber B, Sibilia J, Lotellier M, Candon S, Alain S, Fafi-Kremer S, Boyer O. Evaluation of Humoral Immunity to SARS-CoV-2: Diagnostic Value of a New Multiplex Addressable Laser Bead Immunoassay. Front Microbiol 2020; 11:603931. [PMID: 33324387 PMCID: PMC7726470 DOI: 10.3389/fmicb.2020.603931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/26/2020] [Indexed: 12/17/2022] Open
Abstract
Despite efforts to develop anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody (Ab) immunoassays, reliable serological methods are still needed. We developed a multiplex addressable laser bead immunoassay (ALBIA) to detect and quantify anti-Spike S1 and nucleocapsid N Abs. Recombinant S1 and N proteins were bound to fluorescent beads (ALBIA-IgG-S1/N). Abs were revealed using class-specific anti-human Ig Abs. The performances of the test were analyzed on 575 serum samples including 192 from SARS-CoV-2 polymerase chain reaction-confirmed patients, 13 from seasonal coronaviruses, 70 from different inflammatory/autoimmune diseases, and 300 from healthy donors. Anti-S1 IgM were detected by monoplex ALBIA-IgM-S1. Comparison with chemiluminescent assays or enzyme-linked immunosorbent assays was performed using commercial tests. Multiplex ALBIA-IgG-S1/N was effective in detecting and quantifying anti-SARS-CoV-2 IgG Abs. Two weeks after first symptoms, sensitivity and specificity were 97.7 and 98.0% (anti-S1), and 100 and 98.7% (anti-N), respectively. Agreement with commercial tests was good to excellent, with a higher sensitivity of ALBIA. ALBIA-IgG-S1/N was positive in 53% of patients up to day 7, and in 75% between days 7 and 13. For ALBIA-IgM-S1, sensitivity and specificity were 74.4 and 98.7%, respectively. Patients in intensive care units had higher IgG Ab levels (Mann-Whitney test, p < 0.05). ALBIA provides a robust method for exploring humoral immunity to SARS-CoV-2. Serology should be performed after 2 weeks following first symptoms, when all COVID-19 (coronavirus disease 2019) patients had at least one anti-S1 or anti-N IgG Ab, illustrating the interest of a multiplex test.
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Affiliation(s)
- Laurent Drouot
- Normandie University, UNIROUEN, INSERM, U1234, Rouen, France
| | - Sébastien Hantz
- Limoges University Hospital, National Reference Center for Herpesviruses, Limoges, France
| | - Fabienne Jouen
- Normandie University, UNIROUEN, INSERM, U1234, Rouen, France.,Rouen University Hospital, Department of Immunology, Rouen, France
| | - Aurélie Velay
- Strasbourg University Hospital, Institute of Virology, Strasbourg, France
| | - Bouchra Lamia
- Pulmonology Department, Le Havre Hospital, Montivilliers, France
| | - Benoit Veber
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Jean Sibilia
- Department of Rheumatology, Strasbourg University Hospital, Strasbourg, France
| | | | - Sophie Candon
- Normandie University, UNIROUEN, INSERM, U1234, Rouen, France.,Rouen University Hospital, Department of Immunology, Rouen, France
| | - Sophie Alain
- Limoges University Hospital, National Reference Center for Herpesviruses, Limoges, France
| | - Samira Fafi-Kremer
- Strasbourg University Hospital, Institute of Virology, Strasbourg, France
| | - Olivier Boyer
- Normandie University, UNIROUEN, INSERM, U1234, Rouen, France.,Rouen University Hospital, Department of Immunology, Rouen, France
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49
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Hosseini A, Pandey R, Osman E, Victorious A, Li F, Didar T, Soleymani L. Roadmap to the Bioanalytical Testing of COVID-19: From Sample Collection to Disease Surveillance. ACS Sens 2020; 5:3328-3345. [PMID: 33124797 PMCID: PMC7605339 DOI: 10.1021/acssensors.0c01377] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022]
Abstract
The disease caused by SARS-CoV-2, coronavirus disease 2019 (COVID-19), has led to a global pandemic with tremendous mortality, morbidity, and economic loss. The current lack of effective vaccines and treatments places tremendous value on widespread screening, early detection, and contact tracing of COVID-19 for controlling its spread and minimizing the resultant health and societal impact. Bioanalytical diagnostic technologies have played a critical role in the mitigation of the COVID-19 pandemic and will continue to be foundational in the prevention of the subsequent waves of this pandemic along with future infectious disease outbreaks. In this Review, we aim at presenting a roadmap to the bioanalytical testing of COVID-19, with a focus on the performance metrics as well as the limitations of various techniques. The state-of-the-art technologies, mostly limited to centralized laboratories, set the clinical metrics against which the emerging technologies are measured. Technologies for point-of-care and do-it-yourself testing are rapidly emerging, which open the route for testing in the community, at home, and at points-of-entry to widely screen and monitor individuals for enabling normal life despite of an infectious disease pandemic. The combination of different classes of diagnostic technologies (centralized and point-of-care and relying on multiple biomarkers) are needed for effective diagnosis, treatment selection, prognosis, patient monitoring, and epidemiological surveillance in the event of major pandemics such as COVID-19.
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Affiliation(s)
- Amin Hosseini
- School of Biomedical Engineering,
McMaster University, Hamilton, ON L8S
4L8, Canada
| | - Richa Pandey
- Department of Engineering Physics,
McMaster University, Hamilton, ON L8S
4L8, Canada
| | - Enas Osman
- School of Biomedical Engineering,
McMaster University, Hamilton, ON L8S
4L8, Canada
| | - Amanda Victorious
- School of Biomedical Engineering,
McMaster University, Hamilton, ON L8S
4L8, Canada
| | - Feng Li
- Department of Chemistry,
Brock University, St. Catharines, ON
L2S 3A1, Canada
- Key Laboratory of Green Chemistry and
Technology of Ministry of Education, College of Chemistry,
Sichuan University, Chengdu, Sichuan
610065, China
| | - Tohid Didar
- School of Biomedical Engineering,
McMaster University, Hamilton, ON L8S
4L8, Canada
- Department of Mechanical Engineering,
McMaster University, Hamilton, ON L8S
4L8, Canada
| | - Leyla Soleymani
- School of Biomedical Engineering,
McMaster University, Hamilton, ON L8S
4L8, Canada
- Department of Engineering Physics,
McMaster University, Hamilton, ON L8S
4L8, Canada
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50
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Mboumba Bouassa RS, Péré H, Tonen-Wolyec S, Longo JDD, Moussa S, Mbopi-Keou FX, Mossoro-Kpinde CD, Grésenguet G, Veyer D, Bélec L. Unexpected high frequency of unspecific reactivities by testing pre-epidemic blood specimens from Europe and Africa with SARS-CoV-2 IgG-IgM antibody rapid tests points to IgM as the Achilles heel. J Med Virol 2020; 93:2196-2203. [PMID: 33107601 DOI: 10.1002/jmv.26628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/12/2020] [Accepted: 10/23/2020] [Indexed: 12/15/2022]
Abstract
We aimed to evaluate the rates of false-positive test results of three rapid diagnostic tests (RDTs) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunoglobulin G (IgG) and IgM detection. Two serum panels from patients hospitalized in Paris, France, and from patients living in Bangui, Central African Republic, acquired before the 2019 COVID-19 outbreak, were tested by 3 CE IVD-labeled RDTs for SARS-CoV-2 serology (BIOSYNEX® COVID-19 BSS [IgG/IgM]; SIENNA™ COVID-19 IgG/IgM Rapid Test Cassette; NG-Test® IgG-IgM COVID-19). Detectable IgG or IgM reactivities could be observed in 31 (3.43%) of the 902 IgG and IgM bands of the 3 RDTs used with all pre-epidemic sera. The frequencies of IgG/IgM reactivities were similar for European (3.20%) and African (3.55%) sera. IgM reactivities were observed in 9 European and 14 African sera, while IgG reactivity was observed in only 1 African serum (15.1% vs. 0.66%). The test NG-Test® IgG-IgM COVID-19 showed the highest rates of IgG or IgM reactivities (6.12% [18/294]), while the test BIOSYNEX® COVID-19 BSS (IgG/IgM) showed the lowest rate (1.36% [4/294]). Some combinations of 2 RDTs in series allowed decreasing significantly the risk of false-positive test results. Our observations point to the risk of false-positive reactivities when using currently available RDT for SARS-CoV-2 serological screening, especially for the IgM band, even if the test is CE IVD-labeled and approved by national health authorities, and provide the rational basis for confirmatory testing by another RDT in case of positive initial screening.
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Affiliation(s)
- Ralph-Sydney Mboumba Bouassa
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Ecole Doctorale Régionale D'Afrique Centrale en Infectiologie Tropicale, Franceville, Gabon
| | - Hélène Péré
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Sorbonne Paris Cité, INSERM U970, PARCC, Paris, France
| | - Serge Tonen-Wolyec
- Ecole Doctorale Régionale D'Afrique Centrale en Infectiologie Tropicale, Franceville, Gabon.,Faculty of Medicine and Pharmacy, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Jean De Dieu Longo
- Centre National des Maladies Sexuellement Transmissibles et du SIDA of Bangui, Bangui, Central African Republic.,Faculté des Sciences de la Santé, Université de Bangui, Bangui, Central African Republic
| | - Sandrine Moussa
- Institut Pasteur de Bangui, Bangui, Central African Republic
| | - Francois-Xavier Mbopi-Keou
- The University of Yaounde I, Yaounde, Cameroon.,The Institute for the Development of Africa (The-IDA), Yaounde, Cameroon.,UNAIDS Scientific and Technical Advisory Committee (STAC) and The Board of Health Innovation Exchange, Geneva, Switzerland
| | - Christian Diamant Mossoro-Kpinde
- Faculté des Sciences de la Santé, Université de Bangui, Bangui, Central African Republic.,Laboratoire National de Biologie Clinique et de Santé Publique, Bangui, Central African Republic
| | - Gérard Grésenguet
- Faculté des Sciences de la Santé, Université de Bangui, Bangui, Central African Republic
| | - David Veyer
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Bélec
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Sorbonne Paris Cité, INSERM U970, PARCC, Paris, France
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