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Fox T, Geppert J, Dinnes J, Scandrett K, Bigio J, Sulis G, Hettiarachchi D, Mathangasinghe Y, Weeratunga P, Wickramasinghe D, Bergman H, Buckley BS, Probyn K, Sguassero Y, Davenport C, Cunningham J, Dittrich S, Emperador D, Hooft L, Leeflang MM, McInnes MD, Spijker R, Struyf T, Van den Bruel A, Verbakel JY, Takwoingi Y, Taylor-Phillips S, Deeks JJ. Antibody tests for identification of current and past infection with SARS-CoV-2. Cochrane Database Syst Rev 2022; 11:CD013652. [PMID: 36394900 PMCID: PMC9671206 DOI: 10.1002/14651858.cd013652.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The diagnostic challenges associated with the COVID-19 pandemic resulted in rapid development of diagnostic test methods for detecting SARS-CoV-2 infection. Serology tests to detect the presence of antibodies to SARS-CoV-2 enable detection of past infection and may detect cases of SARS-CoV-2 infection that were missed by earlier diagnostic tests. Understanding the diagnostic accuracy of serology tests for SARS-CoV-2 infection may enable development of effective diagnostic and management pathways, inform public health management decisions and understanding of SARS-CoV-2 epidemiology. OBJECTIVES To assess the accuracy of antibody tests, firstly, to determine if a person presenting in the community, or in primary or secondary care has current SARS-CoV-2 infection according to time after onset of infection and, secondly, to determine if a person has previously been infected with SARS-CoV-2. Sources of heterogeneity investigated included: timing of test, test method, SARS-CoV-2 antigen used, test brand, and reference standard for non-SARS-CoV-2 cases. SEARCH METHODS The COVID-19 Open Access Project living evidence database from the University of Bern (which includes daily updates from PubMed and Embase and preprints from medRxiv and bioRxiv) was searched on 30 September 2020. We included additional publications from the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) 'COVID-19: Living map of the evidence' and the Norwegian Institute of Public Health 'NIPH systematic and living map on COVID-19 evidence'. We did not apply language restrictions. SELECTION CRITERIA We included test accuracy studies of any design that evaluated commercially produced serology tests, targeting IgG, IgM, IgA alone, or in combination. Studies must have provided data for sensitivity, that could be allocated to a predefined time period after onset of symptoms, or after a positive RT-PCR test. Small studies with fewer than 25 SARS-CoV-2 infection cases were excluded. We included any reference standard to define the presence or absence of SARS-CoV-2 (including reverse transcription polymerase chain reaction tests (RT-PCR), clinical diagnostic criteria, and pre-pandemic samples). DATA COLLECTION AND ANALYSIS We use standard screening procedures with three reviewers. Quality assessment (using the QUADAS-2 tool) and numeric study results were extracted independently by two people. Other study characteristics were extracted by one reviewer and checked by a second. We present sensitivity and specificity with 95% confidence intervals (CIs) for each test and, for meta-analysis, we fitted univariate random-effects logistic regression models for sensitivity by eligible time period and for specificity by reference standard group. Heterogeneity was investigated by including indicator variables in the random-effects logistic regression models. We tabulated results by test manufacturer and summarised results for tests that were evaluated in 200 or more samples and that met a modification of UK Medicines and Healthcare products Regulatory Agency (MHRA) target performance criteria. MAIN RESULTS We included 178 separate studies (described in 177 study reports, with 45 as pre-prints) providing 527 test evaluations. The studies included 64,688 samples including 25,724 from people with confirmed SARS-CoV-2; most compared the accuracy of two or more assays (102/178, 57%). Participants with confirmed SARS-CoV-2 infection were most commonly hospital inpatients (78/178, 44%), and pre-pandemic samples were used by 45% (81/178) to estimate specificity. Over two-thirds of studies recruited participants based on known SARS-CoV-2 infection status (123/178, 69%). All studies were conducted prior to the introduction of SARS-CoV-2 vaccines and present data for naturally acquired antibody responses. Seventy-nine percent (141/178) of studies reported sensitivity by week after symptom onset and 66% (117/178) for convalescent phase infection. Studies evaluated enzyme-linked immunosorbent assays (ELISA) (165/527; 31%), chemiluminescent assays (CLIA) (167/527; 32%) or lateral flow assays (LFA) (188/527; 36%). Risk of bias was high because of participant selection (172, 97%); application and interpretation of the index test (35, 20%); weaknesses in the reference standard (38, 21%); and issues related to participant flow and timing (148, 82%). We judged that there were high concerns about the applicability of the evidence related to participants in 170 (96%) studies, and about the applicability of the reference standard in 162 (91%) studies. Average sensitivities for current SARS-CoV-2 infection increased by week after onset for all target antibodies. Average sensitivity for the combination of either IgG or IgM was 41.1% in week one (95% CI 38.1 to 44.2; 103 evaluations; 3881 samples, 1593 cases), 74.9% in week two (95% CI 72.4 to 77.3; 96 evaluations, 3948 samples, 2904 cases) and 88.0% by week three after onset of symptoms (95% CI 86.3 to 89.5; 103 evaluations, 2929 samples, 2571 cases). Average sensitivity during the convalescent phase of infection (up to a maximum of 100 days since onset of symptoms, where reported) was 89.8% for IgG (95% CI 88.5 to 90.9; 253 evaluations, 16,846 samples, 14,183 cases), 92.9% for IgG or IgM combined (95% CI 91.0 to 94.4; 108 evaluations, 3571 samples, 3206 cases) and 94.3% for total antibodies (95% CI 92.8 to 95.5; 58 evaluations, 7063 samples, 6652 cases). Average sensitivities for IgM alone followed a similar pattern but were of a lower test accuracy in every time slot. Average specificities were consistently high and precise, particularly for pre-pandemic samples which provide the least biased estimates of specificity (ranging from 98.6% for IgM to 99.8% for total antibodies). Subgroup analyses suggested small differences in sensitivity and specificity by test technology however heterogeneity in study results, timing of sample collection, and smaller sample numbers in some groups made comparisons difficult. For IgG, CLIAs were the most sensitive (convalescent-phase infection) and specific (pre-pandemic samples) compared to both ELISAs and LFAs (P < 0.001 for differences across test methods). The antigen(s) used (whether from the Spike-protein or nucleocapsid) appeared to have some effect on average sensitivity in the first weeks after onset but there was no clear evidence of an effect during convalescent-phase infection. Investigations of test performance by brand showed considerable variation in sensitivity between tests, and in results between studies evaluating the same test. For tests that were evaluated in 200 or more samples, the lower bound of the 95% CI for sensitivity was 90% or more for only a small number of tests (IgG, n = 5; IgG or IgM, n = 1; total antibodies, n = 4). More test brands met the MHRA minimum criteria for specificity of 98% or above (IgG, n = 16; IgG or IgM, n = 5; total antibodies, n = 7). Seven assays met the specified criteria for both sensitivity and specificity. In a low-prevalence (2%) setting, where antibody testing is used to diagnose COVID-19 in people with symptoms but who have had a negative PCR test, we would anticipate that 1 (1 to 2) case would be missed and 8 (5 to 15) would be falsely positive in 1000 people undergoing IgG or IgM testing in week three after onset of SARS-CoV-2 infection. In a seroprevalence survey, where prevalence of prior infection is 50%, we would anticipate that 51 (46 to 58) cases would be missed and 6 (5 to 7) would be falsely positive in 1000 people having IgG tests during the convalescent phase (21 to 100 days post-symptom onset or post-positive PCR) of SARS-CoV-2 infection. AUTHORS' CONCLUSIONS Some antibody tests could be a useful diagnostic tool for those in whom molecular- or antigen-based tests have failed to detect the SARS-CoV-2 virus, including in those with ongoing symptoms of acute infection (from week three onwards) or those presenting with post-acute sequelae of COVID-19. However, antibody tests have an increasing likelihood of detecting an immune response to infection as time since onset of infection progresses and have demonstrated adequate performance for detection of prior infection for sero-epidemiological purposes. The applicability of results for detection of vaccination-induced antibodies is uncertain.
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Affiliation(s)
- Tilly Fox
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Julia Geppert
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jacqueline Dinnes
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Katie Scandrett
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jacob Bigio
- Research Institute of the McGill University Health Centre, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Giorgia Sulis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Dineshani Hettiarachchi
- Department of Anatomy Genetics and Biomedical Informatics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Yasith Mathangasinghe
- Department of Anatomy Genetics and Biomedical Informatics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Australian Regenerative Medicine Institute, Monash University, Clayton, Australia
| | - Praveen Weeratunga
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | | | - Brian S Buckley
- Cochrane Response, Cochrane, London, UK
- Department of Surgery, University of the Philippines, Manila, Philippines
| | | | | | - Clare Davenport
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Jane Cunningham
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Lotty Hooft
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht , Netherlands
| | - Mariska Mg Leeflang
- Epidemiology and Data Science, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Amsterdam, Netherlands
| | | | - René Spijker
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Thomas Struyf
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Ann Van den Bruel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jan Y Verbakel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Sian Taylor-Phillips
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan J Deeks
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
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2
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Siddiqui SM, Bowman KA, Zhu AL, Fischinger S, Beger S, Maron JS, Bartsch YC, Atyeo C, Gorman MJ, Yanis A, Hultquist JF, Lorenzo-Redondo R, Ozer EA, Simons LM, Talj R, Rankin DA, Chapman L, Meade K, Steinhart J, Mullane S, Siebert S, Streeck H, Sabeti P, Halasa N, Musk ER, Barouch DH, Menon AS, Nilles EJ, Lauffenburger DA, Alter G. Serological Markers of SARS-CoV-2 Reinfection. mBio 2022; 13:e0214121. [PMID: 35073738 PMCID: PMC8787477 DOI: 10.1128/mbio.02141-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/13/2021] [Indexed: 01/09/2023] Open
Abstract
As public health guidelines throughout the world have relaxed in response to vaccination campaigns against SARS-CoV-2, it is likely that SARS-CoV-2 will remain endemic, fueled by the rise of more infectious SARS-CoV-2 variants. Moreover, in the setting of waning natural and vaccine immunity, reinfections have emerged across the globe, even among previously infected and vaccinated individuals. As such, the ability to detect reexposure to and reinfection by SARS-CoV-2 is a key component for global protection against this virus and, more importantly, against the potential emergence of vaccine escape mutations. Accordingly, there is a strong and continued need for the development and deployment of simple methods to detect emerging hot spots of reinfection to inform targeted pandemic response and containment, including targeted and specific deployment of vaccine booster campaigns. In this study, we identify simple, rapid immune biomarkers of reinfection in rhesus macaques, including IgG3 antibody levels against nucleocapsid and FcγR2A receptor binding activity of anti-RBD antibodies, that are recapitulated in human reinfection cases. As such, this cross-species analysis underscores the potential utility of simple antibody titers and function as price-effective and scalable markers of reinfection to provide increased resolution and resilience against new outbreaks. IMPORTANCE As public health and social distancing guidelines loosen in the setting of waning global natural and vaccine immunity, a deeper understanding of the immunological response to reexposure and reinfection to this highly contagious pathogen is necessary to maintain public health. Viral sequencing analysis provides a robust but unrealistic means to monitor reinfection globally. The identification of scalable pathogen-specific biomarkers of reexposure and reinfection, however, could significantly accelerate our capacity to monitor the spread of the virus through naive and experienced hosts, providing key insights into mechanisms of disease attenuation. Using a nonhuman primate model of controlled SARS-CoV-2 reexposure, we deeply probed the humoral immune response following rechallenge with various doses of viral inocula. We identified virus-specific humoral biomarkers of reinfection, with significant increases in antibody titer and function upon rechallenge across a range of humoral features, including IgG1 to the receptor binding domain of the spike protein of SARS-CoV-2 (RBD), IgG3 to the nucleocapsid protein (N), and FcγR2A receptor binding to anti-RBD antibodies. These features not only differentiated primary infection from reexposure and reinfection in monkeys but also were recapitulated in a sequencing-confirmed reinfection patient and in a cohort of putatively reinfected humans that evolved a PCR-positive test in spite of preexisting seropositivity. As such, this cross-species analysis using a controlled primate model and human cohorts reveals increases in antibody titers as promising cross-validated serological markers of reinfection and reexposure.
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Affiliation(s)
- Sameed M. Siddiqui
- Computational and Systems Biology Program, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Kathryn A. Bowman
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Alex L. Zhu
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Stephanie Fischinger
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- PhD Program in Immunology and Virology, University of Duisburg-Essen, Essen, Germany
| | - Samuel Beger
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Jenny S. Maron
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- PhD Program in Virology, Division of Medical Sciences, Harvard University, Boston, Massachusetts, USA
| | - Yannic C. Bartsch
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Caroline Atyeo
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- PhD Program in Virology, Division of Medical Sciences, Harvard University, Boston, Massachusetts, USA
| | - Matthew J. Gorman
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Ahmad Yanis
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Judd F. Hultquist
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Pathogen Genomics and Microbial Evolution, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ramon Lorenzo-Redondo
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Pathogen Genomics and Microbial Evolution, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Egon A. Ozer
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Pathogen Genomics and Microbial Evolution, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lacy M. Simons
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Pathogen Genomics and Microbial Evolution, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rana Talj
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Danielle A. Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Lindsay Chapman
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Kyle Meade
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Jordan Steinhart
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Sean Mullane
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Suzanne Siebert
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Hendrik Streeck
- Institute of Virology, University Hospital, University of Bonn, and German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Pardis Sabeti
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
- Howard Hughes Medical Institute, Chevy Chase, Maryland, USA
- Massachusetts Consortium on Pathogen Readiness, Boston, Massachusetts, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elon R. Musk
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Dan H. Barouch
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
| | - Anil S. Menon
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Eric J. Nilles
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
- Harvard Humanitarian Initiative, Boston, Massachusetts, USA
| | - Douglas A. Lauffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- Massachusetts Consortium on Pathogen Readiness, Boston, Massachusetts, USA
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3
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Trombetta BA, Kandigian SE, Kitchen RR, Grauwet K, Webb PK, Miller GA, Jennings CG, Jain S, Miller S, Kuo Y, Sweeney T, Gilboa T, Norman M, Simmons DP, Ramirez CE, Bedard M, Fink C, Ko J, De León Peralta EJ, Watts G, Gomez-Rivas E, Davis V, Barilla RM, Wang J, Cunin P, Bates S, Morrison-Smith C, Nicholson B, Wong E, El-Mufti L, Kann M, Bolling A, Fortin B, Ventresca H, Zhou W, Pardo S, Kwock M, Hazra A, Cheng L, Ahmad QR, Toombs JA, Larson R, Pleskow H, Luo NM, Samaha C, Pandya UM, De Silva P, Zhou S, Ganhadeiro Z, Yohannes S, Gay R, Slavik J, Mukerji SS, Jarolim P, Walt DR, Carlyle BC, Ritterhouse LL, Suliman S. Evaluation of serological lateral flow assays for severe acute respiratory syndrome coronavirus-2. BMC Infect Dis 2021; 21:580. [PMID: 34134647 PMCID: PMC8206878 DOI: 10.1186/s12879-021-06257-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/25/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND COVID-19 has resulted in significant morbidity and mortality worldwide. Lateral flow assays can detect anti-Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) antibodies to monitor transmission. However, standardized evaluation of their accuracy and tools to aid in interpreting results are needed. METHODS We evaluated 20 IgG and IgM assays selected from available tests in April 2020. We evaluated the assays' performance using 56 pre-pandemic negative and 56 SARS-CoV-2-positive plasma samples, collected 10-40 days after symptom onset, confirmed by a molecular test and analyzed by an ultra-sensitive immunoassay. Finally, we developed a user-friendly web app to extrapolate the positive predictive values based on their accuracy and local prevalence. RESULTS Combined IgG + IgM sensitivities ranged from 33.9 to 94.6%, while combined specificities ranged from 92.6 to 100%. The highest sensitivities were detected in Lumiquick for IgG (98.2%), BioHit for both IgM (96.4%), and combined IgG + IgM sensitivity (94.6%). Furthermore, 11 LFAs and 8 LFAs showed perfect specificity for IgG and IgM, respectively, with 15 LFAs showing perfect combined IgG + IgM specificity. Lumiquick had the lowest estimated limit-of-detection (LOD) (0.1 μg/mL), followed by a similar LOD of 1.5 μg/mL for CareHealth, Cellex, KHB, and Vivachek. CONCLUSION We provide a public resource of the accuracy of select lateral flow assays with potential for home testing. The cost-effectiveness, scalable manufacturing process, and suitability for self-testing makes LFAs an attractive option for monitoring disease prevalence and assessing vaccine responsiveness. Our web tool provides an easy-to-use interface to demonstrate the impact of prevalence and test accuracy on the positive predictive values.
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Affiliation(s)
- Bianca A Trombetta
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Boston, MA, USA
| | - Savannah E Kandigian
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Boston, MA, USA
| | - Robert R Kitchen
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Mass General Brigham Innovation, Boston, MA, USA
| | - Korneel Grauwet
- Cardiology Division, Massachusetts General Hospital, Charlestown, MA, USA
| | - Pia Kivisäkk Webb
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Charles G Jennings
- Cardiology Division, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sejal Jain
- Department of Medical Oncology and Center for Cancer-Genome Discovery, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Samara Miller
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Stem Cell Institute, Cambridge, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Yikai Kuo
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Boston, MA, USA
- Cardiology Division, Massachusetts General Hospital, Charlestown, MA, USA
| | - Thadryan Sweeney
- Cardiology Division, Massachusetts General Hospital, Charlestown, MA, USA
| | - Tal Gilboa
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maia Norman
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Sackler School of Biomedical Sciences, Tufts University School of Medicine, Boston, MA, USA
| | - Daimon P Simmons
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher E Ramirez
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Boston, MA, USA
| | - Melissa Bedard
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Catherine Fink
- Medical Diagnostic Technology Evaluation, LLC, Carlisle, MA, USA
| | - Jina Ko
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Esmarline J De León Peralta
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
- Wellman Center for Photomedicine, Massachusetts General Research Institute, Boston, MA, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Gerald Watts
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Emma Gomez-Rivas
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Vannessa Davis
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rocky M Barilla
- Evergrande Center for Immunologic Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Jianing Wang
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Pierre Cunin
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Samuel Bates
- Functional Genomics Laboratory, Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Chevaun Morrison-Smith
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin Nicholson
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Edmond Wong
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Leena El-Mufti
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Boston, MA, USA
| | - Michael Kann
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Anna Bolling
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Boston, MA, USA
| | - Brooke Fortin
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Boston, MA, USA
| | - Hayden Ventresca
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Wen Zhou
- Division of Nephrology and Endocrine Unit Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Santiago Pardo
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Boston, MA, USA
| | - Megan Kwock
- Cancer Center Protocol Office, Massachusetts General Hospital, Boston, MA, USA
| | - Aditi Hazra
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Preventative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Leo Cheng
- Radiology and pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Q Rushdy Ahmad
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - James A Toombs
- Brigham Research Institute, Brigham and Women's Hospital, Boston, MA, USA
| | - Rebecca Larson
- Immunology Program, Harvard Medical School, Boston, MA, USA
- Cellular Immunotherapy Program, Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - Haley Pleskow
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Unnati M Pandya
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Vincent Center for Reproductive Biology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Pushpamali De Silva
- Wellman Center for Photomedicine, Massachusetts General Research Institute, Boston, MA, USA
| | - Sally Zhou
- Department of Biology, Northeastern University, Boston, MA, USA
- College of Science, Northeastern University, Boston, MA, USA
| | - Zakary Ganhadeiro
- Department of Biology, Northeastern University, Boston, MA, USA
- College of Science, Northeastern University, Boston, MA, USA
| | - Sara Yohannes
- Brigham Research Institute, Brigham and Women's Hospital, Boston, MA, USA
| | - Rakiesha Gay
- Brigham Research Institute, Brigham and Women's Hospital, Boston, MA, USA
- College of Science, Northeastern University, Boston, MA, USA
| | - Jacqueline Slavik
- Brigham Research Institute, Brigham and Women's Hospital, Boston, MA, USA
| | - Shibani S Mukerji
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Boston, MA, USA
| | - Petr Jarolim
- Department of Pathology, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David R Walt
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Mass General Brigham COVID Center for Innovation, Diagnostics Accelerator, Boston, MA, USA
| | - Becky C Carlyle
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Lauren L Ritterhouse
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
- Mass General Brigham COVID Center for Innovation, Diagnostics Accelerator, Boston, MA, USA
| | - Sara Suliman
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA.
- Mass General Brigham COVID Center for Innovation, Diagnostics Accelerator, Boston, MA, USA.
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4
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Bartsch YC, Fischinger S, Siddiqui SM, Chen Z, Yu J, Gebre M, Atyeo C, Gorman MJ, Zhu AL, Kang J, Burke JS, Slein M, Gluck MJ, Beger S, Hu Y, Rhee J, Petersen E, Mormann B, Aubin MDS, Hasdianda MA, Jambaulikar G, Boyer EW, Sabeti PC, Barouch DH, Julg BD, Musk ER, Menon AS, Lauffenburger DA, Nilles EJ, Alter G. Discrete SARS-CoV-2 antibody titers track with functional humoral stability. Nat Commun 2021; 12:1018. [PMID: 33589636 PMCID: PMC7884400 DOI: 10.1038/s41467-021-21336-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/20/2021] [Indexed: 02/03/2023] Open
Abstract
Antibodies serve as biomarkers of infection, but if sustained can confer long-term immunity. Yet, for most clinically approved vaccines, binding antibody titers only serve as a surrogate of protection. Instead, the ability of vaccine induced antibodies to neutralize or mediate Fc-effector functions is mechanistically linked to protection. While evidence has begun to point to persisting antibody responses among SARS-CoV-2 infected individuals, cases of re-infection have begun to emerge, calling the protective nature of humoral immunity against this highly infectious pathogen into question. Using a community-based surveillance study, we aimed to define the relationship between titers and functional antibody activity to SARS-CoV-2 over time. Here we report significant heterogeneity, but limited decay, across antibody titers amongst 120 identified seroconverters, most of whom had asymptomatic infection. Notably, neutralization, Fc-function, and SARS-CoV-2 specific T cell responses were only observed in subjects that elicited RBD-specific antibody titers above a threshold. The findings point to a switch-like relationship between observed antibody titer and function, where a distinct threshold of activity-defined by the level of antibodies-is required to elicit vigorous humoral and cellular response. This response activity level may be essential for durable protection, potentially explaining why re-infections occur with SARS-CoV-2 and other common coronaviruses.
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Affiliation(s)
| | - Stephanie Fischinger
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
- Institut für HIV Forschung, Universität Duisburg-Essen, Duisburg, Germany
| | - Sameed M Siddiqui
- Computational and Systems Biology Program, Massachusetts Institute of Technology, Cambridge, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Zhilin Chen
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Jingyou Yu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Makda Gebre
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Caroline Atyeo
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | | | - Alex Lee Zhu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Jaewon Kang
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - John S Burke
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Matthew Slein
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Matthew J Gluck
- Space Exploration Technologies Corp, Hawthorne, CA, USA
- Icahn School of Medicine at Mount Sinai, Nw York, USA
| | - Samuel Beger
- Space Exploration Technologies Corp, Hawthorne, CA, USA
| | - Yiyuan Hu
- Space Exploration Technologies Corp, Hawthorne, CA, USA
| | - Justin Rhee
- Space Exploration Technologies Corp, Hawthorne, CA, USA
| | - Eric Petersen
- Space Exploration Technologies Corp, Hawthorne, CA, USA
| | | | | | | | | | | | - Pardis C Sabeti
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
- Massachusetts Consortium on Pandemic Readiness, Cambridge, MA, USA
| | - Dan H Barouch
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Massachusetts Consortium on Pandemic Readiness, Cambridge, MA, USA
| | - Boris D Julg
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Elon R Musk
- Space Exploration Technologies Corp, Hawthorne, CA, USA
| | - Anil S Menon
- Space Exploration Technologies Corp, Hawthorne, CA, USA.
| | - Douglas A Lauffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | | | - Galit Alter
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA.
- Massachusetts Consortium on Pandemic Readiness, Cambridge, MA, USA.
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5
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Nilles EJ, Siddiqui SM, Fischinger S, Bartsch YC, de Saint Aubin M, Zhou G, Gluck MJ, Berger S, Rhee J, Petersen E, Mormann B, Loesche M, Chen Z, Yu J, Gebre M, Atyeo C, Gorman MJ, Lee Zhu A, Burke J, Slein M, Hasdianda MA, Jambaulikar G, Boyer E, Sabeti P, Barouch DH, Julg BD, Kucharski AJ, Musk ER, Lauffenburger DA, Alter G, Menon AS. Epidemiological and immunological features of obesity and SARS-CoV-2. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.11.11.20229724. [PMID: 33200139 PMCID: PMC7668749 DOI: 10.1101/2020.11.11.20229724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Obesity is a key correlate of severe SARS-CoV-2 outcomes while the role of obesity on risk of SARS-CoV-2 infection, symptom phenotype, and immune response are poorly defined. We examined data from a prospective SARS-CoV-2 cohort study to address these questions. Serostatus, body mass index, demographics, comorbidities, and prior COVID-19 compatible symptoms were assessed at baseline and serostatus and symptoms monthly thereafter. SARS-CoV-2 immunoassays included an IgG ELISA targeting the spike RBD, multiarray Luminex targeting 20 viral antigens, pseudovirus neutralization, and T cell ELISPOT assays. Our results from a large prospective SARS-CoV-2 cohort study indicate symptom phenotype is strongly influenced by obesity among younger but not older age groups; we did not identify evidence to suggest obese individuals are at higher risk of SARS-CoV-2 infection; and, remarkably homogenous immune activity across BMI categories suggests natural- and vaccine-induced protection may be similar across these groups.
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Affiliation(s)
- Eric J Nilles
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Harvard Humanitarian Initiative, Boston, MA
- Massachusetts Consortium on Pathogen Readiness, Boston, MA
| | - Sameed M Siddiqui
- Computational and Systems Biology Program, Massachusetts Institute of Technology, Cambridge, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
| | | | | | | | - Guohai Zhou
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Matthew J Gluck
- Space Exploration Technologies Corp, Hawthorne, CA
- Icahn School of Medicine- Mount Sinai, New York, NY
| | | | - Justin Rhee
- Space Exploration Technologies Corp, Hawthorne, CA
| | | | - Benjamin Mormann
- Brigham and Women’s Hospital, Boston, MA
- Space Exploration Technologies Corp, Hawthorne, CA
| | - Michael Loesche
- Brigham and Women’s Hospital, Boston, MA
- Space Exploration Technologies Corp, Hawthorne, CA
| | - Zhilin Chen
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
| | - Jingyou Yu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Makda Gebre
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
- Harvard T.H. Chan School of Public Health, Boston, MA
| | | | | | - Alex Lee Zhu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
| | - John Burke
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
| | - Matthew Slein
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
| | | | | | - Edward Boyer
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Pardis Sabeti
- Massachusetts Consortium on Pathogen Readiness, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
- Harvard T.H. Chan School of Public Health, Boston, MA
- Howard Hughes Medical Institute, Chevy Chase, MD
| | - Dan H Barouch
- Broad Institute of MIT and Harvard, Cambridge, MA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Boris D Julg
- Broad Institute of MIT and Harvard, Cambridge, MA
| | | | - Elon R Musk
- Space Exploration Technologies Corp, Hawthorne, CA
| | | | - Galit Alter
- Massachusetts Consortium on Pathogen Readiness, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Anil S Menon
- Space Exploration Technologies Corp, Hawthorne, CA
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6
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Yue H, Nowak RP, Overwijn D, Payne NC, Fischinger S, Atyeo C, Baden LR, Nilles EJ, Karlson EW, Yu XG, Li JZ, Alter G, Mazitschek R, Fischer ES. Rapid 'mix and read' assay for scalable detection of SARS-CoV-2 antibodies in patient plasma. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.09.01.20184101. [PMID: 32909004 PMCID: PMC7480056 DOI: 10.1101/2020.09.01.20184101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The human beta coronavirus SARS-CoV-2, causative virus of COVID-19, has infected more than 15 million people globally and continues to spread. Widespread, population level testing to detect active and past infections is critical to curb the COVID-19 pandemic. Antibody (serological) testing is the only option for detecting past infections outside the narrow window accessible to nucleic acid-based tests. However, currently available serological assays commonly lack scalability. Here, we describe the development of a rapid homogenous serological assay for the detection of antibodies to SARS-CoV-2 in patient plasma. We show that the fluorescence-based assay accurately detects seroconversion in COVID-19 patients from less than 1 microliter of plasma. Using a cohort of samples from COVID-19 infected or healthy individuals, we demonstrate detection with 100% sensitivity and specificity. This assay addresses an important need for a robust, low barrier to implementation, and scalable serological assay with complementary strengths to currently available serological platforms.
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