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Hoschler K, Ijaz S, Andrews N, Ho S, Dicks S, Jegatheesan K, Poh J, Warrener L, Kankeyan T, Baawuah F, Beckmann J, Okike IO, Ahmad S, Garstang J, Brent AJ, Brent B, Aiano F, Brown KE, Ramsay ME, Brown D, Parry JV, Ladhani SN, Zambon M. SARS Antibody Testing in Children: Development of Oral Fluid Assays for IgG Measurements. Microbiol Spectr 2022; 10:e0078621. [PMID: 34985331 PMCID: PMC8729769 DOI: 10.1128/spectrum.00786-21] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/01/2021] [Indexed: 12/31/2022] Open
Abstract
Seroepidemiological studies to monitor antibody kinetics are important for assessing the extent and spread of SARS-CoV-2 in a population. Noninvasive sampling methods are advantageous for reducing the need for venipuncture, which may be a barrier to investigations, particularly in pediatric populations. Oral fluids are obtained by gingiva-crevicular sampling from children and adults and are very well accepted. Enzyme immunoassays (EIAs) based on these samples have acceptable sensitivity and specificity compared to conventional serum-based antibody EIAs and are suitable for population-based surveillance. We describe the development and evaluation of SARS-CoV-2 IgG EIAs using SARS-CoV-2 viral nucleoprotein (NP) and spike (S) proteins in IgG isotype capture format and an indirect receptor-binding-domain (RBD) IgG EIA, intended for use in children as a primary endpoint. All three assays were assessed using a panel of 1,999 paired serum and oral fluids from children and adults participating in school SARS-CoV-2 surveillance studies during and after the first and second pandemic wave in the United Kingdom. The anti-NP IgG capture assay was the best candidate, with an overall sensitivity of 75% (95% confidence interval [CI]: 71 to 79%) and specificity of 99% (95% CI: 78 to 99%) compared with paired serum antibodies. Sensitivity observed in children (80%, 95% CI: 71 to 88%) was higher than that in adults (67%, CI: 60% to 74%). Oral fluid assays (OF) using spike protein and RBD antigens were also 99% specific and achieved reasonable but lower sensitivity in the target population (78%, 95% CI [68% to 86%] and 53%, 95% CI [43% to 64%], respectively). IMPORTANCE We report on the first large-scale assessment of the suitability of oral fluids for detection of SARS-CoV-2 antibody obtained from healthy children attending school. The sample type (gingiva-crevicular fluid, which is a transudate of blood but is not saliva) can be self collected. Although detection of antibodies in oral fluids is less sensitive than that in blood, our study suggests an optimal format for operational use. The laboratory methods we have developed can reliably measure antibodies in children, who are able to take their own samples. Our findings are of immediate practical relevance for use in large-scale seroprevalence studies designed to measure exposure to infection, as they typically require venipuncture. Overall, our data indicate that OF assays based on the detection of SARS-CoV-2 antibodies are a tool suitable for population-based seroepidemiology studies in children and highly acceptable in children and adults, as venipuncture is no longer necessary.
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Affiliation(s)
- Katja Hoschler
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Samreen Ijaz
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Nick Andrews
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - Sammy Ho
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Steve Dicks
- Virus Reference Department, Public Health England, London, United Kingdom
- Microbiology Services Laboratory, NHS Blood and Transplant, Bristol, United Kingdom
| | - Keerthana Jegatheesan
- Virus Reference Department, Public Health England, London, United Kingdom
- Microbiology Services Laboratory, NHS Blood and Transplant, Bristol, United Kingdom
| | - John Poh
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Lenesha Warrener
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Thivya Kankeyan
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Frances Baawuah
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | | | | | - Shazaad Ahmad
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Joanna Garstang
- Birmingham Community Healthcare NHS Trust, Aston, United Kingdom
| | - Andrew J. Brent
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- University of Oxford, Oxford, United Kingdom
| | - Bernadette Brent
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- University of Oxford, Oxford, United Kingdom
| | - Felicity Aiano
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - Kevin E. Brown
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - Mary E. Ramsay
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - David Brown
- Virus Reference Department, Public Health England, London, United Kingdom
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Vírus Respiratórios e do Sarampo, Rio de Janeiro, Rio de Janeiro, Brasil
| | - John V. Parry
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Shamez N. Ladhani
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
- Paediatric Infectious Diseases Research Group, St. George’s University of London, London, United Kingdom
| | - Maria Zambon
- Virus Reference Department, Public Health England, London, United Kingdom
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Portilho MM, Bezerra CS, Mendonça ACDF, Marques VA, Nabuco LC, Villela-Nogueira CA, Ivantes CAP, Lewis-Ximenez LL, do Lago BV, Villar LM. Applicability of oral fluid samples for tracking hepatitis B virus mutations, genotyping, and phylogenetic analysis. Arch Virol 2021; 166:2435-2442. [PMID: 34146173 DOI: 10.1007/s00705-021-05122-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
Little is known about the usefulness of saliva samples for hepatitis B virus (HBV) genotyping and mutation analysis. The aim of this study was to evaluate the usefulness of oral fluid samples to determine HBV genotype distribution, S/polymerase mutations, and HBV subpopulation diversity among chronically HBV-infected individuals. Serum and oral fluid samples were obtained from 18 individuals for PCR and nucleotide sequencing of the HBV surface antigen gene. Biochemical analysis of liver enzymes (ALT, AST, GGT) and HBV, HCV, and HIV serological tests were also performed. All serum samples were HBsAg (+), anti-HBc (+), and anti-HBs (-); 55.6% were HBeAg (+)/anti-HBe (-), and 11.1% were anti-HIV (+). The mean HBV DNA viral load was 6.1 ± 2.3 log IU/mL. The HBV genotype distribution was as follows: A, 72.2%; D, 11.1%; E, 5.6%; F, 11.1%. A concordance of 100% in genotype classification and 99.8% in sequence similarity between paired oral fluid and serum samples was observed. HBsAg mutations were detected in all samples, but no resistance mutations were found in the polymerase gene. This study demonstrates that oral fluid samples can be used reliably for tracking HBV mutations, genotyping, and phylogenetic analysis. This could be important for molecular epidemiology studies with hard-to-reach populations.
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Affiliation(s)
- Moyra Machado Portilho
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, FIOCRUZ, Helio and Peggy, Ground Floor, Room B09, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 210360-040, Brazil.,Gonçalo Moniz Research Institute, FIOCRUZ, Salvador, BA, Brazil
| | - Cristianne Sousa Bezerra
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, FIOCRUZ, Helio and Peggy, Ground Floor, Room B09, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 210360-040, Brazil.,Federal Institute of Education, Science and Technology, Fortaleza, CE, Brazil
| | - Ana Carolina da Fonseca Mendonça
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, FIOCRUZ, Helio and Peggy, Ground Floor, Room B09, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 210360-040, Brazil
| | - Vanessa Alves Marques
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, FIOCRUZ, Helio and Peggy, Ground Floor, Room B09, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 210360-040, Brazil
| | - Leticia Cancella Nabuco
- Clementino Fraga Filho Hospital, University of Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
| | | | | | - Lia Laura Lewis-Ximenez
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, FIOCRUZ, Helio and Peggy, Ground Floor, Room B09, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 210360-040, Brazil
| | - Bárbara Vieira do Lago
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, FIOCRUZ, Helio and Peggy, Ground Floor, Room B09, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 210360-040, Brazil.,Immunobiological Technology Institute (Bio-Manguinhos), FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Livia Melo Villar
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, FIOCRUZ, Helio and Peggy, Ground Floor, Room B09, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 210360-040, Brazil.
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Using the Past to Maximize the Success Probability of Future Anti-Viral Vaccines. Vaccines (Basel) 2020; 8:vaccines8040566. [PMID: 33019507 PMCID: PMC7712378 DOI: 10.3390/vaccines8040566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/16/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022] Open
Abstract
Rapid obtaining of safe, effective, anti-viral vaccines has recently risen to the top of the international agenda. To maximize the success probability of future anti-viral vaccines, the anti-viral vaccines successful in the past are summarized here by virus type and vaccine type. The primary focus is on viruses with both single-stranded RNA genomes and a membrane envelope, given the pandemic past of influenza viruses and coronaviruses. The following conclusion is reached, assuming that success of future strategies is positively correlated with strategies successful in the past. The primary strategy, especially for emerging pandemic viruses, should be development of vaccine antigens that are live-attenuated viruses; the secondary strategy should be development of vaccine antigens that are inactivated virus particles. Support for this conclusion comes from the complexity of immune systems. These conclusions imply the need for a revision in current strategic planning.
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