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Hills T, Paterson A, Woodward R, Middleton F, Carlton LH, McGregor R, Barfoot S, Ramiah C, Whitcombe AL, Zimbron VM, Mahuika D, Brown J, Palmer-Neels K, Manning B, Jani D, Reeves B, Whitta GT, Morpeth S, Beasley R, Weatherall M, Jordan A, McIntyre P, Moreland NJ, Mirjalili SA. The effect of needle length and skin to deltoid muscle distance in adults receiving an mRNA COVID-19 vaccine. Vaccine 2022; 40:4827-4834. [PMID: 35792021 PMCID: PMC9239984 DOI: 10.1016/j.vaccine.2022.06.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 01/07/2023]
Abstract
Background The mRNA COVID vaccines are only licensed for intramuscular injection but it is unclear whether successful intramuscular administration is required for immunogenicity. Methods In this observational study, eligible adults receiving their first ComirnatyTM/BNT162b2 dose had their skin to deltoid muscle distance (SDMD) measured by ultrasound. The relationship between SDMD and height, weight, body mass index, and arm circumference was assessed. Three needle length groups were identified: ‘clearly sufficient’ (needle exceeding SDMD by >5 mm), ‘probably sufficient’ (needle exceeding SDMD by ≤ 5 mm), and ‘insufficient’ (needle length ≤ SDMD). Baseline and follow-up finger prick blood samples were collected and the primary outcome variable was mean spike antibody levels in the three needle length groups. Results Participants (n = 402) had a mean age of 34.7 years, BMI 29.1 kg/m2, arm circumference 37.5 cm, and SDMD 13.3 mm. The SDMD was >25 mm in 23/402 (5.7%) and >20 mm in 61/402 (15.2%) participants. Both arm circumference (≥40 cm) and BMI (≥33 kg/m2) were able to identify those with a SDMD of >25 mm, the length of a standard injection needle, with a sensitivity of 100% and specificities of 71.2 and 79.9%, respectively. Of 249/402 (62%) participants with paired blood samples, there was no significant difference in spike antibody titres between needle length groups. The mean (SD) spike BAU/mL was 464.5 (677.1) in 'clearly sufficient needle length' (n = 217) compared with 506.4 (265.1) in 'probably sufficient' (n = 21, p = 0.09), and 489.4 (452.3) in 'insufficient needle length' (n = 11, p = 0.65). Conclusions A 25 mm needle length is likely to be inadequate to ensure vaccine deposition within the deltoid muscle in a small proportion of adults. Vaccine-induced spike antibody titres were comparable in those vaccinated with a needle of sufficient versus insufficient length suggesting deltoid muscle deposition may not be required for an adequate antibody response to mRNA vaccines.
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Affiliation(s)
- Thomas Hills
- Medical Research Institute of New Zealand, New Zealand; Auckland District Health Board, New Zealand
| | - Aimee Paterson
- School of Medical Sciences, The University of Auckland, New Zealand
| | - Rebecca Woodward
- Auckland Radiology Group Auckland Radiology Group, Auckland, New Zealand
| | | | - Lauren H Carlton
- School of Medical Sciences, The University of Auckland, New Zealand
| | - Reuben McGregor
- School of Medical Sciences, The University of Auckland, New Zealand
| | | | - Ciara Ramiah
- School of Medical Sciences, The University of Auckland, New Zealand
| | | | - Victor M Zimbron
- School of Medical Sciences, The University of Auckland, New Zealand
| | - David Mahuika
- School of Medical Sciences, The University of Auckland, New Zealand
| | - Joshua Brown
- School of Medical Sciences, The University of Auckland, New Zealand
| | | | - Brittany Manning
- School of Medical Sciences, The University of Auckland, New Zealand
| | - Devanshi Jani
- School of Medical Sciences, The University of Auckland, New Zealand
| | - Brooke Reeves
- School of Medical Sciences, The University of Auckland, New Zealand
| | - Georgia T Whitta
- School of Medical Sciences, The University of Auckland, New Zealand
| | | | | | - Mark Weatherall
- Capital and Coast District Health Board, New Zealand; University of Otago Wellington, New Zealand
| | | | | | - Nicole J Moreland
- School of Medical Sciences, The University of Auckland, New Zealand.
| | - S Ali Mirjalili
- School of Medical Sciences, The University of Auckland, New Zealand.
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Whitcombe AL, McGregor R, Bennett J, Gurney JK, Williamson DA, Baker MG, Moreland NJ. OUP accepted manuscript. J Infect Dis 2022; 226:167-176. [PMID: 35134931 PMCID: PMC9373162 DOI: 10.1093/infdis/jiac043] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/01/2022] [Indexed: 11/26/2022] Open
Abstract
Background Group A Streptococcus (GAS) causes superficial pharyngitis and skin infections as well as serious autoimmune sequelae such as acute rheumatic fever (ARF) and subsequent rheumatic heart disease. ARF pathogenesis remains poorly understood. Immune priming by repeated GAS infections is thought to trigger ARF, and there is growing evidence for the role of skin infections in this process. Methods We utilized our recently developed 8-plex immunoassay, comprising antigens used in clinical serology for diagnosis of ARF (SLO, DNase B, SpnA), and 5 conserved putative GAS vaccine antigens (Spy0843, SCPA, SpyCEP, SpyAD, Group A carbohydrate), to characterize antibody responses in sera from New Zealand children with a range of clinically diagnosed GAS disease: ARF (n = 79), GAS-positive pharyngitis (n = 94), GAS-positive skin infection (n = 51), and matched healthy controls (n = 90). Results The magnitude and breadth of antibodies in ARF was very high, giving rise to a distinct serological profile. An average of 6.5 antigen-specific reactivities per individual was observed in ARF, compared to 4.2 in skin infections and 3.3 in pharyngitis. Conclusions ARF patients have a unique serological profile, which may be the result of repeated precursor pharyngitis and skin infections that progressively boost antibody breadth and magnitude.
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Affiliation(s)
- Alana L Whitcombe
- School of Medical Sciences and Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
| | - Reuben McGregor
- School of Medical Sciences and Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
| | - Julie Bennett
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jason K Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Deborah A Williamson
- University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nicole J Moreland
- Correspondence: Nicole J. Moreland, BSc, PhD, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand ()
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Whitcombe AL, Han F, McAlister SM, Kirkham LAS, Young PG, Ritchie SR, Atatoa Carr P, Proft T, Moreland NJ. An eight-plex immunoassay for Group A streptococcus serology and vaccine development. J Immunol Methods 2021; 500:113194. [PMID: 34801540 DOI: 10.1016/j.jim.2021.113194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022]
Abstract
Group A Streptococcus (GAS) is a major human pathogen responsible for superficial infections through to life-threatening invasive disease and the autoimmune sequelae acute rheumatic fever (ARF). Despite a significant global economic and health burden, there is no licensed vaccine available to prevent GAS disease. Several pre-clinical vaccines that target conserved GAS antigens are in development. Assays that measure antigen-specific antibodies are essential for vaccine research. The aim of this study was to develop a multiplex beadbased immunoassay that can detect and quantify antibody responses to multiple GAS antigen targets in small volume blood samples. This builds on our existing triplex assay comprised of antigens used in clinical serology for the diagnosis of ARF (SLO, DNase B and SpnA). Five additional conserved putative GAS vaccine antigens (Spy0843, SCPA, SpyCEP, SpyAD and the Group A carbohydrate), were coupled to spectrally unique beads to form an 8-plex antigen panel. After optimisation of the assay protocol, standard curves were generated, and assessments of assay specificity, precision and reproducibility were conducted. A broad range of antibody (IgG) titres were able to be quickly and accurately quantified from a single serum dilution. Assay utility was assessed using a panel of 62 clinical samples including serum from adults with GAS bacteraemia and children with ARF. Circulating IgG to all eight antigens was elevated in patients with GAS disease (n = 23) compared to age-matched controls (n = 39) (P < 0.05). The feasibility of using dried blood samples to quantify antigen-specific IgG was also demonstrated. In summary, a robust and reproducible 8-plex assay has been developed that simultaneously quantifies IgG antibodies to GAS vaccine and diagnostic antigens.
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Affiliation(s)
- Alana L Whitcombe
- School of Medical Sciences, The University of Auckland, New Zealand; Maurice Wilkins Centre for Biodiscovery, The University of Auckland, New Zealand
| | - Franklin Han
- School of Medical Sciences, The University of Auckland, New Zealand
| | - Sonia M McAlister
- Wesfarmers Centre of Vaccines & Infectious Disease, Telethon Kids Institute, Perth, Western Australia, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Lea-Ann S Kirkham
- Wesfarmers Centre of Vaccines & Infectious Disease, Telethon Kids Institute, Perth, Western Australia, Australia; Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Paul G Young
- School of Biological Sciences, The University of Auckland, New Zealand
| | | | | | - Thomas Proft
- School of Medical Sciences, The University of Auckland, New Zealand; Maurice Wilkins Centre for Biodiscovery, The University of Auckland, New Zealand
| | - Nicole J Moreland
- School of Medical Sciences, The University of Auckland, New Zealand; Maurice Wilkins Centre for Biodiscovery, The University of Auckland, New Zealand.
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Bennett J, Moreland NJ, Williamson DA, Carapetis J, Crane J, Whitcombe AL, Jack S, Harwood M, Baker MG. Comparison of group A streptococcal titres in healthy children and those with pharyngitis and skin infections. J Infect 2021; 84:24-30. [PMID: 34710392 DOI: 10.1016/j.jinf.2021.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/04/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Rates of acute rheumatic fever, a sequelae of group A Streptococcal (GAS) infection, remain unacceptably high in Indigenous Māori and Pacific children in New Zealand. This prospective study aimed to describe GAS antibody titres in healthy children (5-14 years) by ethnicity, and to determine how paired titres vary with GAS culture positive and negative pharyngitis, and GAS skin infections. METHODS Analysis included 887 children (32% Māori, 36% Pacific, 33% European/Other) from Auckland, New Zealand. Cases comprise 772 children who had a sore throat or skin infection, which resulted in a swab taken for culture. Healthy controls were asymptomatic (N = 154) and matched by age, ethnicity and region. All participants had a serum sample, with a second sample collected from cases only. Sera were analysed for anti-streptolysin O (ASO) and anti-DNase-B (ADB) antibodies. RESULTS Healthy Māori and Pacific children had higher GAS antibody titres than healthy European/Other children. Children with GAS-positive sore throat had the highest mean ASO titres and children with GAS-positive skin infection had the highest mean ADB titres. When a two-fold increase or an upper limit of normal cut-off (ASO 450 IU/ml, ADB 400 U/ml) was applied to titres from children with GAS-positive sore throat, 62.1% were classified as having serologically confirmed GAS pharyngitis and 37.9% had GAS detected without serological response. CONCLUSIONS Elevated ASO titres were associated with GAS pharyngitis and elevated ADB titres were associated with GAS skin infections in New Zealand children. Higher ASO/ADB titres in healthy Māori and Pacific children could indicate a greater prior exposure to GAS infections.
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Affiliation(s)
- Julie Bennett
- Department of Public Health, University of Otago, 23A Mein Street, Newtown, Wellington 6021, New Zealand.
| | - Nicole J Moreland
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
| | - Deborah A Williamson
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute and Perth Children's Hospital, University of Western Australia, Perth 6009, Australia
| | - Julian Crane
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Alana L Whitcombe
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
| | - Susan Jack
- Public Health South, Southern District Health Board, Dunedin, New Zealand
| | - Matire Harwood
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Michael G Baker
- Department of Public Health, University of Otago, 23A Mein Street, Newtown, Wellington 6021, New Zealand; Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
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Osowicki J, Azzopardi KI, Fabri L, Frost HR, Rivera-Hernandez T, Neeland MR, Whitcombe AL, Grobler A, Gutman SJ, Baker C, Wong JMF, Lickliter JD, Waddington CS, Pandey M, Schuster T, Cheng AC, Pollard AJ, McCarthy JS, Good MF, Dale JB, Batzloff M, Moreland NJ, Walker MJ, Carapetis JR, Smeesters PR, Steer AC. A controlled human infection model of Streptococcus pyogenes pharyngitis (CHIVAS-M75): an observational, dose-finding study. Lancet Microbe 2021; 2:e291-e299. [PMID: 35544165 DOI: 10.1016/s2666-5247(20)30240-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/17/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Streptococcus pyogenes is a leading cause of infection-related morbidity and mortality. A reinvigorated vaccine development effort calls for new clinically relevant human S pyogenes experimental infection models to support proof of concept evaluation of candidate vaccines. We describe the initial Controlled Human Infection for Vaccination Against S pyogenes (CHIVAS-M75) study, in which we aimed to identify a dose of emm75 S pyogenes that causes acute pharyngitis in at least 60% of volunteers when applied to the pharynx by swab. METHODS This observational, dose-finding study was done in a clinical trials facility in Melbourne (VIC, Australia). Groups of healthy volunteers aged 18-40 years, at low risk of complicated S pyogenes disease, and without high type-specific anti-emm75 IgG antibodies against the challenge strain were challenged and closely monitored as inpatients for up to 6 days, and then as outpatients for 6 months. Antibiotics were started upon diagnosis (clinical signs and symptoms of pharyngitis and a positive rapid molecular test) or after 5 days in those without pharyngitis. Rapid test results were confirmed by standard bacterial culture. After a sentinel participant, cohorts of five and then ten participants were challenged, with protocol-directed dose-escalation or de-escalation for subsequent cohorts. The primary outcome was the proportion of participants at each dose level with pharyngitis by day 5 after challenge. The study is registered with ClinicalTrials.gov, NCT03361163. FINDINGS Between July 10, 2018, and Sept 23, 2019, 25 healthy adults were challenged with emm75 S pyogenes and included in analyses. Pharyngitis was diagnosed in 17 (85%; 95% CI 62-97) of 20 participants at the starting dose level (1-3 × 105 colony-forming units [CFU]/mL). This high proportion prompted dose de-escalation. At the lower dose level (1-3 × 104 CFU/mL), pharyngitis was diagnosed in one of five participants. Immunological, biochemical, and microbiological results supported the clinical picture, with acute symptomatic pharyngitis characterised by pharyngeal colonisation by S pyogenes accompanied by significantly elevated C-reactive protein and inflammatory cytokines (eg, interferon-γ and interleukin-6), and modest serological responses to streptolysin O and deoxyribonuclease B. There were no severe (grade 3) or serious adverse events related to challenge. INTERPRETATION We have established a reliable pharyngitis human infection model with reassuring early safety findings to accelerate development of vaccines and other interventions to control disease due to S pyogenes. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Joshua Osowicki
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia.
| | - Kristy I Azzopardi
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Loraine Fabri
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Paediatric Department, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Hannah R Frost
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Tania Rivera-Hernandez
- Unidad de Investigación Médica en Inmunoquímica, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico; School of Chemistry and Molecular Biosciences and Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Melanie R Neeland
- Epigenetics Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Alana L Whitcombe
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Anneke Grobler
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Sarah J Gutman
- Department of Cardiology, The Alfred Hospital, Melbourne, VIC, Australia; Imaging Research, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Ciara Baker
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | | | | | - Claire S Waddington
- Department of Medicine, University of Cambridge, Cambridge, UK; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Manisha Pandey
- The Institute for Glycomics, Griffith University, Gold Coast, QLD, Australia
| | - Tibor Schuster
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, UK
| | - James S McCarthy
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia; QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Michael F Good
- The Institute for Glycomics, Griffith University, Gold Coast, QLD, Australia
| | - James B Dale
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michael Batzloff
- The Institute for Glycomics, Griffith University, Gold Coast, QLD, Australia
| | - Nicole J Moreland
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Mark J Walker
- School of Chemistry and Molecular Biosciences and Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia; Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatric Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia
| | - Pierre R Smeesters
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Paediatric Department, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium; Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew C Steer
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
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Craigie A, McGregor R, Whitcombe AL, Carlton L, Harte D, Sutherland M, Parry M, Smit E, McAuliffe G, Ussher J, Moreland NJ, Jack S, Upton A. SARS-CoV-2 antibodies in the Southern Region of New Zealand, 2020. Pathology 2021; 53:645-651. [PMID: 34119335 PMCID: PMC8130540 DOI: 10.1016/j.pathol.2021.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/15/2022]
Abstract
During New Zealand's first outbreak in early 2020 the Southern Region had the highest per capita SARS-CoV-2 infection rate. Polymerase chain reaction (PCR) testing was initially limited by a narrow case definition and limited laboratory capacity, and cases may have been missed. Our objectives were to evaluate the Abbott SARS-CoV-2 IgG nucleocapsid assay, alongside spike-based assays, and to determine the frequency of antibodies among PCR-confirmed and probable cases, and higher risk individuals in the Southern Region of New Zealand. Pre-pandemic sera (n=300) were used to establish assay specificity and sera from PCR-confirmed SARS-CoV-2 patients (n=78) to establish sensitivity. For prevalence analysis, all samples (n=1214) were tested on the Abbott assay, and all PCR-confirmed cases (n=78), probable cases (n=9), and higher risk individuals with 'grey-zone' (n=14) or positive results (n=11) were tested on four additional SARS-CoV-2 serological assays. The median time from infection onset to serum collection for PCR-confirmed cases was 14 weeks (range 11-17 weeks). The Abbott assay demonstrated a specificity of 99.7% (95% CI 98.2-99.99%) and a sensitivity of 76.9% (95% CI 66.0-85.7%). Spike-based assays demonstrated superior sensitivity ranging 89.7-94.9%. Nine previously undiagnosed sero-positive individuals were identified, and all had epidemiological risk factors. Spike-based assays demonstrated higher sensitivity than the Abbott IgG assay, likely due to temporal differences in antibody persistence. No unexpected SARS-CoV-2 infections were found in the Southern Region of New Zealand, supporting the elimination status of the country at the time this study was conducted.
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Affiliation(s)
- Alyson Craigie
- Southern Community Laboratories, Dunedin, New Zealand; Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Reuben McGregor
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
| | - Alana L Whitcombe
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
| | - Lauren Carlton
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
| | - David Harte
- Institute of Environmental Science and Research, Wellington, New Zealand
| | | | - Matthew Parry
- Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - Erasmus Smit
- Institute of Environmental Science and Research, Wellington, New Zealand
| | - Gary McAuliffe
- Labtests, Auckland, New Zealand; LabPlus, Auckland Hospital, Auckland, New Zealand
| | - James Ussher
- Southern Community Laboratories, Dunedin, New Zealand; Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Nicole J Moreland
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
| | - Susan Jack
- Public Health South, Southern District Health Board, Dunedin, New Zealand
| | - Arlo Upton
- Southern Community Laboratories, Dunedin, New Zealand.
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Whitcombe AL, McGregor R, Craigie A, James A, Charlewood R, Lorenz N, Dickson JM, Sheen CR, Koch B, Fox-Lewis S, McAuliffe G, Roberts SA, Morpeth SC, Taylor S, Webb RH, Jack S, Upton A, Ussher JE, Moreland NJ. Comprehensive analysis of SARS-CoV-2 antibody dynamics in New Zealand. Clin Transl Immunology 2021; 10:e1261. [PMID: 33747511 PMCID: PMC7955949 DOI: 10.1002/cti2.1261] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Circulating antibodies are important markers of previous infection and immunity. Questions remain with respect to the durability and functionality of SARS-CoV-2 antibodies. This study explored antibody responses in recovered COVID-19 patients in a setting where the probability of re-exposure is effectively nil, owing to New Zealand's successful elimination strategy. METHODS A triplex bead-based assay that detects antibody isotype (IgG, IgM and IgA) and subclass (IgG1, IgG2, IgG3 and IgG4) responses against Nucleocapsid (N) protein, the receptor binding domain (RBD) and Spike (S) protein of SARS-CoV-2 was developed. After establishing baseline levels with pre-pandemic control sera (n = 113), samples from PCR-confirmed COVID-19 patients with mild-moderate disease (n = 189) collected up to 8 months post-infection were examined. The relationship between antigen-specific antibodies and neutralising antibodies (NAbs) was explored with a surrogate neutralisation assay that quantifies inhibition of the RBD/hACE-2 interaction. RESULTS While most individuals had broad isotype and subclass responses to each antigen shortly after infection, only RBD and S protein IgG, as well as NAbs, were relatively stable over the study period, with 99%, 96% and 90% of samples, respectively, having responses over baseline 4-8 months post-infection. Anti-RBD antibodies were strongly correlated with NAbs at all time points (Pearson's r ≥ 0.87), and feasibility of using finger prick sampling to accurately measure anti-RBD IgG was demonstrated. CONCLUSION Antibodies to SARS-CoV-2 persist for up to 8 months following mild-to-moderate infection. This robust response can be attributed to the initial exposure without immune boosting given the lack of community transmission in our setting.
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Affiliation(s)
- Alana L Whitcombe
- Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre University of Auckland Auckland New Zealand
| | - Reuben McGregor
- Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre University of Auckland Auckland New Zealand
| | | | - Alex James
- Te Punaha Matatini and School of Mathematics and Statistics University of Canterbury Christchurch New Zealand
| | | | - Natalie Lorenz
- Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre University of Auckland Auckland New Zealand
| | - James Mj Dickson
- School of Biological Sciences University of Auckland Auckland New Zealand
| | - Campbell R Sheen
- Protein Science and Engineering Callaghan Innovation Christchurch New Zealand
| | - Barbara Koch
- Protein Science and Engineering Callaghan Innovation Christchurch New Zealand
| | | | | | - Sally A Roberts
- Maurice Wilkins Centre University of Auckland Auckland New Zealand
- LabPLUS Auckland City Hospital Auckland New Zealand
| | | | | | - Rachel H Webb
- Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre University of Auckland Auckland New Zealand
- Starship Children's Hospital and Kidz First Children's Hospital Auckland New Zealand
| | - Susan Jack
- Public Health South Southern District Health Board Dunedin New Zealand
| | - Arlo Upton
- Southern Community Laboratories Dunedin New Zealand
| | - James E Ussher
- Maurice Wilkins Centre University of Auckland Auckland New Zealand
- Southern Community Laboratories Dunedin New Zealand
- Department of Microbiology and Immunology University of Otago Dunedin New Zealand
| | - Nicole J Moreland
- Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre University of Auckland Auckland New Zealand
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McGregor R, Whitcombe AL, Sheen CR, Dickson JM, Day CL, Carlton LH, Sharma P, Lott JS, Koch B, Bennett J, Baker MG, Ritchie SR, Fox-Lewis S, Morpeth SC, Taylor SL, Roberts SA, Webb RH, Moreland NJ. Collaborative networks enable the rapid establishment of serological assays for SARS-CoV-2 during nationwide lockdown in New Zealand. PeerJ 2020; 8:e9863. [PMID: 32953275 PMCID: PMC7474877 DOI: 10.7717/peerj.9863] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/13/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Serological assays that detect antibodies to SARS-CoV-2 are critical for determining past infection and investigating immune responses in the COVID-19 pandemic. We established ELISA-based immunoassays using locally produced antigens when New Zealand went into a nationwide lockdown and the supply chain of diagnostic reagents was a widely held domestic concern. The relationship between serum antibody binding measured by ELISA and neutralising capacity was investigated using a surrogate viral neutralisation test (sVNT). METHODS A pre-pandemic sera panel (n = 113), including respiratory infections with symptom overlap with COVID-19, was used to establish assay specificity. Sera from PCR‑confirmed SARS-CoV-2 patients (n = 21), and PCR-negative patients with respiratory symptoms suggestive of COVID-19 (n = 82) that presented to the two largest hospitals in Auckland during the lockdown period were included. A two-step IgG ELISA based on the receptor binding domain (RBD) and spike protein was adapted to determine seropositivity, and neutralising antibodies that block the RBD/hACE‑2 interaction were quantified by sVNT. RESULTS The calculated cut-off (>0.2) in the two-step ELISA maximised specificity by classifying all pre-pandemic samples as negative. Sera from all PCR-confirmed COVID-19 patients were classified as seropositive by ELISA ≥7 days after symptom onset. There was 100% concordance between the two-step ELISA and the sVNT with all 7+ day sera from PCR‑confirmed COVID-19 patients also classified as positive with respect to neutralising antibodies. Of the symptomatic PCR-negative cohort, one individual with notable travel history was classified as positive by two-step ELISA and sVNT, demonstrating the value of serology in detecting prior infection. CONCLUSIONS These serological assays were established and assessed at a time when human activity was severely restricted in New Zealand. This was achieved by generous sharing of reagents and technical expertise by the international scientific community, and highly collaborative efforts of scientists and clinicians across the country. The assays have immediate utility in supporting clinical diagnostics, understanding transmission in high-risk cohorts and underpinning longer‑term 'exit' strategies based on effective vaccines and therapeutics.
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Affiliation(s)
- Reuben McGregor
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
| | - Alana L. Whitcombe
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
| | - Campbell R. Sheen
- Protein Science and Engineering, Callaghan Innovation, Christchurch, New Zealand
| | - James M. Dickson
- School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Catherine L. Day
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Lauren H. Carlton
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Prachi Sharma
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - J. Shaun Lott
- Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
- School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Barbara Koch
- Protein Science and Engineering, Callaghan Innovation, Christchurch, New Zealand
| | - Julie Bennett
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Michael G. Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Stephen R. Ritchie
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Infectious Diseases Department, Auckland City Hospital, Auckland, New Zealand
| | - Shivani Fox-Lewis
- Department of Microbiology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | | | | | - Sally A. Roberts
- Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
- Department of Microbiology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Rachel H. Webb
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Starship Children’s Hospital, Auckland, New Zealand
| | - Nicole J. Moreland
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
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Chung AW, Ho TKC, Hanson‐Manful P, Tritscheller S, Raynes JM, Whitcombe AL, Tay ML, McGregor R, Lorenz N, Oliver JR, Gurney JK, Print CG, Wilson NJ, Martin WJ, Williamson DA, Baker MG, Moreland NJ. Systems immunology reveals a linked IgG3–C4 response in patients with acute rheumatic fever. Immunol Cell Biol 2019; 98:12-21. [DOI: 10.1111/imcb.12298] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/08/2019] [Accepted: 10/15/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Amy W Chung
- Peter Doherty Institute for Infection and Immunity University of Melbourne Melbourne VIC Australia
| | - Timothy KC Ho
- School of Medical Sciences University of Auckland Auckland New Zealand
| | - Paulina Hanson‐Manful
- School of Medical Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biodiscovery University of Auckland Auckland New Zealand
| | | | - Jeremy M Raynes
- School of Medical Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biodiscovery University of Auckland Auckland New Zealand
| | - Alana L Whitcombe
- School of Medical Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biodiscovery University of Auckland Auckland New Zealand
| | - Mei Lin Tay
- School of Medical Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biodiscovery University of Auckland Auckland New Zealand
| | - Reuben McGregor
- School of Medical Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biodiscovery University of Auckland Auckland New Zealand
| | - Natalie Lorenz
- School of Medical Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biodiscovery University of Auckland Auckland New Zealand
| | - Jane R Oliver
- Peter Doherty Institute for Infection and Immunity University of Melbourne Melbourne VIC Australia
- University of Otago Wellington New Zealand
| | | | - Cristin G Print
- School of Medical Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biodiscovery University of Auckland Auckland New Zealand
| | | | - William J Martin
- Science for Technological Innovation Science Challenge Callaghan Innovation Wellington New Zealand
| | - Deborah A Williamson
- Peter Doherty Institute for Infection and Immunity University of Melbourne Melbourne VIC Australia
| | | | - Nicole J Moreland
- School of Medical Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biodiscovery University of Auckland Auckland New Zealand
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Hanson-Manful P, Whitcombe AL, Young PG, Atatoa Carr PE, Bell A, Didsbury A, Mitchell EA, Dunbar PR, Proft T, Moreland NJ. The novel Group A Streptococcus antigen SpnA combined with bead-based immunoassay technology improves streptococcal serology for the diagnosis of acute rheumatic fever. J Infect 2017; 76:361-368. [PMID: 29269013 DOI: 10.1016/j.jinf.2017.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/27/2017] [Accepted: 12/12/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Streptococcal serology provides evidence of prior Group A Streptococcus (GAS) exposure, crucial to the diagnosis of acute rheumatic fever (ARF) and post-streptococcal glomerulonephritis. However, current tests, which measure anti-streptolysin-O and anti-DNaseB antibodies, are limited by false positives in GAS endemic settings, and incompatible methodology requiring the two tests to be run in parallel. The objective was to improve streptococcal serology by combining the novel GAS antigen, SpnA, with streptolysin-O and DNaseB in a contemporary, bead-based immunoassay. METHODS Recombinant streptolysin-O, DNAseB and SpnA were conjugated to polystyrene beads with unique fluorescence positions so antibody binding to all three antigens could be detected simultaneously by cytometric bead array. Multiplex assays were run on sera collected in three groups: ARF; ethnically matched healthy children; and healthy adults. RESULTS The ability of the antigens to detect a previous GAS exposure in ARF was assessed using the 80th centile of the healthy children group as cut-off (upper limit of normal). SpnA had the highest sensitivity at 88%, compared with 75% for streptolysin-O and 56% for DNaseB. CONCLUSIONS SpnA has favorable immunokinetics for streptococcal serology, and can be combined with anti-streptolysin-O and anti-DNaseB in a multiplex format to improve efficiency and accuracy.
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Affiliation(s)
- Paulina Hanson-Manful
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand
| | - Alana L Whitcombe
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Paul G Young
- Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand; School of Biological Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Polly E Atatoa Carr
- Waikato District Health Board, Hamilton, New Zealand; National Institute of Demographic and Economic Analysis, University of Waikato, Waikato, New Zealand
| | - Anita Bell
- Waikato District Health Board, Hamilton, New Zealand
| | - Alicia Didsbury
- Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand; School of Biological Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Edwin A Mitchell
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - P Rod Dunbar
- Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand; School of Biological Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Thomas Proft
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand.
| | - Nicole J Moreland
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand.
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