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Zhang X, Chen Y, Pan Y, Ma X, Hu G, Li S, Deng Y, Chen Z, Chen H, Wu Y, Jiang Z, Li Z. Research progress of severe acute respiratory syndrome coronavirus 2 on aerosol collection and detection. CHINESE CHEM LETT 2023:108378. [PMID: 37362323 PMCID: PMC10039702 DOI: 10.1016/j.cclet.2023.108378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/02/2023] [Accepted: 03/22/2023] [Indexed: 06/28/2023]
Abstract
The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late 2019 has negatively affected people's lives and productivity. Because the mode of transmission of SARS-CoV-2 is of great concern, this review discusses the sources of virus aerosols and possible transmission routes. First, we discuss virus aerosol collection methods, including natural sedimentation, solid impact, liquid impact, centrifugal, cyclone and electrostatic adsorption methods. Then, we review common virus aerosol detection methods, including virus culture, metabolic detection, nucleic acid-based detection and immunology-based detection methods. Finally, possible solutions for the detection of SARS-CoV-2 aerosols are introduced. Point-of-care testing has long been a focus of attention. In the near future, the development of an instrument that integrates sampling and output results will enable the real-time, automatic monitoring of patients.
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Affiliation(s)
- Xinyu Zhang
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, China
| | - Yuting Chen
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, China
| | - Yueying Pan
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, China
| | - Xinye Ma
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, China
| | - Gui Hu
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, China
| | - Song Li
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, China
| | - Yan Deng
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, China
| | - Zhu Chen
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, China
| | - Hui Chen
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, China
| | - Yanqi Wu
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, 999078, China
- Shenzhen Lemniscare Med Technol Co. Ltd., Shenzhen, 518000, China
| | - Zhihong Jiang
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, 999078, China
| | - Zhiyang Li
- Department of Clinical Laboratory, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
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Hoang VT, Pham TD, Nguyen QT, Nguyen DC, Nguyen DT, Nguyen TB, Tran TKT, Phan TL, Vo PLN, Dao TL, Fenollar F, Gautret P. Seroprevalence of SARS-CoV-2 among high-density communities and hyper-endemicity of COVID-19 in Vietnam. Trop Med Int Health 2022; 27:515-521. [PMID: 35303386 PMCID: PMC9115418 DOI: 10.1111/tmi.13744] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the magnitude of active and recovering COVID-19 patients among at-risk communities and to identify the factors associated with positive serology. METHODS Four hundred and eighty-three close contacts of COVID-19 patients residing in Ho Chi Minh City, Vietnam, during the fourth wave of the COVID-19 epidemic (September and October 2021) were included. Five weeks after exposure to a COVID-19 patient, they underwent a serology test using the BIOSYNEX COVID-19 BSS kit. RESULTS The median age of participants was 37 years. A total of 34.6% individuals presented at least one clinical symptom between the time of contact with the COVID-19 patient and inclusion in study. A total of 1.7% unvaccinated individuals tested positive for SARS-CoV-2 using real-time PCR, and 9.5% had evidence of recent infection (positive PCR and/or IgM). A further 26.7% unvaccinated individuals presented evidence of a past infection (positive IgG only). Socio-demographic characteristics, vaccination status and clinical symptoms were not associated with a positive IgM test. CONCLUSION This is the first serosurvey conducted during the fourth wave of the epidemic in Vietnam. It revealed a seropositivity rate higher than in previous studies and confirmed the hyperendemicity of SARS-CoV-2. Testing using rapid serological tests proved to be a reliable, easy-to-use method and enabled a rapid estimation of the burden of COVID-19.
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Affiliation(s)
- Van Thuan Hoang
- Thai Binh University of Medicine and PharmacyThai BinhVietnam
| | - Thi Dung Pham
- Thai Binh University of Medicine and PharmacyThai BinhVietnam
| | | | | | | | | | | | - Trong Lan Phan
- General Department of Preventive MedicineMinistry of HealthHa NoiVietnam
| | | | - Thi Loi Dao
- Thai Binh University of Medicine and PharmacyThai BinhVietnam
| | - Florence Fenollar
- Aix Marseille UnivIRDAP‐HMSSA, VITROMEMarseilleFrance
- IHU‐Méditerranée InfectionMarseilleFrance
| | - Philippe Gautret
- Aix Marseille UnivIRDAP‐HMSSA, VITROMEMarseilleFrance
- IHU‐Méditerranée InfectionMarseilleFrance
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Visco V, Lippi ME, Salerno G, Licata MAVAC, de Dominicis C, Antolino G, La Verde G, Santino I, Simmaco M, Sciacchitano S. Challenges in Diagnosis and Clinical Management of COVID-19 in Patient with B-Cell Chronic Lymphocytic Leukemia (CLL): Report of One Case. Hematol Rep 2022; 14:31-37. [PMID: 35323177 PMCID: PMC8950198 DOI: 10.3390/hematolrep14010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/03/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022] Open
Abstract
We report here a case of a patient affected by B-cell chronic lymphocytic leukemia (CLL) that developed COVID-19 during the actual SARS-CoV-2 outbreak. The coexistence of CLL and COVID-19 raises many questions regarding the possible increased risk of developing COVID-19 among patients with CLL, the problems in managing therapies for both diseases and, above all, the difficulties in diagnosing COVID-19 in patients affected by CLL. In our patient, an 84-year-old man, the recognition of COVID-19 was delayed because of its atypical clinical presentation and technical problems related to the methods used for the diagnosis. Based on the symptoms and the radiological aspect of the lung, the occurrence of COVID-19 was suspected. Repeated tests on oro/nasopharyngeal swabs gave negative results, causing a delay in the diagnosis. Moreover, different methods used to identify the SARS-CoV-2 antibodies in serum gave conflicting results, and only two tests were able to identify SARS-CoV-2 Abs of the IgG type. During the clinical course of unrecognized COVID-19, our patient developed severe complications and did not receive any specific treatment for the two diseases. Recognition of COVID-19 in patients with CLL is a challenging task and the most accurate methods are necessary to overcome the diagnostic difficulties encountered.
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Affiliation(s)
- Vincenzo Visco
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (G.S.); (G.A.); (G.L.V.); (S.S.)
- Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (I.S.); (M.S.)
- Correspondence: ; Tel.: +39-06-33776771
| | | | - Gerardo Salerno
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (G.S.); (G.A.); (G.L.V.); (S.S.)
| | - Maria Angela Vittoria A. C. Licata
- Pulmonary Diseases Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Rome, Italy;
| | - Chiara de Dominicis
- Department of Surgical and Medical Sciences and Translational Medicine, “Sapienza” University of Rome, 00185 Rome, Italy;
| | - Giusy Antolino
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (G.S.); (G.A.); (G.L.V.); (S.S.)
- Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (I.S.); (M.S.)
| | - Giacinto La Verde
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (G.S.); (G.A.); (G.L.V.); (S.S.)
- Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (I.S.); (M.S.)
| | - Iolanda Santino
- Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (I.S.); (M.S.)
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), “Sapienza” University of Rome, 00185 Rome, Italy
| | - Maurizio Simmaco
- Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (I.S.); (M.S.)
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), “Sapienza” University of Rome, 00185 Rome, Italy
| | - Salvatore Sciacchitano
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (G.S.); (G.A.); (G.L.V.); (S.S.)
- Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (I.S.); (M.S.)
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, 00166 Rome, Italy
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Novello S, Terzolo M, Paola B, Gianetta M, Bianco V, Arizio F, Brero D, Perini AME, Boccuzzi A, Caramello V, Perboni A, Bellavia F, Scagliotti GV. Humoral immune response to SARS-CoV-2 in five different groups of individuals at different environmental and professional risk of infection. Sci Rep 2021; 11:24503. [PMID: 34969967 PMCID: PMC8718534 DOI: 10.1038/s41598-021-04279-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/13/2021] [Indexed: 02/08/2023] Open
Abstract
It is partially unknown whether the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection persists with time. To address this issue, we detected the presence of SARS-CoV-2 antibodies in different groups of individuals previously diagnosed with COVID-19 disease (group 1 and 2), or potentially exposed to SARS-CoV-2 infection (group 3 and 4), and in a representative group of individuals with limited environmental exposure to the virus due to lockdown restrictions (group 5). The primary outcome was specific anti-SARS-CoV-2 antibodies in the different groups assessed by qualitative and quantitative analysis at baseline, 3 and 6 months follow-up. The seroconversion rate at baseline test was 95% in group 1, 61% in group 2, 40% in group 3, 17% in group 4 and 3% in group 5. Multivariate logistic regression analysis revealed male gender, close COVID-19 contact and presence of COVID-19 related symptoms strongly associated with serological positivity. The percentage of positive individuals as assessed by the qualitative and quantitative tests was superimposable. At the quantitative test, the median level of SARS-CoV-2 antibody levels measured in positive cases retested at 6-months increased significantly from baseline. The study indicates that assessing antibody response to SARS-CoV-2 through qualitative and quantitative testing is a reliable disease surveillance tool.
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Affiliation(s)
- Silvia Novello
- Department of Oncology at San Luigi Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Massimo Terzolo
- Department of Clinical & Biological Sciences at San Luigi Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Berchialla Paola
- Department of Clinical & Biological Sciences at San Luigi Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Martina Gianetta
- Department of Oncology at San Luigi Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Valentina Bianco
- Department of Oncology at San Luigi Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Francesca Arizio
- Department of Oncology at San Luigi Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Dalila Brero
- Department of Clinical & Biological Sciences at San Luigi Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Anna Maria Elena Perini
- Department of Clinical & Biological Sciences at San Luigi Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Adriana Boccuzzi
- Emergency Care Division, San Luigi Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Valeria Caramello
- Emergency Care Division, San Luigi Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Alberto Perboni
- Respiratory Medicine Division, San Luigi Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Fabio Bellavia
- Respiratory Medicine Division, San Luigi Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Giorgio Vittorio Scagliotti
- Department of Oncology at San Luigi Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Torino, Italy.
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Zhang K, Fan Z, Ding Y, Li J, Li H. Thiol-sensitive probe enables dynamic electrochemical assembly of serum protein for detecting SARS-Cov-2 marker protease in clinical samples. Biosens Bioelectron 2021; 194:113579. [PMID: 34474279 PMCID: PMC8383480 DOI: 10.1016/j.bios.2021.113579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/15/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022]
Abstract
The poor situational awareness about the spreading of the virus especially in the underdeveloped regions calls for novel virus assays of low cost and simple operation. Currently, such assays are exclusively restricted to nucleic acid detection. In this investigation, a virus protein serum assay has been proposed in a one-step and reagent-less route. Specifically, in this assay, the main protease of the virus is targeted by a short probe mimicking its substrate. While the probe-protein interaction brings them together, a fluorescent thiol targeting molecule reacts with the free thiol groups on the target protein near the probe, generating a fluorescence signal proportional to the concentration of the target. This induces an electroactive 2D peptide nano-network on the sensing surface only in the presence of the target protein. The sensitivity of the method is enhanced through potential electrochemical scanning during incubation with serum samples. The successful detection of the virus marker protein in the serum of the infected patients encourages further development of incorporation of this method into clinical practice.
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Affiliation(s)
- Kai Zhang
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, 214063, China
| | - Zhenqiang Fan
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, 214063, China
| | - Yuedi Ding
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, 214063, China
| | - Jinlong Li
- Department of Laboratory Medicine, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210003, PR China.
| | - Hao Li
- School of Biological Science and Technology, University of Jinan, No. 106 Jiwei Road, Jinan, Shandong, 250022, China.
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Doi A, Iwata K, Kuroda H, Hasuike T, Nasu S, Nishioka H, Tomii K, Morimoto T, Kihara Y. A cross-sectional follow up study to estimate seroprevalence of coronavirus disease 2019 in Kobe, Japan. Medicine (Baltimore) 2021; 100:e28066. [PMID: 35049228 PMCID: PMC9191319 DOI: 10.1097/md.0000000000028066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/09/2021] [Indexed: 11/26/2022] Open
Abstract
We conducted a study to estimate the seroprevalence of coronavirus disease 2019 (COVID-19) in Kobe, Japan with positive immunoglobulin G (IgG) rate of 3.3% (95% confidence interval [CI] 2.3%-4.6%) in April 2020. Because there were large concerns about the spread of COVID-19 among citizens thereafter, we conduct a follow-up cross-sectional study to estimate the seroprevalence, and we also added a validation study using a different assay.We conducted cross-sectional serologic testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody using 1000 samples from patients at outpatient settings who visited the clinic from May 26 to June 7, 2020, stratified by the decade of age and sex. We used both Kurabo and Abbott serology assays to identify IgG against SARS-CoV-2.There were 18 and 2 positive IgG among 1000 serum samples using Kurabo and Abbott serology assays, respectively (1.8%, 95% CI 1.1%-2.8%, and 0.2%, 95% CI 0.02%-0.7% respectively). By applying the latter figure to the census of Kobe City (population: 1,518,870), it is estimated that the number of people with positive IgG is 3038 (95% CI: 304-10,632) while a total of 285 patients were identified by polymerase chain reaction (PCR) testing at the end of the study period. Assuming Abbott assay as the reference, Kurabo assay had calculated sensitivity and specificity of 100% and 98.4% respectively. Age and sex adjusted prevalence of positivity was calculated to be 0.17%.We found a lower seroprevalence than 2 months before in Kobe city although the figures were still higher than those detected by PCR. Kurabo assay showed more false positives than true positives despite reasonable sensitivity and specificity, due to low prevalence in Kobe.
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Affiliation(s)
- Asako Doi
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Kentaro Iwata
- Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hirokazu Kuroda
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Toshikazu Hasuike
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Seiko Nasu
- Department of Laboratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Hiroaki Nishioka
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical College, Nishinomiya, Hyogo, Japan
| | - Yasuki Kihara
- Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
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Hassan S, West KA, Conry-Cantilena K, De Giorgi V. Regulatory challenges of convalescent plasma collection during the evolving stages of COVID-19 pandemic in the United States. Transfusion 2021; 62:483-492. [PMID: 34778974 PMCID: PMC8661755 DOI: 10.1111/trf.16751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Sajjad Hassan
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Kamille A West
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Kathleen Conry-Cantilena
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Valeria De Giorgi
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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Djulbegovic B. Ethics of uncertainty. PATIENT EDUCATION AND COUNSELING 2021; 104:2628-2634. [PMID: 34312034 DOI: 10.1016/j.pec.2021.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
Uncertainty is inherent in clinical medicine. However, just because absolute certainty is unachievable does not mean that rational and optimal decisions cannot be made. It is argued that we need to distinguish legitimate from illegitimate scientific uncertainties that are generated by manufacturing doubts aiming to create mis- and disinformation. The attempt to create doubts implies that actions under uncertainties are impossible. Such a belief ultimately harms public, which requires reasoned actions within a context of genuine scientific and medical uncertainties. The latter indicates that rational decisions, even in the absence of guaranteed absolute certainty, are not only possible but, on average, beneficial both for society and individuals.
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Affiliation(s)
- Benjamin Djulbegovic
- Beckman Research Institute, Department of Computational & Quantitative Medicine, City of Hope, 1500 East Duarte Rd., Duarte, CA, USA; Division of Health Analytics, 1500 East Duarte Rd., Duarte, CA, USA; Evidence-based Medicine & Comparative Effectiveness Research, 1500 East Duarte Rd., Duarte, CA, USA.
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Suhandynata RT, Bevins NJ, Tran JT, Huang D, Hoffman MA, Lund K, Kelner MJ, McLawhon RW, Gonias SL, Nemazee D, Fitzgerald RL. SARS-CoV-2 Serology Status Detected by Commercialized Platforms Distinguishes Previous Infection and Vaccination Adaptive Immune Responses. J Appl Lab Med 2021; 6:1109-1122. [PMID: 34170314 PMCID: PMC8409063 DOI: 10.1093/jalm/jfab080] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/22/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected over 110 million individuals and led to 2.5 million deaths worldwide. As more individuals are vaccinated, the clinical performance and utility of SARS-CoV-2 serology platforms needs to be evaluated. METHODS The ability of 4 commercial SARS-CoV-2 serology platforms to detect previous infection or vaccination were evaluated using a cohort of 53 patients who were SARS-CoV-2 PCR positive, 89 SARS-CoV-2-vaccinated healthcare workers (Pfizer or Moderna), and 127 patients who were SARS-CoV-2 negative. Serology results were compared to a cell-based SARS-CoV-2 pseudovirus (PSV) neutralizing antibodies assay. RESULTS The Roche S-(spike) antibody and Diazyme neutralizing antibodies (NAbs) assays detected adaptive immune response in 100.0% and 90.1% of vaccinated individuals who received 2 doses of vaccine (initial and booster), respectively. The Roche N-(nucleocapsid) antibody assay and Diazyme IgG assay did not detect adaptive immune response in vaccinated individuals. The Diazyme NAbs assay correlated with the PSV SARS-CoV-2 median infective dose (ID50) neutralization titers (R2 = 0.70), while correlation of the Roche S-antibody assay was weaker (R2 = 0.39). Median PSV SARS-CoV-2 ID50 titers more than doubled in vaccinated individuals who received 2 doses of the Moderna vaccine (ID50, 597) compared to individuals who received a single dose (ID50, 284). CONCLUSIONS The Roche S-antibody and Diazyme NAbs assays robustly detected adaptive immune responses in SARS-CoV-2 vaccinated individuals and SARS-CoV-2 infected individuals. The Diazyme NAbs assay strongly correlates with the PSV SARS-CoV-2 NAbs in vaccinated individuals. Understanding the reactivity of commercially available serology platforms is important when distinguishing vaccination response versus natural infection.
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Affiliation(s)
| | | | - Jenny T Tran
- Department of Immunology and Microbiology, The Scripps Research Institution, San Diego, CA
| | - Deli Huang
- Department of Immunology and Microbiology, The Scripps Research Institution, San Diego, CA
| | | | - Kyle Lund
- Department of Pathology, UC San Diego Health, San Diego, CA
| | | | | | | | - David Nemazee
- Department of Immunology and Microbiology, The Scripps Research Institution, San Diego, CA
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Azzi L. Saliva is the Key Element for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Mass Screening. Clin Infect Dis 2021; 73:e566-e568. [PMID: 33083834 PMCID: PMC7665330 DOI: 10.1093/cid/ciaa1440] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/19/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Lorenzo Azzi
- Unit of Oral Medicine and Pathology, Azienda Socio Sanitaria Territoriale dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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11
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Kolivras A, Thompson C, Pastushenko I, Mathieu M, Bruderer P, de Vicq M, Feoli F, Harag S, Meiers I, Olemans C, Sass U, Dehavay F, Fakih A, Lam-Hoai XL, Marneffe A, Van De Borne L, Vandersleyen V, Richert B. A clinicopathological description of COVID-19-induced chilblains (COVID-toes) correlated with a published literature review. J Cutan Pathol 2021; 49:17-28. [PMID: 34272741 PMCID: PMC8444728 DOI: 10.1111/cup.14099] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/14/2021] [Accepted: 07/12/2021] [Indexed: 12/17/2022]
Abstract
Background The abundance of publications of COVID‐19‐induced chilblains has resulted in a confusing situation. Methods This is a prospective single‐institution study from 15 March to 13 May 2020. Thirty‐two patients received PCR nasopharyngeal swabs. Of these, 28 patients had a thoracic CT‐scan, 31 patients had blood and urine examinations, 24 patients had skin biopsies including immunohistochemical and direct immunofluorescence studies, and four patients had electron microscopy. Results COVID‐19‐induced chilblains are clinically and histopathologically identical to chilblains from other causes. Although intravascular thrombi are sometimes observed, no patient had a systemic coagulopathy or severe clinical course. The exhaustive clinical, radiological, and laboratory work‐up in this study ruled‐out other primary and secondary causes. Electron microscopy revealed rare, probable viral particles whose core and spikes measured from 120 to 133 nm within endothelium and eccrine glands in two cases. Conclusion This study provides further clinicopathologic evidence of COVID‐19‐related chilblains. Negative PCR and antibody tests do not rule‐out infection. Chilblains represent a good prognosis, occurring later in the disease course. No systemic coagulopathy was identified in any patient. Patients presenting with acral lesions should be isolated, and chilblains should be distinguished from thrombotic lesions (livedo racemosa, retiform purpura, or ischemic acral necrosis).
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Affiliation(s)
- Athanassios Kolivras
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Curtis Thompson
- Departments of Dermatology and Pathology, Oregon Health and Science University, Portland, Oregon, USA.,CTA Pathology, Portland, Oregon, USA
| | - Ievgenia Pastushenko
- Laboratory of Stem Cells and Cancer, Université Libre de Bruxelles, Brussels, Belgium
| | - Marisa Mathieu
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Pascal Bruderer
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marine de Vicq
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Francesco Feoli
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Saadia Harag
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Meiers
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Catherine Olemans
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Ursula Sass
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Florence Dehavay
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Ali Fakih
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Xuan-Lan Lam-Hoai
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Alice Marneffe
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Van De Borne
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Valerie Vandersleyen
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Bertrand Richert
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
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12
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Tang MS, Case JB, Franks CE, Chen RE, Anderson NW, Henderson JP, Diamond MS, Gronowski AM, Farnsworth CW. Association between SARS-CoV-2 Neutralizing Antibodies and Commercial Serological Assays. Clin Chem 2021; 66:1538-1547. [PMID: 32894750 PMCID: PMC7499494 DOI: 10.1093/clinchem/hvaa211] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022]
Abstract
Introduction Commercially available SARS-CoV-2 serological assays based on different viral antigens have been approved for the qualitative determination of anti-SARS-CoV-2 antibodies. However, there are limited published data associating the results from commercial assays with neutralizing antibodies. Methods 67 specimens from 48 patients with PCR-confirmed COVID-19 and a positive result by the Roche Elecsys Anti-SARS-CoV-2, Abbott SARS-CoV-2 IgG, or EUROIMMUN SARS-CoV-2 IgG assays and 5 control specimens were analyzed for the presence of neutralizing antibodies to SARS-CoV-2. Correlation, concordance, positive percent agreement (PPA), and negative percent agreement (NPA) were calculated at several cutoffs. Results were compared in patients categorized by clinical outcomes. Results The correlation between SARS-CoV-2 neutralizing titer (EC50) and the Roche, Abbott, and EUROIMMUN assays was 0.29, 0.47, and 0.46 respectively. At an EC50 of 1:32, the concordance kappa with Roche was 0.49 (95% CI; 0.23-0.75), with Abbott was 0.52 (0.28-0.77), and with EUROIMMUN was 0.61 (0.4-0.82). At the same neutralizing titer, the PPA and NPA for the Roche was 100% (94-100) & 56% (30-80); Abbott was 96% (88-99) & 69% (44-86); and EUROIMMUN was 91% (80-96) & 81% (57-93) for distinguishing neutralizing antibodies. Patients who were intubated, had cardiac injury, or acute kidney injury from COVID-19 infection had higher neutralizing titers relative to those with mild symptoms. Conclusion COVID-19 patients generate an antibody response to multiple viral proteins such that the calibrator ratios on the Roche, Abbott, and EUROIMMUN assays are all associated with SARS-CoV-2 neutralization. Nevertheless, commercial serological assays have poor NPA for SARS-CoV-2 neutralization, making them imperfect proxies for neutralization.
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Affiliation(s)
- Mei San Tang
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - James Brett Case
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Caroline E Franks
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Rita E Chen
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Neil W Anderson
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey P Henderson
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Michael S Diamond
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO.,Department of Medicine, Washington University School of Medicine, St. Louis, MO.,Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO
| | - Ann M Gronowski
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
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13
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Safiabadi Tali SH, LeBlanc JJ, Sadiq Z, Oyewunmi OD, Camargo C, Nikpour B, Armanfard N, Sagan SM, Jahanshahi-Anbuhi S. Tools and Techniques for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)/COVID-19 Detection. Clin Microbiol Rev 2021; 34:e00228-20. [PMID: 33980687 PMCID: PMC8142517 DOI: 10.1128/cmr.00228-20] [Citation(s) in RCA: 162] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory disease coronavirus 2 (SARS-CoV-2), has led to millions of confirmed cases and deaths worldwide. Efficient diagnostic tools are in high demand, as rapid and large-scale testing plays a pivotal role in patient management and decelerating disease spread. This paper reviews current technologies used to detect SARS-CoV-2 in clinical laboratories as well as advances made for molecular, antigen-based, and immunological point-of-care testing, including recent developments in sensor and biosensor devices. The importance of the timing and type of specimen collection is discussed, along with factors such as disease prevalence, setting, and methods. Details of the mechanisms of action of the various methodologies are presented, along with their application span and known performance characteristics. Diagnostic imaging techniques and biomarkers are also covered, with an emphasis on their use for assessing COVID-19 or monitoring disease severity or complications. While the SARS-CoV-2 literature is rapidly evolving, this review highlights topics of interest that have occurred during the pandemic and the lessons learned throughout. Exploring a broad armamentarium of techniques for detecting SARS-CoV-2 will ensure continued diagnostic support for clinicians, public health, and infection prevention and control for this pandemic and provide advice for future pandemic preparedness.
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Affiliation(s)
- Seyed Hamid Safiabadi Tali
- Department of Chemical and Materials Engineering, Gina Cody School of Engineering, Concordia University, Montréal, Québec, Canada
- Department of Mechanical, Industrial, and Aerospace Engineering, Gina Cody School of Engineering, Concordia University, Montréal, Québec, Canada
| | - Jason J LeBlanc
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Zubi Sadiq
- Department of Chemical and Materials Engineering, Gina Cody School of Engineering, Concordia University, Montréal, Québec, Canada
| | - Oyejide Damilola Oyewunmi
- Department of Chemical and Materials Engineering, Gina Cody School of Engineering, Concordia University, Montréal, Québec, Canada
| | - Carolina Camargo
- Department of Microbiology and Immunology, McGill University, Montréal, Québec, Canada
| | - Bahareh Nikpour
- Department of Electrical and Computer Engineering, McGill University, Montréal, Québec, Canada
| | - Narges Armanfard
- Department of Electrical and Computer Engineering, McGill University, Montréal, Québec, Canada
- Mila-Quebec AI Institute, Montréal, Québec, Canada
| | - Selena M Sagan
- Department of Microbiology and Immunology, McGill University, Montréal, Québec, Canada
- Department of Biochemistry, McGill University, Montréal, Québec, Canada
| | - Sana Jahanshahi-Anbuhi
- Department of Chemical and Materials Engineering, Gina Cody School of Engineering, Concordia University, Montréal, Québec, Canada
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14
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Lopez L, Nguyen T, Weber G, Kleimola K, Bereda M, Liu Y, Accorsi EK, Skates SJ, Santa Maria JP, Smith KR, Kalinich M. Seroprevalence of anti-SARS-CoV-2 IgG antibodies in the staff of a public school system in the midwestern United States. PLoS One 2021; 16:e0243676. [PMID: 34111144 PMCID: PMC8191884 DOI: 10.1371/journal.pone.0243676] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/14/2021] [Indexed: 11/18/2022] Open
Abstract
Since March 2020, the United States has lost over 580,000 lives to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. A growing body of literature describes population-level SARS-CoV-2 exposure, but studies of antibody seroprevalence within school systems are critically lacking, hampering evidence-based discussions on school reopenings. The Lake Central School Corporation (LCSC), a public school system in suburban Indiana, USA, assessed SARS-CoV-2 seroprevalence in its staff and identified correlations between seropositivity and subjective histories and demographics. This study is a cross-sectional, population-based analysis of the seroprevalence of SARS-CoV-2 in LCSC staff measured in July 2020. We tested for seroprevalence with the Abbott Alinity™ SARS-CoV-2 IgG antibody test. The primary outcome was the total seroprevalence of SARS-CoV-2, and secondary outcomes included trends of antibody presence in relation to baseline attributes. 753 participants representative of the staff at large were enrolled. 22 participants (2.9%, 95% CI: 1.8% - 4.4%) tested positive for SARS-CoV-2 antibodies. Correcting for test performance parameters, the seroprevalence is estimated at 1.7% (90% Credible Interval: 0.27% - 3.3%). Multivariable logistic regression including mask wearing, travel history, symptom history, and contact history revealed a 48-fold increase in the odds of seropositivity if an individual previously tested positive for COVID-19 (OR: 48, 95% CI: 4–600). Amongst individuals with no previous positive test, exposure to a person diagnosed with COVID-19 increased the odds of seropositivity by 7-fold (OR: 7.2, 95% CI: 2.6–19). Assuming the presence of antibodies is associated with immunity against SARS-CoV-2 infection, these results demonstrate a broad lack of herd immunity amongst the school corporation’s staff irrespective of employment role or location. Protective measures like contact tracing, face coverings, and social distancing are therefore vital to maintaining the safety of both students and staff as the school year progresses.
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Affiliation(s)
- Lilah Lopez
- Lake Central School Corporation, Saint John, IN, United States of America
| | - Thao Nguyen
- Lake Central School Corporation, Saint John, IN, United States of America
| | - Graham Weber
- Lake Central School Corporation, Saint John, IN, United States of America
| | | | - Megan Bereda
- Independent Researcher, Cleveland, OH, United States of America
| | - Yiling Liu
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Emma K. Accorsi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Steven J. Skates
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - John P. Santa Maria
- Novartis Institutes for Biomedical Research, Cambridge, MA, United States of America
| | - Kendal R. Smith
- Lake Central School Corporation, Saint John, IN, United States of America
- * E-mail: (MK); (KRS)
| | - Mark Kalinich
- Harvard Medical School, Boston, MA, United States of America
- * E-mail: (MK); (KRS)
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15
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Tang MS, Farnsworth CW. Associating SARS-CoV-2 Serological Assays with Protection: Where the Field Stands. Clin Chem 2021; 67:707-709. [PMID: 33772260 PMCID: PMC8083671 DOI: 10.1093/clinchem/hvab039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/26/2021] [Accepted: 02/09/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Mei San Tang
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO
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16
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Mekonnen D, Mengist HM, Derbie A, Nibret E, Munshea A, He H, Li B, Jin T. Diagnostic accuracy of serological tests and kinetics of severe acute respiratory syndrome coronavirus 2 antibody: A systematic review and meta-analysis. Rev Med Virol 2021; 31:e2181. [PMID: 33152146 DOI: 10.1002/rmv.2181] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/18/2020] [Accepted: 09/26/2020] [Indexed: 12/22/2022]
Abstract
This study aimed to assess the diagnostic test accuracy (DTA) of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) serological test methods and the kinetics of antibody positivity. Systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We included articles evaluating the diagnostic accuracy of serological tests and the kinetics of antibody positivity. MEDLINE through PubMed, Scopus, medRxiv and bioRxiv were sources of articles. Methodological qualities of included articles were appraised using QUADAS-2 while Metandi performs bivariate meta-analysis of DTA using a generalized linear mixed-model approach. Stata 14 and Review Manager 5.3 were used for data analysis. The summary sensitivity/specificity of chemiluminescence immunoassay (CLIA), enzyme-linked immunosorbent assay (ELISA) and lateral flow immunoassay (LFIA) were 92% (95% CI: 86%-95%)/99% (CI: 97%-99%), 86% (CI: 82%-89%)/99% (CI: 98%-100%) and 78% (CI: 71%-83%)/98% (95% CI: 96%-99%), respectively. Moreover, CLIA-based assays produced nearly 100% sensitivity within 11-15 days post-symptom onset (DPSO). Based on antibody type, the sensitivity of ELISA-total antibody, CLIA-IgM/G and CLIA-IgG gauged at 94%, 92% and 92%, respectively. The sensitivity of CLIA-RBD assay reached 96%, while LFIA-S demonstrated the lowest sensitivity, 71% (95% CI: 58%-80%). CLIA assays targeting antibodies against RBD considered the best DTA. The antibody positivity rate increased corresponding with DPSO, but there was some decrement when moving from acute phase to convalescent phase of infection. As immunoglobulin isotope-related DTA was heterogeneous, our data have insufficient evidence to recommend CLIA/ELISA for clinical decision-making, but likely to have comparative advantage over RT-qPCR in certain circumstances and geographic regions.
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Affiliation(s)
- Daniel Mekonnen
- Department of Obstetrics and Gynecology, Division of Molecular Medicine, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Diseases, University of Science and Technology of China, Hefei, Anhui, China
- School of Basic Medical Sciences, Division of Life Sciences and Medicine, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Disease, University of Science & Technology of China, Hefei, Anhui, China
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Hylemariam Mihiretie Mengist
- Department of Obstetrics and Gynecology, Division of Molecular Medicine, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Diseases, University of Science and Technology of China, Hefei, Anhui, China
- School of Basic Medical Sciences, Division of Life Sciences and Medicine, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Disease, University of Science & Technology of China, Hefei, Anhui, China
| | - Awoke Derbie
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- The Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDTAfrica), Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Abaineh Munshea
- Department of Biology, Bahir Dar University, Bahir Dar, Ethiopia
| | - Hongliang He
- Department of Obstetrics and Gynecology, Division of Molecular Medicine, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Diseases, University of Science and Technology of China, Hefei, Anhui, China
- School of Basic Medical Sciences, Division of Life Sciences and Medicine, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Disease, University of Science & Technology of China, Hefei, Anhui, China
| | - Bofeng Li
- School of Basic Medical Sciences, Division of Life Sciences and Medicine, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Disease, University of Science & Technology of China, Hefei, Anhui, China
- Department of Medical Oncology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Tengchuan Jin
- Department of Obstetrics and Gynecology, Division of Molecular Medicine, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Diseases, University of Science and Technology of China, Hefei, Anhui, China
- School of Basic Medical Sciences, Division of Life Sciences and Medicine, Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Disease, University of Science & Technology of China, Hefei, Anhui, China
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17
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Kohler PP, Kahlert CR, Sumer J, Flury D, Güsewell S, Leal-Neto OB, Notter J, Albrich WC, Babouee Flury B, McGeer A, Kuster S, Risch L, Schlegel M, Vernazza P. Prevalence of SARS-CoV-2 antibodies among Swiss hospital workers: Results of a prospective cohort study. Infect Control Hosp Epidemiol 2021; 42:604-608. [PMID: 33028454 PMCID: PMC7582018 DOI: 10.1017/ice.2020.1244] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 01/31/2023]
Abstract
In this prospective cohort of 1,012 Swiss hospital employees, 3 different assays were used to screen serum for SARS-CoV-2 antibodies. Seropositivity was 1%; the positive predictive values of the lateral-flow immunoassay were 64% (IgG) and 13% (IgM). History of fever and myalgia most effectively differentiated seropositive and seronegative participants.
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Affiliation(s)
- Philipp P. Kohler
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Christian R. Kahlert
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
- Children’s Hospital of Eastern Switzerland, Department of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Johannes Sumer
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Domenica Flury
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Sabine Güsewell
- Clinical Trials Unit, Cantonal Hospital of St Gallen, St Gallen, Switzerland
| | - Onicio B. Leal-Neto
- Epitrack, Recife, Brazil
- Department of Economics, University of Zurich, Zurich, Switzerland
| | - Julia Notter
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Werner C. Albrich
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Baharak Babouee Flury
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | | | | | - Lorenz Risch
- Labormedizinisches Zentrum Dr. Risch, Buchs, Switzerland
| | - Matthias Schlegel
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Pietro Vernazza
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
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18
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Prevalence of antibodies against SARS-CoV-2 in hemodialysis patients. Int Urol Nephrol 2021; 54:457-458. [PMID: 33893618 PMCID: PMC8064699 DOI: 10.1007/s11255-021-02852-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/11/2021] [Indexed: 11/30/2022]
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19
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Doi A, Iwata K, Kuroda H, Hasuike T, Nasu S, Kanda A, Nagao T, Nishioka H, Tomii K, Morimoto T, Kihara Y. Estimation of seroprevalence of novel coronavirus disease (COVID-19) using preserved serum at an outpatient setting in Kobe, Japan: A cross-sectional study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 11:100747. [PMID: 33898863 PMCID: PMC8053595 DOI: 10.1016/j.cegh.2021.100747] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/12/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives Coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 has been affecting many people on earth and our society. Japan is known to have relatively smaller number of its infections as well as deaths among developed nations. However, accurate prevalence of COVID-19 in Japan remains unknown. Therefore, we conducted a cross-sectional study to estimate seroprevalence of SARS-CoV-2 infection. Methods We conducted a cross-sectional serologic testing for SARS-CoV-2 antibody using 1000 samples from patients at outpatient settings who visited the clinic from March 31 to April 7, 2020, stratified by the decade of age and sex. Results There were 33 positive IgG among 1000 serum samples (3.3%, 95%CI: 2.3–4.6%). By applying this figure to the census of Kobe City (population: 1,518,870), it is estimated that the number of people with positive IgG be 50,123 (95%CI: 34,934–69,868). Age and sex adjusted prevalence of positivity was calculated 2.7% (95%CI: 1.8–3.9%), and the estimated number of people with positive IgG was 40,999 (95%CI: 27,333–59,221). These numbers were 396 to 858-fold more than confirmed cases with PCR testing in Kobe City. Conclusions Our cross-sectional serological study suggests that the number of people with seropositive for SARS-CoV-2 infection in Kobe, Japan is far more than the confirmed cases by PCR testing.
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Affiliation(s)
- Asako Doi
- Department of Infection Control, Kobe City Medical Center General Hospital, Chuoku, 6500047, Kobe, Hyogo, Japan.,Department of Infectious Diseases, Kobe City Medical Center General Hospital, Chuoku, 6500047, Kobe, Hyogo, Japan
| | - Kentaro Iwata
- Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, Chuoku, 6500017, Kobe, Hyogo, Japan
| | - Hirokazu Kuroda
- Department of Infection Control, Kobe City Medical Center General Hospital, Chuoku, 6500047, Kobe, Hyogo, Japan.,Department of Infectious Diseases, Kobe City Medical Center General Hospital, Chuoku, 6500047, Kobe, Hyogo, Japan
| | - Toshikazu Hasuike
- Department of Infection Control, Kobe City Medical Center General Hospital, Chuoku, 6500047, Kobe, Hyogo, Japan.,Department of Infectious Diseases, Kobe City Medical Center General Hospital, Chuoku, 6500047, Kobe, Hyogo, Japan
| | - Seiko Nasu
- Department of Infection Control, Kobe City Medical Center General Hospital, Chuoku, 6500047, Kobe, Hyogo, Japan.,Department of Laboratory Medicine, Kobe City Medical Center General Hospital, Chuokum, 6500047, Kobe, Hyogo, Japan
| | - Aya Kanda
- Department of Laboratory Medicine, Kobe City Medical Center General Hospital, Chuokum, 6500047, Kobe, Hyogo, Japan
| | - Tomomi Nagao
- Department of Laboratory Medicine, Kobe City Medical Center General Hospital, Chuokum, 6500047, Kobe, Hyogo, Japan
| | - Hiroaki Nishioka
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, Chuoku, 6500047, Kobe, Hyogo, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Chuoku, 6500047, Kobe, Hyogo, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical College, Mukogawa, 6638501, Nishinomiya, Hyogo, Japan
| | - Yasuki Kihara
- Kobe City Medical Center General Hospital, Chuoku, 6500047, Kobe, Hyogo, Japan
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20
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Bonomo G, Caldiroli D, Bonomo R, Pugliese R, DiMeco F, Zoia C. Reactivation of COVID-19 in a neurosurgical patient with early neuropsychiatric presentation. Does seroconversion mean immunity? Surg Neurol Int 2021; 12:166. [PMID: 34084594 PMCID: PMC8168796 DOI: 10.25259/sni_831_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/10/2021] [Indexed: 12/13/2022] Open
Abstract
Background: In the aftermath of COVID-19 outbreak, there is a strong need to find strategies to monitor SARSCoV-2 transmission. While the application of screening techniques plays a major role to this end, there is evidence challenging the real significance of seroconversion. We reported a case of COVID-19 reactivation associated with a neurosurgical operation with early neuropsychiatric involvement presumably promoted by olfactory and gustatory impairment in the first infection. Case Descriptio: A 57-year-old man was referred for a 2-month history of progressive development of imbalance, dizziness, and vomiting. Magnetic resonance imaging showed two bilateral hemispheric cerebellar lesions. In line with our triage protocol, the patient underwent a nasopharyngeal swab for RNA of SARS-CoV-2 detection, which resulted positive. Of note, the patient had reported in the previous month hyposmia and hypogeusia. After a period of 14 days, three new swabs were performed with negative results, leading the way to surgery. In the early post-operative period, the patient manifested acute onset of psychotic symptoms with hyperactive delirium, followed by fever and acute respiratory failure. A chest computed tomography revealed a specific pattern of ground-glass opacities in the lower lobes bilaterally, suggesting a viral pneumonia. Serological tests demonstrated the seroconversion and a new nasopharyngeal swab confirmed SARS-CoV-2 infection. Conclusion: Our report highlights the importance of comprehensive screening assessments in sensitive cases highly susceptible to COVID-19 recurrence.
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Affiliation(s)
- Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Italy
| | - Dario Caldiroli
- Neuroanaesthesia and Intensive Care, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy
| | - Roberta Bonomo
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Raffaelino Pugliese
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Italy
| | - Cesare Zoia
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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21
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Wang X, Yang P, Zheng J, Liu P, Wei C, Guo J, Zhang Y, Zhao D. Dynamic changes of acquired maternal SARS-CoV-2 IgG in infants. Sci Rep 2021; 11:8021. [PMID: 33850202 PMCID: PMC8044122 DOI: 10.1038/s41598-021-87535-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 03/30/2021] [Indexed: 01/06/2023] Open
Abstract
At present, there are still ambiguous reports about the perinatal infection of infants born to mothers infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The dynamic characteristics of infantile serum antibodies born to mother with SARS-CoV-2 has not been well described. In this study, we analyzed the seroconversion of 27 newborns born to 26 pregnant women infected with SARS-CoV-2. The SARS-CoV-2 IgG positive rate of parturient was 80.8%, and half of their infants obtained maternal IgG. IgG transfer rates were 18.8% and 81.8% in those infants whose mother infected less and more than 2 weeks before delivery. In the first two months of life, the IgG level of infants dropped sharply to one tenth of that at birth. These results suggest that maternal SARS-CoV-2 IgG provides limited protection for infants.
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Affiliation(s)
- Xia Wang
- Department of Pediatrics, Children's Digital Health and Data Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Pu Yang
- Department of Pediatrics, Children's Digital Health and Data Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Junwen Zheng
- Department of Pediatrics, Children's Digital Health and Data Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Pin Liu
- Department of Pediatrics, Children's Digital Health and Data Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Cong Wei
- Department of Pediatrics, Children's Digital Health and Data Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Juanjuan Guo
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Clinical Medicine Research Center of Prenatal Diagnosis, Birth Health in Hubei Province, Wuhan, China
| | - Yuanzhen Zhang
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Clinical Medicine Research Center of Prenatal Diagnosis, Birth Health in Hubei Province, Wuhan, China
| | - Dongchi Zhao
- Department of Pediatrics, Children's Digital Health and Data Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
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22
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Higgins V, Fabros A, Wang XY, Bhandari M, Daghfal DJ, Kulasingam V. Anti-SARS-CoV-2 IgM improves clinical sensitivity early in disease course. Clin Biochem 2021; 90:1-7. [PMID: 33476578 PMCID: PMC7816645 DOI: 10.1016/j.clinbiochem.2021.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is diagnosed by molecular-based detection of SARS-CoV-2 RNA. Serologic testing detects antibodies specific to SARS-CoV-2 and IgM specifically may serve as an adjunct test to PCR early in disease. We evaluated the Abbott anti-SARS-CoV-2 IgM and IgG assays along with DiaSorin anti-SARS-CoV-2 IgG and Roche anti-SARS-CoV-2 Total. METHODS Specimens from 175 PCR-positive patients and 107 control specimens were analyzed using Abbott IgM and IgG, DiaSorin IgG, and Roche Total (IgA, IgG, IgM) assays. Sensitivity, specificity, cross-reactivity, concordance between assays, trends over time, positive predictive value (PPV), and negative predictive value (NPV) were determined. RESULTS Abbott IgM sensitivity was 63.6% at 0 days post-PCR positivity, 76.5% at 1-5d, 76.3% at 6-14d, 85.2% at 15-30d, and 63.6% at > 30d. All assays exhibited highest sensitivity 15-30d post-PCR positivity (83.3-85.2%). Combining Abbott IgM and IgG improved sensitivity by 22.7% compared to IgG alone when tested 0d post-PCR positivity. All assays had a specificity of 100% and only Abbott IgG exhibited cross-reactivity (anti-dsDNA). Cohen's kappa varied between 0.86 and 0.93. Time to seroconversion from PCR positivity was lowest for Abbott IgM and highest for Abbott IgG. NPV was highest for Abbott IgM < 14 days post-PCR positivity and Abbott IgG ≥ 14 days. CONCLUSION The Abbott IgM assay exhibited the earliest response and greatest signal in most patients evaluated for serial sampling and had the highest NPV < 14 days post-PCR positivity, suggesting its potential utility as an adjunct test to PCR early in disease course.
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Affiliation(s)
- Victoria Higgins
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Anselmo Fabros
- Department of Clinical Biochemistry, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Xiao Yan Wang
- Department of Clinical Biochemistry, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | | | | | - Vathany Kulasingam
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Clinical Biochemistry, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.
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23
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Eberhardt KA, Dewald F, Heger E, Gieselmann L, Vanshylla K, Wirtz M, Kleipass F, Johannis W, Schommers P, Gruell H, Brensing KA, Müller RU, Augustin M, Lehmann C, Koch M, Klein F, Di Cristanziano V. Evaluation of a New Spike (S)-Protein-Based Commercial Immunoassay for the Detection of Anti-SARS-CoV-2 IgG. Microorganisms 2021; 9:733. [PMID: 33807490 PMCID: PMC8067155 DOI: 10.3390/microorganisms9040733] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/26/2022] Open
Abstract
Background: The investigation of the antibody response to SARS-CoV-2 represents a key aspect in facing the COVID-19 pandemic. In the present study, we compared the new Immundiagnostik IDK® anti-SARS-CoV-2 S1 IgG assay with four widely-used commercial serological assays for the detection of antibodies targeting S (spike) and NC (nucleocapsid) proteins. Methods: Serum samples were taken from an unbiased group of convalescent patients and from a negative control group. Sample were simultaneously analyzed by the new Immundiagnostik IDK® anti-SARS-CoV-2 S1 IgG assay, by the DiaSorin LIAISON® SARS-CoV-2 S1/S2 IgG assay, and by the Euroimmun anti-SARS-CoV-2 S1 IgG ELISA. Antibodies binding NC were detected by the Abbott SARS-CoV-2 IgG assay and by the pan-immunoglobulin immunoassay Roche Elecsys® anti-SARS-CoV-2. Moreover, we investigated samples of a group of COVID-19 convalescent subjects that were primarily tested S1 IgG non-reactive. Samples were also tested by live virus and pseudovirus neutralization tests. Results: Overall, the IDK® anti-SARS-CoV-2 S1 IgG assay showed the highest sensitivity among the evaluated spike (S) protein-based assays. Additionally, the Immundiagnostik assay correlated well with serum-neutralizing activity. Conclusions: The novel IDK® anti-SARS-CoV-2 S1 IgG assay showed high sensitivity and specificity, representing a valid option for use in the routine diagnostic.
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Affiliation(s)
- Kirsten Alexandra Eberhardt
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
- Institute for Transfusion Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Felix Dewald
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (F.D.); (E.H.); (L.G.); (K.V.); (M.W.); (F.K.); (P.S.); (H.G.); (F.K.)
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany; (R.-U.M.); (C.L.); (M.K.)
| | - Eva Heger
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (F.D.); (E.H.); (L.G.); (K.V.); (M.W.); (F.K.); (P.S.); (H.G.); (F.K.)
| | - Lutz Gieselmann
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (F.D.); (E.H.); (L.G.); (K.V.); (M.W.); (F.K.); (P.S.); (H.G.); (F.K.)
| | - Kanika Vanshylla
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (F.D.); (E.H.); (L.G.); (K.V.); (M.W.); (F.K.); (P.S.); (H.G.); (F.K.)
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany; (R.-U.M.); (C.L.); (M.K.)
| | - Maike Wirtz
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (F.D.); (E.H.); (L.G.); (K.V.); (M.W.); (F.K.); (P.S.); (H.G.); (F.K.)
| | - Franziska Kleipass
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (F.D.); (E.H.); (L.G.); (K.V.); (M.W.); (F.K.); (P.S.); (H.G.); (F.K.)
| | - Wibke Johannis
- Institute for Clinical Chemistry, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Philipp Schommers
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (F.D.); (E.H.); (L.G.); (K.V.); (M.W.); (F.K.); (P.S.); (H.G.); (F.K.)
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 50931 Cologne, Germany
| | - Henning Gruell
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (F.D.); (E.H.); (L.G.); (K.V.); (M.W.); (F.K.); (P.S.); (H.G.); (F.K.)
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 50931 Cologne, Germany
| | | | - Roman-Ulrich Müller
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany; (R.-U.M.); (C.L.); (M.K.)
- Department II of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, CECAD, University of Cologne, 50931 Cologne, Germany
| | - Max Augustin
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Clara Lehmann
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany; (R.-U.M.); (C.L.); (M.K.)
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 50931 Cologne, Germany
| | - Manuel Koch
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany; (R.-U.M.); (C.L.); (M.K.)
- Institute for Experimental Dentistry and Oral Musculoskeletal Biology, and Center for Biochemistry, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
| | - Florian Klein
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (F.D.); (E.H.); (L.G.); (K.V.); (M.W.); (F.K.); (P.S.); (H.G.); (F.K.)
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany; (R.-U.M.); (C.L.); (M.K.)
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 50931 Cologne, Germany
| | - Veronica Di Cristanziano
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (F.D.); (E.H.); (L.G.); (K.V.); (M.W.); (F.K.); (P.S.); (H.G.); (F.K.)
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany; (R.-U.M.); (C.L.); (M.K.)
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24
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Kreuzberger N, Hirsch C, Vanshylla K, Di Cristanziano V, Dorando E, Khosravi Z, Neidhardt M, Salomon S, Monsef I, Lange B, Skoetz N. Persistence of immunoglobulin G after natural infection with SARS-CoV-2. Hippokratia 2021. [DOI: 10.1002/14651858.cd014946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Nina Kreuzberger
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; Faculty of Medicine and University Hospital Cologne, University of Cologne; Cologne Germany
| | - Caroline Hirsch
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; Faculty of Medicine and University Hospital Cologne, University of Cologne; Cologne Germany
| | - Kanika Vanshylla
- Laboratory of Experimental Immunology, Institute of Virology; Faculty of Medicine and University Hospital Cologne, University of Cologne; Cologne Germany
| | - Veronica Di Cristanziano
- Laboratory of Experimental Immunology, Institute of Virology; Faculty of Medicine and University Hospital Cologne, University of Cologne; Cologne Germany
| | - Elena Dorando
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; Faculty of Medicine and University Hospital Cologne, University of Cologne; Cologne Germany
| | - Zahra Khosravi
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; Faculty of Medicine and University Hospital Cologne, University of Cologne; Cologne Germany
| | - Miriam Neidhardt
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; Faculty of Medicine and University Hospital Cologne, University of Cologne; Cologne Germany
| | - Susanne Salomon
- Laboratory of Experimental Immunology, Institute of Virology; Faculty of Medicine and University Hospital Cologne, University of Cologne; Cologne Germany
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; Faculty of Medicine and University Hospital Cologne, University of Cologne; Cologne Germany
| | - Berit Lange
- Department of Epidemiology; Helmholtz Centre for Infection Research; Braunschweig Germany
| | - Nicole Skoetz
- Cochrane Cancer, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; Faculty of Medicine and University Hospital Cologne, University of Cologne; Cologne Germany
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25
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Fotis C, Meimetis N, Tsolakos N, Politou M, Akinosoglou K, Pliaka V, Minia A, Terpos E, Trougakos IP, Mentis A, Marangos M, Panayiotakopoulos G, Dimopoulos MA, Gogos C, Spyridonidis A, Alexopoulos LG. Accurate SARS-CoV-2 seroprevalence surveys require robust multi-antigen assays. Sci Rep 2021; 11:6614. [PMID: 33758278 PMCID: PMC7988055 DOI: 10.1038/s41598-021-86035-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/03/2021] [Indexed: 12/18/2022] Open
Abstract
There is a plethora of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) serological tests based either on nucleocapsid phosphoprotein (N), S1-subunit of spike glycoprotein (S1) or receptor binding domain (RBD). Although these single-antigen based tests demonstrate high clinical performance, there is growing evidence regarding their limitations in epidemiological serosurveys. To address this, we developed a Luminex-based multiplex immunoassay that detects total antibodies (IgG/IgM/IgA) against the N, S1 and RBD antigens and used it to compare antibody responses in 1225 blood donors across Greece. Seroprevalence based on single-antigen readouts was strongly influenced by both the antigen type and cut-off value and ranged widely [0.8% (95% CI 0.4–1.5%)–7.5% (95% CI 6.0–8.9%)]. A multi-antigen approach requiring partial agreement between RBD and N or S1 readouts (RBD&N|S1 rule) was less affected by cut-off selection, resulting in robust seroprevalence estimation [0.6% (95% CI 0.3–1.1%)–1.2% (95% CI 0.7–2.0%)] and accurate identification of seroconverted individuals.
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Affiliation(s)
- Christos Fotis
- Biomedical Systems Laboratory, National Technical University of Athens, Athens, Greece
| | - Nikolaos Meimetis
- Biomedical Systems Laboratory, National Technical University of Athens, Athens, Greece
| | | | - Marianna Politou
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Karolina Akinosoglou
- Division of Infectious Diseases, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Vaia Pliaka
- ProtATonce Ltd, Demokritos Science Park, Athens, Greece
| | | | - Evangelos Terpos
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis P Trougakos
- Department of Cell Biology and Biophysics, Faculty of Biology, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Mentis
- Medicinal Microbiology Laboratory, Hellenic Pasteur Institute, Athens, Greece
| | - Markos Marangos
- Division of Infectious Diseases, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - George Panayiotakopoulos
- Pharmacology Laboratory, University of Patras, Patras, Greece.,National Public Health Organization, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalampos Gogos
- Division of Infectious Diseases, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Alexandros Spyridonidis
- Department of Internal Medicine, BMT Unit and CBMDP Donor Center, University of Patras, Patras, Greece.
| | - Leonidas G Alexopoulos
- Biomedical Systems Laboratory, National Technical University of Athens, Athens, Greece. .,ProtATonce Ltd, Demokritos Science Park, Athens, Greece.
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26
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Quantitative Measurement of Anti-SARS-CoV-2 Antibodies: Analytical and Clinical Evaluation. J Clin Microbiol 2021; 59:JCM.03149-20. [PMID: 33483360 PMCID: PMC8092751 DOI: 10.1128/jcm.03149-20] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/20/2021] [Indexed: 11/28/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). While molecular-based testing is used to diagnose COVID-19, serologic testing of antibodies specific to SARS-CoV-2 is used to detect past infection. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). Molecular-based testing is used to diagnose COVID-19, and serologic testing of antibodies specific to SARS-CoV-2 is used to detect past infection. While most serologic assays are qualitative, a quantitative serologic assay was recently developed that measures antibodies against the S protein, the target of vaccines. Quantitative antibody determination may help determine antibody titer and facilitate longitudinal monitoring of the antibody response, including antibody response to vaccines. We evaluated the quantitative Roche Elecsys anti-SARS-CoV-2 S assay. Specimens from 167 PCR-positive patients and 103 control specimens were analyzed using the Elecsys anti-SARS-CoV-2 S assay on the cobas e411 (Roche Diagnostics). Analytical evaluation included assessing linearity, imprecision, and analytical sensitivity. Clinical evaluation included assessing clinical sensitivity, specificity, cross-reactivity, positive predictive value (PPV), negative predictive value (NPV), and serial sampling from the same patient. The Elecsys anti-SARS-CoV-2 S assay exhibited its highest sensitivity (84.0%) at 15 to 30 days post-PCR positivity and exhibited no cross-reactivity, a specificity and PPV of 100%, and an NPV between 98.3% and 99.8% at ≥14 days post-PCR positivity, depending on the seroprevalence estimate. Imprecision was <2% at 9.06 U/ml across 6 days, the negative quality control (QC) was consistently negative (<0.40 U/ml), the manufacturer’s claimed limit of quantitation of 0.40 U/ml was verified, and linearity across the analytical measuring range was observed, except at the low end (<20 U/ml). Lastly, antibody response showed high interindividual variation in level and time of peak antibody titer and trends over time.
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27
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Suhandynata RT, Bevins NJ, Tran JT, Huang D, Hoffman MA, Lund K, Kelner MJ, McLawhon RW, Gonias SL, Nemazee D, Fitzgerald RL. SARS-CoV-2 Serology Status Detected by Commercialized Platforms Distinguishes Previous Infection and Vaccination Adaptive Immune Responses. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.03.10.21253299. [PMID: 33758902 PMCID: PMC7987061 DOI: 10.1101/2021.03.10.21253299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected over 110 million individuals and led to 2.5 million deaths worldwide. As more individuals are vaccinated, the clinical performance and utility of SARS-CoV-2 serology platforms needs to be evaluated. Methods The ability of four commercial SARS-CoV-2 serology platforms to detect previous infection or vaccination were evaluated using a cohort of 53 SARS-CoV-2 PCR-positive patients, 89 SARS-CoV-2-vaccinated healthcare workers (Pfizer or Moderna), and 127 SARS-CoV-2 negative patients. Serology results were compared to a cell based SARS-CoV-2 pseudovirus (PSV) neutralizing antibodies assay. Results The Roche S-(spike) antibody and Diazyme neutralizing antibodies (NAbs) assays detected adaptive immune response in 100.0% and 90.1% of vaccinated individuals who received two-doses of vaccine (initial and booster), respectively. The Roche N-(nucleocapsid) antibody assay and Diazyme IgG assay did not detect adaptive immune response in vaccinated individuals. The Diazyme Nabs assay correlated with the PSV SARS-CoV-2 ID50 neutralization titers (R2= 0.70), while correlation of the Roche S-antibody assay was weaker (R2= 0.39). Median PSV SARS-CoV-2 ID50 titers more than doubled in vaccinated individuals who received two-doses of the Moderna vaccine (ID50: 597) compared to individuals that received a single dose (ID50: 284). Conclusions The Roche S-antibody and Diazyme NAbs assays robustly detected adaptive immune responses in SARS-CoV-2 vaccinated individuals and SARS-CoV-2 infected individuals. The Diazyme NAbs assay strongly correlates with the PSV SARS-CoV-2 NAbs in vaccinated individuals. Understanding the reactivity of commercially available serology platforms is important when distinguishing vaccination response versus natural infection.
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Affiliation(s)
| | | | - Jenny T Tran
- Department of Immunology and Microbiology, The Scripps Research Institution, San Diego, CA
| | - Deli Huang
- Department of Immunology and Microbiology, The Scripps Research Institution, San Diego, CA
| | | | - Kyle Lund
- Department of Pathology UC San Diego Health, San Diego CA
| | | | | | | | - David Nemazee
- Department of Immunology and Microbiology, The Scripps Research Institution, San Diego, CA
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28
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Suhandynata RT, Hoffman MA, Huang D, Tran JT, Kelner MJ, Reed SL, McLawhon RW, Voss JE, Nemazee D, Fitzgerald RL. Commercial Serology Assays Predict Neutralization Activity against SARS-CoV-2. Clin Chem 2021; 67:404-414. [PMID: 33084854 DOI: 10.1093/clinchem/hvaa262] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/12/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND It is unknown whether a positive serology result correlates with protective immunity against SARS-CoV-2. There are also concerns regarding the low positive predictive value of SARS-CoV-2 serology tests, especially when testing populations with low disease prevalence. METHODS A neutralization assay was validated in a set of PCR-confirmed positive specimens and in a negative cohort. In addition, 9530 specimens were screened using the Diazyme SARS-CoV-2 IgG serology assay and all positive results (N = 164 individuals) were reanalyzed using the neutralization assay, the Roche total immunoglobin assay, and the Abbott IgG assay. The relationship between the magnitude of a positive SARS-CoV-2 serology result and neutralizing activity was determined. Neutralizing antibody titers (50% inhibitory dilution, ID50) were also longitudinally monitored in patients confirmed to have SARS-CoV-2 by PCR. RESULTS The SARS-CoV-2 neutralization assay had a positive percentage agreement (PPA) of 96.6% with a SARS-CoV-2 PCR test and a negative percentage agreement (NPA) of 98.0% across 100 negative control individuals. ID50 neutralization titers positively correlated with all 3 clinical serology platforms. Longitudinal monitoring of hospitalized PCR-confirmed patients with COVID-19 demonstrated they made high neutralization titers against SARS-CoV-2. PPA between the Diazyme IgG assay alone and the neutralization assay was 50.6%, while combining the Diazyme IgG assay with either the Roche or Abbott platforms increased the PPA to 79.2 and 78.4%, respectively. CONCLUSIONS These 3 clinical serology assays positively correlate with SARS-CoV-2 neutralization activity observed in patients with COVID-19. All patients confirmed SARS-CoV-2 positive by PCR develop neutralizing antibodies.
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Affiliation(s)
| | | | - Deli Huang
- Department of Immunology and Microbiology, The Scripps Research Institute, San Diego, CA
| | - Jenny T Tran
- Department of Immunology and Microbiology, The Scripps Research Institute, San Diego, CA
| | | | - Sharon L Reed
- Department of Pathology, UC San Diego Health, San Diego, CA
| | | | - James E Voss
- Department of Immunology and Microbiology, The Scripps Research Institute, San Diego, CA
| | - David Nemazee
- Department of Immunology and Microbiology, The Scripps Research Institute, San Diego, CA
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Abstract
Laboratory evaluation of SARS-CoV-2 involves the detection of viral nucleic acid, viral protein antigens, and the antibody response. Molecular detection of SARS-CoV-2 is the only diagnostic test currently available in acutely or recently infected individuals. In contrast, serological testing is typically performed once viral RNA has been cleared and symptoms have resolved. This leads to some confusion among clinicians as to which test to order and when each is appropriate. While SARS-CoV-2 assays can suffer from poor sensitivity, all FDA authorized assays to date are intended to be qualitative. Serological tests have multiple assay formats, detect various classes of immunoglobulins, and have a distinct role in seroprevalence studies; however, the association with long-term protection remains unclear. Both molecular and serological testing for SARS-CoV-2 have complementary roles in patient management, and we highlight the challenges faced by clinicians and laboratorians alike in the evaluation and interpretation of the currently available laboratory assays.
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Affiliation(s)
- Bijal A. Parikh
- Corresponding author. 660 South Euclid Ave., Campus Box 8118, St. Louis, MO, 63110, United States
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Brown RCH, Kelly D, Wilkinson D, Savulescu J. The scientific and ethical feasibility of immunity passports. THE LANCET. INFECTIOUS DISEASES 2021; 21:e58-e63. [PMID: 33075284 PMCID: PMC7567527 DOI: 10.1016/s1473-3099(20)30766-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/07/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023]
Abstract
There is much debate about the use of immunity passports in the response to the COVID-19 pandemic. Some have argued that immunity passports are unethical and impractical, pointing to uncertainties relating to COVID-19 immunity, issues with testing, perverse incentives, doubtful economic benefits, privacy concerns, and the risk of discriminatory effects. We first review the scientific feasibility of immunity passports. Considerable hurdles remain, but increasing understanding of the neutralising antibody response to COVID-19 might make identifying members of the community at low risk of contracting and transmitting COVID-19 possible. We respond to the ethical arguments against immunity passports and give the positive ethical arguments. First, a strong presumption should be in favour of preserving people's free movement if at all feasible. Second, failing to recognise the reduced infection threat immune individuals pose risks punishing people for low-risk behaviour. Finally, further individual and social benefits are likely to accrue from allowing people to engage in free movement. Challenges relating to the implementation of immunity passports ought to be met with targeted solutions so as to maximise their benefit.
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Affiliation(s)
- Rebecca C H Brown
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.
| | - Dominic Kelly
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Department of Paediatrics, Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK; National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK
| | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK; Biomedical Ethics Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Melbourne Law School, Melbourne University, Melbourne, VIC, Australia
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31
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Emeribe AU, Abdullahi IN, Shuwa HA, Uzairue L, Musa S, Anka AU, Adekola HA, Bello ZM, Rogo LD, Aliyu D, Haruna S, Usman Y, Muhammad HY, Gwarzo AM, Nwofe JO, Chiwar HM, Okwume CC, Animasaun OS, Fasogbon SA, Olayemi L, Ogar C, Emeribe CH, Ghamba PE, Awoniyi LO, Musa BOP. Humoral immunological kinetics of severe acute respiratory syndrome coronavirus 2 infection and diagnostic performance of serological assays for coronavirus disease 2019: an analysis of global reports. Int Health 2021; 14:18-52. [PMID: 33620427 PMCID: PMC7928871 DOI: 10.1093/inthealth/ihab005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/23/2020] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
As the coronavirus disease 2019 (COVID-19) pandemic continues to rise and second waves are reported in some countries, serological test kits and strips are being considered to scale up an adequate laboratory response. This study provides an update on the kinetics of humoral immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and performance characteristics of serological protocols (lateral flow assay [LFA], chemiluminescence immunoassay [CLIA] and ELISA) used for evaluations of recent and past SARS-CoV-2 infection. A thorough and comprehensive review of suitable and eligible full-text articles was performed on PubMed, Scopus, Web of Science, Wordometer and medRxiv from 10 January to 16 July 2020. These articles were searched using the Medical Subject Headings terms ‘COVID-19’, ‘Serological assay’, ‘Laboratory Diagnosis’, ‘Performance characteristics’, ‘POCT’, ‘LFA’, ‘CLIA’, ‘ELISA’ and ‘SARS-CoV-2’. Data from original research articles on SARS-CoV-2 antibody detection ≥second day postinfection were included in this study. In total, there were 7938 published articles on humoral immune response and laboratory diagnosis of COVID-19. Of these, 74 were included in this study. The detection, peak and decline period of blood anti-SARS-CoV-2 IgM, IgG and total antibodies for point-of-care testing (POCT), ELISA and CLIA vary widely. The most promising of these assays for POCT detected anti-SARS-CoV-2 at day 3 postinfection and peaked on the 15th day; ELISA products detected anti-SARS-CoV-2 IgM and IgG at days 2 and 6 then peaked on the eighth day; and the most promising CLIA product detected anti-SARS-CoV-2 at day 1 and peaked on the 30th day. The most promising LFA, ELISA and CLIA that had the best performance characteristics were those targeting total SARS-CoV-2 antibodies followed by those targeting anti-SARS-CoV-2 IgG then IgM. Essentially, the CLIA-based SARS-CoV-2 tests had the best performance characteristics, followed by ELISA then POCT. Given the varied performance characteristics of all the serological assays, there is a need to continuously improve their detection thresholds, as well as to monitor and re-evaluate their performances to assure their significance and applicability for COVID-19 clinical and epidemiological purposes.
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Affiliation(s)
- Anthony Uchenna Emeribe
- Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, University of Calabar, P.M.B 1115, Calabar, Cross River State, Nigeria
| | - Idris Nasir Abdullahi
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Halima Ali Shuwa
- University Health Services, College of Health and Medical Sciences, Federal University, Dutse, Nigeria
| | - Leonard Uzairue
- Department of Microbiology, Federal University of Agriculture Abeokuta, Nigeria
| | - Sanusi Musa
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Abubakar Umar Anka
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | | | - Zakariyya Muhammad Bello
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Lawal Dahiru Rogo
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, Bayero University, Kano Nigeria
| | - Dorcas Aliyu
- Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, University of Calabar, P.M.B 1115, Calabar, Cross River State, Nigeria
| | - Shamsuddeen Haruna
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Yahaya Usman
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Habiba Yahaya Muhammad
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, Bayero University, Kano Nigeria
| | | | | | - Hassan Musa Chiwar
- Department of Medical Laboratory Science, University of Maiduguri Maiduguri, Nigeria
| | - Chukwudi Crescent Okwume
- Department of Medical Laboratory Services, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Olawale Sunday Animasaun
- Nigeria Field Epidemiology and Laboratory Training Programme, African Field Epidemiology Network, Abuja, Nigeria
| | - Samuel Ayobami Fasogbon
- Public Health In-vitro Diagnostic Control Laboratory, Medical Laboratory Science Council of Nigeria, Lagos, Nigeria
| | - Lawal Olayemi
- School of Medicine, Faculty of Health Sciences, National University of Samoa, Apia, Samoa
| | - Christopher Ogar
- Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, University of Calabar, P.M.B 1115, Calabar, Cross River State, Nigeria
| | - Chinenye Helen Emeribe
- Department of Family Medicine, University of Calabar Teaching Hospital, PMB 1278 Calabar, Cross River, Nigeria
| | - Peter Elisha Ghamba
- WHO National Polio Reference Laboratory, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Luqman O Awoniyi
- Institute of Biomedicine, and MediCity Research Laboratories, University of Turku, 20014 Turku, Finland
| | - Bolanle O P Musa
- Immunology Unit, Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
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Zhang C, Zheng T, Wang H, Chen W, Huang X, Liang J, Qiu L, Han D, Tan W. Rapid One-Pot Detection of SARS-CoV-2 Based on a Lateral Flow Assay in Clinical Samples. Anal Chem 2021; 93:3325-3330. [PMID: 33570399 PMCID: PMC7885334 DOI: 10.1021/acs.analchem.0c05059] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/05/2021] [Indexed: 01/01/2023]
Abstract
Rapid tests for pathogen identification and spread assessment are critical for infectious disease control and prevention. The control of viral outbreaks requires a nucleic acid diagnostic test that is sensitive and simple and delivers fast and reliable results. Here, we report a one-pot direct reverse transcript loop-mediated isothermal amplification (RT-LAMP) assay of SARS-CoV-2 based on a lateral flow assay in clinical samples. The entire contiguous sample-to-answer workflow takes less than 40 min from a clinical swab sample to a diagnostic result without professional instruments and technicians. The assay achieved an accuracy of 100% in 12 synthetic and 12 clinical samples compared to the data from PCR-based assays. We anticipate that our method will provide a universal platform for rapid and point-of-care detection of emerging infectious diseases.
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Affiliation(s)
- Chao Zhang
- Institute
of Molecular Medicine (IMM), Shanghai Key Laboratory for Nucleic Acid
Chemistry and Nanomedicine, State Key Laboratory of Oncogenes and
Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Tingting Zheng
- Institute
of Molecular Medicine (IMM), Shanghai Key Laboratory for Nucleic Acid
Chemistry and Nanomedicine, State Key Laboratory of Oncogenes and
Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Hua Wang
- Department
of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Wei Chen
- Clinical
Laboratory, Central Hospital of Loudi, Loudi, Hunan 417099, China
| | - Xiaoye Huang
- Clinical
Laboratory, Central Hospital of Loudi, Loudi, Hunan 417099, China
| | - Jianqi Liang
- Clinical
Laboratory, Central Hospital of Loudi, Loudi, Hunan 417099, China
| | - Liping Qiu
- Molecular
Science and Biomedicine Laboratory (MBL), State Key Laboratory of
Chemo/Bio- Sensing and Chemometrics, College of Chemistry and Chemical
Engineering, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, Hunan 410082, China
| | - Da Han
- Institute
of Molecular Medicine (IMM), Shanghai Key Laboratory for Nucleic Acid
Chemistry and Nanomedicine, State Key Laboratory of Oncogenes and
Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Weihong Tan
- Institute
of Molecular Medicine (IMM), Shanghai Key Laboratory for Nucleic Acid
Chemistry and Nanomedicine, State Key Laboratory of Oncogenes and
Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
- Molecular
Science and Biomedicine Laboratory (MBL), State Key Laboratory of
Chemo/Bio- Sensing and Chemometrics, College of Chemistry and Chemical
Engineering, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, Hunan 410082, China
- Institute
of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, The Cancer Hospital of the University of Chinese Academy
of Sciences, Hangzhou, Zhejiang 310018, China
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Ahmad K, Rezvanizadeh V, Dahal S, Kinninger A, Ghanem AK, Lakshmanan S, Hamal S, Flores F, Dailing C, Roy SK, Budoff MJ. COVID-19 IgG/IgM antibody testing in Los Angeles County, California. Eur J Clin Microbiol Infect Dis 2021; 40:457-459. [PMID: 33241444 PMCID: PMC7688294 DOI: 10.1007/s10096-020-04111-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/20/2020] [Indexed: 11/26/2022]
Abstract
Evidence suggests that asymptomatic and mild SARS-CoV-2 infections comprise > 95% of all cases. Developing a test that indicates past infection and possible immunity against the virus is important. We administered 244 antibody tests to three groups of high-risk population. The test consisted of an IgG component and an IgM component. The overall IgM/IgG positivity for patients with none, mild, moderate, and severe symptoms were 21.1%, 21.8%, 14.2%, and 26.9%, respectively. Those with moderate or severe symptoms were no more or less likely to have positive antibody tests than those with no or mild symptoms.
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Affiliation(s)
- Khadije Ahmad
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - Vahid Rezvanizadeh
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - Suraj Dahal
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - April Kinninger
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - Ahmed K Ghanem
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - Suvasini Lakshmanan
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - Sajad Hamal
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - Ferdinand Flores
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - Christopher Dailing
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - Sion K Roy
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - Matthew J Budoff
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA.
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Sánchez-Romero M, di Lego V, Prskawetz A, L. Queiroz B. An indirect method to monitor the fraction of people ever infected with COVID-19: An application to the United States. PLoS One 2021; 16:e0245845. [PMID: 33508030 PMCID: PMC7842943 DOI: 10.1371/journal.pone.0245845] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/10/2021] [Indexed: 01/16/2023] Open
Abstract
The number of COVID-19 infections is key for accurately monitoring the pandemics. However, due to differential testing policies, asymptomatic individuals and limited large-scale testing availability, it is challenging to detect all cases. Seroprevalence studies aim to address this gap by retrospectively assessing the number of infections, but they can be expensive and time-intensive, limiting their use to specific population subgroups. In this paper, we propose a complementary approach that combines estimated (1) infection fatality rates (IFR) using a Bayesian melding SEIR model with (2) reported case-fatality rates (CFR) in order to indirectly estimate the fraction of people ever infected (from the total population) and detected (from the ever infected). We apply the technique to the U.S. due to their remarkable regional diversity and because they count with almost a quarter of all global confirmed cases and deaths. We obtain that the IFR varies from 1.25% (0.39-2.16%, 90% CI) in Florida, the most aged population, to 0.69% in Utah (0.21-1.30%, 90% CI), the youngest population. By September 8, 2020, we estimate that at least five states have already a fraction of people ever infected between 10% and 20% (New Jersey, New York, Massachussets, Connecticut, and District of Columbia). The state with the highest estimated fraction of people ever infected is New Jersey with 17.3% (10.0, 55.8, 90% CI). Moreover, our results indicate that with a probability of 90 percent the fraction of detected people among the ever infected since the beginning of the epidemic has been less than 50% in 15 out of the 20 states analyzed in this paper. Our approach can be a valuable tool that complements seroprevalence studies and indicates how efficient have testing policies been since the beginning of the outbreak.
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Affiliation(s)
- Miguel Sánchez-Romero
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Vienna Institute of Demography/Austrian Academy of Sciences, Vienna, Austria
| | - Vanessa di Lego
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Vienna Institute of Demography/Austrian Academy of Sciences, Vienna, Austria
| | - Alexia Prskawetz
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Vienna Institute of Demography/Austrian Academy of Sciences, Vienna, Austria
- Institute of Statistics and Mathematical Methods in Economics, TU Wien, Vienna, Austria
| | - Bernardo L. Queiroz
- Universidade Federal de Minas Gerais, Cedeplar, Belo Horizonte, State of Minas Gerais, Brazil
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Artificial Intelligence-assisted chest X-ray assessment scheme for COVID-19. Eur Radiol 2021; 31:6039-6048. [PMID: 33471219 PMCID: PMC7816060 DOI: 10.1007/s00330-020-07628-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/27/2020] [Accepted: 12/11/2020] [Indexed: 11/14/2022]
Abstract
Objectives To study whether a trained convolutional neural network (CNN) can be of assistance to radiologists in differentiating Coronavirus disease (COVID)–positive from COVID-negative patients using chest X-ray (CXR) through an ambispective clinical study. To identify subgroups of patients where artificial intelligence (AI) can be of particular value and analyse what imaging features may have contributed to the performance of AI by means of visualisation techniques. Methods CXR of 487 patients were classified into [4] categories—normal, classical COVID, indeterminate, and non-COVID by consensus opinion of 2 radiologists. CXR which were classified as “normal” and “indeterminate” were then subjected to analysis by AI, and final categorisation provided as guided by prediction of the network. Precision and recall of the radiologist alone and radiologist assisted by AI were calculated in comparison to reverse transcriptase-polymerase chain reaction (RT-PCR) as the gold standard. Attention maps of the CNN were analysed to understand regions in the CXR important to the AI algorithm in making a prediction. Results The precision of radiologists improved from 65.9 to 81.9% and recall improved from 17.5 to 71.75 when assistance with AI was provided. AI showed 92% accuracy in classifying “normal” CXR into COVID or non-COVID. Analysis of attention maps revealed attention on the cardiac shadow in these “normal” radiographs. Conclusion This study shows how deployment of an AI algorithm can complement a human expert in the determination of COVID status. Analysis of the detected features suggests possible subtle cardiac changes, laying ground for further investigative studies into possible cardiac changes. Key Points • Through an ambispective clinical study, we show how assistance with an AI algorithm can improve recall (sensitivity) and precision (positive predictive value) of radiologists in assessing CXR for possible COVID in comparison to RT-PCR. • We show that AI achieves the best results in images classified as “normal” by radiologists. We conjecture that possible subtle cardiac in the CXR, imperceptible to the human eye, may have contributed to this prediction. • The reported results may pave the way for a human computer collaboration whereby the expert with some help from the AI algorithm achieves higher accuracy in predicting COVID status on CXR than previously thought possible when considering either alone. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-020-07628-5.
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Characteristics of Three Different Chemiluminescence Assays for Testing for SARS-CoV-2 Antibodies. DISEASE MARKERS 2021; 2021:8810196. [PMID: 33532006 PMCID: PMC7834819 DOI: 10.1155/2021/8810196] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/03/2020] [Accepted: 12/24/2020] [Indexed: 01/08/2023]
Abstract
Several tests based on chemiluminescence immunoassay techniques have become available to test for SARS-CoV-2 antibodies. There is currently insufficient data on serology assay performance beyond 35 days after symptoms onset. We aimed to evaluate SARS-CoV-2 antibody tests on three widely used platforms. A chemiluminescent microparticle immunoassay (CMIA; Abbott Diagnostics, USA), a luminescence immunoassay (LIA; Diasorin, Italy), and an electrochemiluminescence immunoassay (ECLIA; Roche Diagnostics, Switzerland) were investigated. In a multigroup study, sensitivity was assessed in a group of participants with confirmed SARS-CoV-2 (n = 145), whereas specificity was determined in two groups of participants without evidence of COVID-19 (i.e., healthy blood donors, n = 191, and healthcare workers, n = 1002). Receiver operating characteristic (ROC) curves, multilevel likelihood ratios (LR), and positive (PPV) and negative (NPV) predictive values were characterized. Finally, analytical specificity was characterized in samples with evidence of the Epstein–Barr virus (EBV) (n = 9), cytomegalovirus (CMV) (n = 7), and endemic common-cold coronavirus infections (n = 12) taken prior to the current SARS-CoV-2 pandemic. The diagnostic accuracy was comparable in all three assays (AUC 0.98). Using the manufacturers' cut-offs, the sensitivities were 90%, 95% confidence interval [84,94] (LIA), 93% [88,96] (CMIA), and 96% [91,98] (ECLIA). The specificities were 99.5% [98.9,99.8] (CMIA), 99.7% [99.3,99.9] (LIA), and 99.9% [99.5,99.98] (ECLIA). The LR at half of the manufacturers' cut-offs were 60 (CMIA), 82 (LIA), and 575 (ECLIA) for positive and 0.043 (CMIA) and 0.035 (LIA, ECLIA) for negative results. ECLIA had higher PPV at low pretest probabilities than CMIA and LIA. No interference with EBV or CMV infection was observed, whereas endemic coronavirus in some cases provided signals in LIA and/or CMIA. Although the diagnostic accuracy of the three investigated assays is comparable, their performance in low-prevalence settings is different. Introducing gray zones at half of the manufacturers' cut-offs is suggested, especially for orthogonal testing approaches that use a second assay for confirmation.
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Comparison of the Clinical Performances of the Abbott Alinity IgG, Abbott Architect IgM, and Roche Elecsys Total SARS-CoV-2 Antibody Assays. J Clin Microbiol 2020; 59:JCM.02104-20. [PMID: 33106364 DOI: 10.1128/jcm.02104-20] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/22/2020] [Indexed: 01/29/2023] Open
Abstract
Critical evaluation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serologic assays is needed to guide clinical decision-making and ensure that these assays provide optimal benefit to patients and the public. Here, three commercially available assays with widespread distribution capabilities are compared. A total of 667 specimens, 103 from patients with confirmed SARS-CoV-2 infections and 564 collected prior to the emergence of SARS-CoV-2, were analyzed in parallel using the Roche Elecsys SARS-CoV-2 total antibody and Abbott Alinity SARS-CoV-2 IgG assays; a subset of 55 samples from patients with confirmed SARS-CoV-2 infections was additionally evaluated using the Abbott Architect SARS-CoV-2 IgM assay. Qualitative agreement between the Abbott IgG and Roche total antibody assays was 98.7% (658/667), with Cohen's kappa value of 0.919 (95% confidence interval [CI], 0.867 to 0.972). Qualitative agreements with the Abbott IgM assay were 92.7% (51/55, Abbott IgG) and 85.5% (47/55, Roche total antibody). Diagnostic specificities determined using pre-COVID-19 samples for the Abbott IgG and Roche total antibody assays were 99.65% (95% CI, 98.72 to 99.90%) and 100.00% (95% CI, 99.32 to 100.00%), respectively, spanning claims made by each manufacturer. Diagnostic sensitivities increased for all three assays with increasing time since the onset of symptoms. Among 51 patients with confirmed SARS-CoV-2 infections, 23 (45.1%), 24 (47.1%), and 22 (43.1%) were reactive by the Abbott IgG, Roche total antibody, and Abbott IgM assays, respectively, with sampling times 0 to 56 days post-positive PCR (median/mean, 2/6.2 days). Combining IgG and IgM screening identified 4/55 additional samples with detectable antibodies that would not have been observed using the assays independently. Notably, one immunocompromised patient with confirmed SARS-CoV-2 infection showed no detectable antibodies using any of the three assays 43 days after onset of symptoms.
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Beran J, Špajdel M, Katzerová V, Holoušová A, Malyš J, Finger Rousková J, Slíva J. Inosine Pranobex Significantly Decreased the Case-Fatality Rate among PCR Positive Elderly with SARS-CoV-2 at Three Nursing Homes in the Czech Republic. Pathogens 2020; 9:pathogens9121055. [PMID: 33339426 PMCID: PMC7766462 DOI: 10.3390/pathogens9121055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022] Open
Abstract
During the COVID-19 pandemic, the elderly population has been disproportionately affected, especially those in nursing homes (NH). Inosine pranobex (IP) has been previously demonstrated to be effective in treating acute viral respiratory infections. In three NH experiencing the SARS-CoV-2 virus epidemic, we started treatment with IP as soon as clients tested PCR+. In Litovel, CZ, the difference in case-fatality rate (CFR) for the PCR+ group using vs. not using IP was statistically significant, and the odds ratio (OR) was 7.2. When comparing all those taking IP in the three NH vs. the non-drug PCR+ group in Litovel, the odds ratio was lower for all three NH, but still significant at 2.9. The CFR in all three tested NHs, age range 75-84, compared to the CFR in all NHs in the Czech Republic, was significantly reduced (7.5% vs. 18%) (OR: 2.8); there was also a significant difference across all age groups (OR: 1.7). In our study with 301 residents, the CFR was significantly reduced (OR: 2.8) to 11.9% (17/142) in comparison to a study in Ireland with 27.6% (211/764). We think the effect of IP was significant in this reduction; nevertheless, these are preliminary results that need larger-scale trials on COVID-19 patients.
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Affiliation(s)
- Jiří Beran
- Department for Tropical, Travel Medicine and Immunization, Institute of Postgraduate Health Education, 100 05 Prague, Czech Republic
- Correspondence: ; Tel.: +420-603-113-867 or +420-495-541-584
| | - Marian Špajdel
- Department of Psychology, Faculty of Philosophy and Arts, Trnava University, 918 43 Trnava, Slovakia;
| | | | - Alena Holoušová
- Sanatorium Topas, 534 01 Holice, Czech Republic; (A.H.); (J.M.)
| | - Jan Malyš
- Sanatorium Topas, 534 01 Holice, Czech Republic; (A.H.); (J.M.)
| | - Jana Finger Rousková
- Senior dům Beránek Úpice, 542 32 Úpice, Czech Republic;
- Department of Pharmacology, Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic;
| | - Jiří Slíva
- Department of Pharmacology, Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic;
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Voo TC, Reis AA, Thomé B, Ho CW, Tam CC, Kelly-Cirino C, Emanuel E, Beca JP, Littler K, Smith MJ, Parker M, Kass N, Gobat N, Lei R, Upshur R, Hurst S, Munsaka S. Immunity certification for COVID-19: ethical considerations. Bull World Health Organ 2020; 99:155-161. [PMID: 33551509 PMCID: PMC7856365 DOI: 10.2471/blt.20.280701] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/24/2020] [Indexed: 01/02/2023] Open
Abstract
Restrictive measures imposed because of the coronavirus disease 2019 (COVID-19) pandemic have resulted in severe social, economic and health effects. Some countries have considered the use of immunity certification as a strategy to relax these measures for people who have recovered from the infection by issuing these individuals a document, commonly called an immunity passport. This document certifies them as having protective immunity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus that causes COVID-19. The World Health Organization has advised against the implementation of immunity certification at present because of uncertainty about whether long-term immunity truly exists for those who have recovered from COVID-19 and concerns over the reliability of the proposed serological test method for determining immunity. Immunity certification can only be considered if scientific thresholds for assuring immunity are met, whether based on antibodies or other criteria. However, even if immunity certification became well supported by science, it has many ethical issues in terms of different restrictions on individual liberties and its implementation process. We examine the main considerations for the ethical acceptability of immunity certification to exempt individuals from restrictive measures during the COVID-19 pandemic. As well as needing to meet robust scientific criteria, the ethical acceptability of immunity certification depends on its uses and policy objectives and the measures in place to reduce potential harms, and prevent disproportionate burdens on non-certified individuals and violation of individual liberties and rights.
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Affiliation(s)
- Teck Chuan Voo
- Centre for Biomedical Ethics, National University of Singapore, Blk MD 11, 10 Medical Drive #02-03, Singapore117597, Singapore
| | - Andreas A Reis
- Health Ethics and Governance Unit, World Health Organization, Geneva, Switzerland
| | - Beatriz Thomé
- Preventive Medicine Department, Federal University of São Paulo, São Paulo, Brazil
| | - Calvin Wl Ho
- Faculty of Law, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Clarence C Tam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Ezekiel Emanuel
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, United States of America
| | - Juan P Beca
- Centro de Bioética, Universidad del Desarrollo, Santiago, Chile
| | - Katherine Littler
- Health Ethics and Governance Unit, World Health Organization, Geneva, Switzerland
| | - Maxwell J Smith
- Faculty of Health Sciences, Western University, Ontario, Canada
| | - Michael Parker
- Wellcome Centre of Ethics and Humanities, University of Oxford, Oxford, England
| | - Nancy Kass
- Berman Institute of Bioethics and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Nina Gobat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Ruipeng Lei
- School of Philosophy and Center for Bioethics, Huazhong University of Science and Technology, Wuhan, China
| | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Samia Hurst
- Institute for Ethics, History, and the Humanities, University of Geneva, Geneva, Switzerland
| | - Sody Munsaka
- School of Health Sciences, University of Zambia, Lusaka, Zambia
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Risch M, Weber M, Thiel S, Grossmann K, Wohlwend N, Lung T, Hillmann D, Ritzler M, Ferrara F, Bigler S, Egli K, Bodmer T, Imperiali M, Salimi Y, Fleisch F, Cusini A, Renz H, Kohler P, Vernazza P, Kahlert CR, Paprotny M, Risch L. Temporal Course of SARS-CoV-2 Antibody Positivity in Patients with COVID-19 following the First Clinical Presentation. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9878453. [PMID: 33224987 PMCID: PMC7673235 DOI: 10.1155/2020/9878453] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/13/2020] [Accepted: 10/22/2020] [Indexed: 11/18/2022]
Abstract
Knowledge of the sensitivities of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody tests beyond 35 days after the clinical onset of COVID-19 is insufficient. We aimed to describe positivity rate of SARS-CoV-2 assays employing three different measurement principles over a prolonged period. Two hundred sixty-eight samples from 180 symptomatic patients with COVID-19 and a reverse transcription polymerase chain reaction (RT-PCR) test followed by serological investigation of SARS-CoV-2 antibodies were included. We conducted three chemiluminescence (including electrochemiluminescence assay (ECLIA)), four enzyme-linked immunosorbent assay (ELISA), and one lateral flow immunoassay (LFIA) test formats. Positivity rates, as well as positive (PPVs) and negative predictive values (NPVs), were calculated for each week after the first clinical presentation for COVID-19. Furthermore, combinations of tests were assessed within an orthogonal testing approach employing two independent assays and predictive values were calculated. Heat maps were constructed to graphically illustrate operational test characteristics. During a follow-up period of more than 9 weeks, chemiluminescence assays and one ELISA IgG test showed stable positivity rates after the third week. With the exception of ECLIA, the PPVs of the other chemiluminescence assays were ≥95% for COVID-19 only after the second week. ELISA and LFIA had somewhat lower PPVs. IgM exhibited insufficient predictive characteristics. An orthogonal testing approach provided PPVs ≥ 95% for patients with a moderate pretest probability (e.g., symptomatic patients), even for tests with a low single test performance. After the second week, NPVs of all but IgM assays were ≥95% for patients with low to moderate pretest probability. The confirmation of negative results using an orthogonal algorithm with another assay provided lower NPVs than the single assays. When interpreting results from SARS-CoV-2 tests, the pretest probability, time of blood draw, and assay characteristics must be carefully considered. An orthogonal testing approach increases the accuracy of positive, but not negative, predictions.
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Affiliation(s)
- Martin Risch
- Zentrallabor, Kantonsspital Graubünden, Loësstrasse 170, 7000 Chur, Switzerland
| | - Myriam Weber
- Liechtensteinisches Landesspital, Heiligkreuz, 9490 Vaduz, Liechtenstein
| | - Sarah Thiel
- Liechtensteinisches Landesspital, Heiligkreuz, 9490 Vaduz, Liechtenstein
| | - Kirsten Grossmann
- Labormedizinisches Zentrum Dr. Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein
- Private Universität im Fürstentum Liechtenstein, Dorfstrasse, 9495 Triesen, Liechtenstein
| | - Nadia Wohlwend
- Labormedizinisches Zentrum Dr. Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein
| | - Thomas Lung
- Labormedizinisches Zentrum Dr. Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein
| | - Dorothea Hillmann
- Labormedizinisches Zentrum Dr. Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein
| | - Michael Ritzler
- Labormedizinisches Zentrum Dr. Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein
| | - Francesca Ferrara
- Labormedizinisches Zentrum Dr. Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein
| | - Susanna Bigler
- Labormedizinisches Zentrum Dr. Risch, Waldeggstrasse 37, 3097 Liebefeld, Switzerland
| | - Konrad Egli
- Labormedizinisches Zentrum Dr. Risch, Waldeggstrasse 37, 3097 Liebefeld, Switzerland
| | - Thomas Bodmer
- Labormedizinisches Zentrum Dr. Risch, Waldeggstrasse 37, 3097 Liebefeld, Switzerland
| | - Mauro Imperiali
- Centro Medicina di Laboratorio Dr. Risch, Via Arbostra 2, 6963 Pregassona, Switzerland
| | - Yacir Salimi
- Clm Dr. Risch Arc Lémanique SA, Chemin de l'Esparcette 10, 1023 Crissier, Switzerland
| | - Felix Fleisch
- Division of Infectious Diseases, Cantonal Hospital Chur, Loësstrasse 170, 7000 Chur, Switzerland
| | - Alexia Cusini
- Division of Infectious Diseases, Cantonal Hospital Chur, Loësstrasse 170, 7000 Chur, Switzerland
| | - Harald Renz
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg, University Hospital Giessen and Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - Philipp Kohler
- Cantonal Hospital St. Gallen, Department of Infectious Diseases and Hospital Epidemiology, Rohrschacherstrasse 95, 9007 St. Gallen, Switzerland
| | - Pietro Vernazza
- Cantonal Hospital St. Gallen, Department of Infectious Diseases and Hospital Epidemiology, Rohrschacherstrasse 95, 9007 St. Gallen, Switzerland
| | - Christian R. Kahlert
- Cantonal Hospital St. Gallen, Department of Infectious Diseases and Hospital Epidemiology, Rohrschacherstrasse 95, 9007 St. Gallen, Switzerland
- Children's Hospital of Eastern Switzerland, Department of Infectious Diseases and Hospital Epidemiology, Claudiusstrasse 6, 9006 St. Gallen, Switzerland
| | - Matthias Paprotny
- Liechtensteinisches Landesspital, Heiligkreuz, 9490 Vaduz, Liechtenstein
| | - Lorenz Risch
- Labormedizinisches Zentrum Dr. Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein
- Private Universität im Fürstentum Liechtenstein, Dorfstrasse, 9495 Triesen, Liechtenstein
- Center of Laboratory Medicine, University Institute of Clinical Chemistry, University of Bern, Inselspital, 3010 Bern, Switzerland
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Lopez L, Nguyen T, Weber G, Kleimola K, Bereda M, Liu Y, Accorsi EK, Skates SJ, Santa Maria JP, Smith KR, Kalinich M. Seroprevalence of anti-SARS-CoV-2 IgG Antibodies in the Staff of a Public School System in the Midwestern United States. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.10.23.20218651. [PMID: 33140066 PMCID: PMC7605578 DOI: 10.1101/2020.10.23.20218651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since March 2020, the United States has lost over 200,000 lives to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. A growing body of literature describes population-level SARS-CoV-2 exposure, but studies of antibody seroprevalence within school systems are critically lacking, hampering evidence-based discussions on school reopenings. The Lake Central School Corporation (LCSC), a public school system in suburban Indiana, USA, assessed SARS-CoV-2 seroprevalence in its staff and identified correlations between seropositivity and subjective histories and demographics. METHODS This study is a cross-sectional, population-based analysis of the seroprevalence of SARS-CoV-2 in LCSC staff measured in July 2020. We tested for seroprevalence with the Abbott Alinity™ SARS-CoV-2 IgG antibody test. The primary outcome was the total seroprevalence of SARS-CoV-2, and secondary outcomes included trends of antibody presence in relation to baseline attributes. FINDINGS 753 participants representative of the staff at large were enrolled. 22 participants (2·9%, 95% CI: 1·8% - 4·4%) tested positive for SARS-CoV-2 antibodies. Correcting for test performance parameters, the seroprevalence is estimated at 1·7% (90% Credible Interval: 0·27% - 3·3%). Multivariable logistic regression including mask wearing, travel history, symptom history, and contact history revealed a 48-fold increase in the odds of seropositivity if an individual previously tested positive for COVID-19 (OR: 48.2, 95% CI: 4 - 600). Amongst individuals with no previous positive test, exposure to a person diagnosed with COVID-19 increased the odds of seropositivity by 7-fold (OR: 6.5, 95% CI: 2.06 - 18.9). INTERPRETATION Assuming the presence of antibodies is associated with immunity against SARS-CoV-2 infection, these results demonstrate a broad lack of herd immunity amongst the school corporation's staff irrespective of employment role or location. Protective measures like contact tracing face coverings, and social distancing are therefore vital to maintaining the safety of both students and staff as the school year progresses. FUNDING Lake Central School Corporation. RESEARCH IN CONTEXT Evidence before this study: We searched PubMed, SSRN, Research Square, and Gale Power Search for peer-reviewed articles, preprints, and research reports on the seroprevalence of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG antibodies, published in English, using the search terms "COVID-19 in schools," "COVID-19 seroprevalence," "COVID antibodies," and similar terms up to August 30, 2020. We identified several articles pertaining to the spread of COVID-19 within schools and among children. Current evidence on the pediatric transmission of COVID-19 is mixed, but early data on secondary school transmission are sobering. Shared among this literature was an acknowledgement of the paucity of data regarding how the pandemic may progress in the students and staff of primary and secondary education systems. To our knowledge, there is no study that specifically interrogates the seroprevalence of COVID-19 among US public school staff.Added value of this study: As of September 2020, the United States has had more COVID-19 cases than any other country. With many US schools opening for in-person classes for the 2020-2021 school year, a granular understanding of the transmission dynamics within public school systems is vital to effectively and appropriately defending against COVID-19. Most seroprevalence studies have been based on city or hospital-level populations; this study establishes a baseline seroprevalence of SARS-CoV-2 antibodies in a Midwest public school district prior to the initiation of the school year.Implications of all available evidence: The results of this study reveal that the majority (98·3%) of LCSC staff have not been exposed to COVID-19 prior to the start of the school year. Staff are therefore vulnerable to a large outbreak after the school opens, underscoring the importance of maintaining rigorous sanitary practices within the schools. It is vital that all members of LCSC and similar school districts across the country continue social distancing and mask wearing throughout the school day to limit exposure to COVID-19. Contact tracing in combination with rapid testing for individuals exposed to an individual with COVID-19 should also be employed.
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Affiliation(s)
- Lilah Lopez
- Lake Central School Corporation, Saint John, IN
| | - Thao Nguyen
- Lake Central School Corporation, Saint John, IN
| | | | | | | | - Yiling Liu
- Biostatistics Center, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Emma K. Accorsi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Steven J. Skates
- Biostatistics Center, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Abstract
The SARS-CoV-2 virus caused a globally growing pandemic called coronavirus disease 2019 (COVID-19) that has disrupted social, political, and medical environments around the world. Nations are assessing ways to reopen businesses while trying to balance health care risks and economic fallouts. Strategies involving antibody testing have been proposed before phased reopening of the economy. Therefore, assessing the sensitivity and specificity of antibody tests for symptomatic and asymptomatic COVID-19 patients remains paramount to prevent COVID-19 outbreaks. The antibody tests for SARS-CoV-2 detect the presence of IgA, IgM, or IgG antibodies produced by B cells. There are four major types of antibody tests: rapid diagnostic tests, enzyme-linked immunosorbent assays, neutralization assays, and chemiluminescent immunoassays. Currently, there is no standard antibody test for detecting SARS-CoV-2 antibodies during or after exposure or infection. The antibody tests for SARS-CoV-2 have a low specificity within the first week of exposure and increase in the second and third weeks. The current data on antibody tests have several limitations in quality and the presence of bias. Specifically, many antibody tests have a high false-negative rate and a high risk of bias for participant selection, application of index tests, reference standard used, and flow and timing for antibody tests that may incorrectly report the accuracy of COVID-19 antibody tests. In this review, we summarize the current methods, sensitivity/specificity, and gaps in knowledge concerning COVID-19 antibody testing.
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Affiliation(s)
- Jonathan Kopel
- Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Hemant Goyal
- The Wright Center for Graduate Medical Education, Scranton, Pennsylvania
| | - Abhilash Perisetti
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Bowsher RR, Devanarayan V. Are Lessons Learned in Setting Cut Points for Detection of Anti-Drug Antibodies Also Useful in Serology Assays for Robust Detection of SARS-CoV-2 Reactive Antibodies? AAPS J 2020; 22:127. [PMID: 33025311 PMCID: PMC7538034 DOI: 10.1208/s12248-020-00510-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ronald R Bowsher
- B2S Life Sciences llc, 97 East Monroe Street, Franklin, Indiana, 46131, USA.
| | - Viswanath Devanarayan
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania, 19426, USA
- University of Illinois at Chicago, 1200 W. Harrison Street, Chicago, Illinois, 60607, USA
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44
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Herron JBT, Dennis J, Brennan PA. Coronavirus antibody positive tests and continued use of personal protective equipment throughout the pandemic. Br J Oral Maxillofac Surg 2020; 58:1014-1016. [PMID: 32660877 PMCID: PMC7305874 DOI: 10.1016/j.bjoms.2020.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 01/01/2023]
Abstract
The COVID-19 pandemic has thrust not only a novel virus onto the world, but new challenges resulting in novel approaches. Governments have reduced regulation in order to facilitate timely advances to combat the disease. Antibody testing has rapidly been deployed but it is creating challenges for staff and patients. Mask use has come to the forefront and human factor (HF) strategies must be examined to reduce risk associated with lack of engagement from both healthcare staff and patients. In this we explore these issues and suggest some solutions.
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Affiliation(s)
- J B T Herron
- Faculty of Health Sciences and Wellbeing Sunderland University, Chester Road, Sunderland SR1 3SD, UK.
| | - J Dennis
- Academic Foundation Year Two, Faculty of Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College, London SW7 2AZ, UK
| | - P A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
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Miller TE, Garcia Beltran WF, Bard AZ, Gogakos T, Anahtar MN, Astudillo MG, Yang D, Thierauf J, Fisch AS, Mahowald GK, Fitzpatrick MJ, Nardi V, Feldman J, Hauser BM, Caradonna TM, Marble HD, Ritterhouse LL, Turbett SE, Batten J, Georgantas NZ, Alter G, Schmidt AG, Harris JB, Gelfand JA, Poznansky MC, Bernstein BE, Louis DN, Dighe A, Charles RC, Ryan ET, Branda JA, Pierce VM, Murali MR, Iafrate AJ, Rosenberg ES, Lennerz JK. Clinical sensitivity and interpretation of PCR and serological COVID-19 diagnostics for patients presenting to the hospital. FASEB J 2020; 34:13877-13884. [PMID: 32856766 PMCID: PMC7461169 DOI: 10.1096/fj.202001700rr] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022]
Abstract
The diagnosis of COVID-19 requires integration of clinical and laboratory data. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic assays play a central role in diagnosis and have fixed technical performance metrics. Interpretation becomes challenging because the clinical sensitivity changes as the virus clears and the immune response emerges. Our goal was to examine the clinical sensitivity of two most common SARS-CoV-2 diagnostic test modalities, polymerase chain reaction (PCR) and serology, over the disease course to provide insight into their clinical interpretation in patients presenting to the hospital. We conducted a single-center, retrospective study. To derive clinical sensitivity of PCR, we identified 209 PCR-positive SARS-CoV-2 patients with multiple PCR test results (624 total PCR tests) and calculated daily sensitivity from date of symptom onset or first positive test. Clinical sensitivity of PCR decreased with days post symptom onset with >90% clinical sensitivity during the first 5 days after symptom onset, 70%-71% from Days 9 to 11, and 30% at Day 21. To calculate daily clinical sensitivity by serology, we utilized 157 PCR-positive patients with a total of 197 specimens tested by enzyme-linked immunosorbent assay for IgM, IgG, and IgA anti-SARS-CoV-2 antibodies. In contrast to PCR, serological sensitivity increased with days post symptom onset with >50% of patients seropositive by at least one antibody isotype after Day 7, >80% after Day 12, and 100% by Day 21. Taken together, PCR and serology are complimentary modalities that require time-dependent interpretation. Superimposition of sensitivities over time indicate that serology can function as a reliable diagnostic aid indicating recent or prior infection.
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Affiliation(s)
- Tyler E. Miller
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | | | - Adam Z. Bard
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Tasos Gogakos
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Melis N. Anahtar
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | | | - Diane Yang
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Julia Thierauf
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Adam S. Fisch
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Grace K. Mahowald
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Megan J. Fitzpatrick
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Valentina Nardi
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Jared Feldman
- Ragon Institute of MGH, MIT, and HarvardCambridgeMAUSA
| | | | | | - Hetal D. Marble
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Lauren L. Ritterhouse
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Sara E. Turbett
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Julie Batten
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | | | - Galit Alter
- Ragon Institute of MGH, MIT, and HarvardCambridgeMAUSA
| | | | - Jason B. Harris
- Division of Infectious DiseasesDepartment of PediatricsMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Jeffrey A. Gelfand
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Mark C. Poznansky
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Bradley E. Bernstein
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - David N. Louis
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Anand Dighe
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Richelle C. Charles
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Edward T. Ryan
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - John A. Branda
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Virginia M. Pierce
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
- Division of Infectious DiseasesDepartment of PediatricsMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Mandakolathur R. Murali
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
- Division of Allergy and ImmunologyDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - A. John Iafrate
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Eric S. Rosenberg
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Jochen K. Lennerz
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
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Whitman JD, Hiatt J, Mowery CT, Shy BR, Yu R, Yamamoto TN, Rathore U, Goldgof GM, Whitty C, Woo JM, Gallman AE, Miller TE, Levine AG, Nguyen DN, Bapat SP, Balcerek J, Bylsma SA, Lyons AM, Li S, Wong AWY, Gillis-Buck EM, Steinhart ZB, Lee Y, Apathy R, Lipke MJ, Smith JA, Zheng T, Boothby IC, Isaza E, Chan J, Acenas DD, Lee J, Macrae TA, Kyaw TS, Wu D, Ng DL, Gu W, York VA, Eskandarian HA, Callaway PC, Warrier L, Moreno ME, Levan J, Torres L, Farrington LA, Loudermilk RP, Koshal K, Zorn KC, Garcia-Beltran WF, Yang D, Astudillo MG, Bernstein BE, Gelfand JA, Ryan ET, Charles RC, Iafrate AJ, Lennerz JK, Miller S, Chiu CY, Stramer SL, Wilson MR, Manglik A, Ye CJ, Krogan NJ, Anderson MS, Cyster JG, Ernst JD, Wu AHB, Lynch KL, Bern C, Hsu PD, Marson A. Evaluation of SARS-CoV-2 serology assays reveals a range of test performance. Nat Biotechnol 2020; 38:1174-1183. [PMID: 32855547 PMCID: PMC7740072 DOI: 10.1038/s41587-020-0659-0] [Citation(s) in RCA: 198] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/29/2020] [Indexed: 12/18/2022]
Abstract
Appropriate use and interpretation of serological tests for assessments of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure, infection and potential immunity require accurate data on assay performance. We conducted a head-to-head evaluation of ten point-of-care-style lateral flow assays (LFAs) and two laboratory-based enzyme-linked immunosorbent assays to detect anti-SARS-CoV-2 IgM and IgG antibodies in 5-d time intervals from symptom onset and studied the specificity of each assay in pre-coronavirus disease 2019 specimens. The percent of seropositive individuals increased with time, peaking in the latest time interval tested (>20 d after symptom onset). Test specificity ranged from 84.3% to 100.0% and was predominantly affected by variability in IgM results. LFA specificity could be increased by considering weak bands as negative, but this decreased detection of antibodies (sensitivity) in a subset of SARS-CoV-2 real-time PCR-positive cases. Our results underline the importance of seropositivity threshold determination and reader training for reliable LFA deployment. Although there was no standout serological assay, four tests achieved more than 80% positivity at later time points tested and more than 95% specificity.
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Affiliation(s)
- Jeffrey D Whitman
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Joseph Hiatt
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- Biomedical Sciences Graduate Program, University of California, San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Cody T Mowery
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- Biomedical Sciences Graduate Program, University of California, San Francisco, San Francisco, CA, USA
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Brian R Shy
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Ruby Yu
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Tori N Yamamoto
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Ujjwal Rathore
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory M Goldgof
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Caroline Whitty
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Jonathan M Woo
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Antonia E Gallman
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Howard Hughes Medical Institute, University of California, San Francisco, San Francisco, USA
| | - Tyler E Miller
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Andrew G Levine
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - David N Nguyen
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, USA
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - Sagar P Bapat
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Joanna Balcerek
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sophia A Bylsma
- Department of Bioengineering, University of California, Berkeley, Berkeley, CA, USA
| | - Ana M Lyons
- Department of Integrative Biology, University of California, Berkeley, Berkeley, CA, USA
| | - Stacy Li
- Department of Integrative Biology, University of California, Berkeley, Berkeley, CA, USA
| | - Allison Wai-Yi Wong
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
| | - Eva Mae Gillis-Buck
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Zachary B Steinhart
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Youjin Lee
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
| | - Ryan Apathy
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Mitchell J Lipke
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Anne Smith
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Tina Zheng
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- Biomedical Sciences Graduate Program, University of California, San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | - Ian C Boothby
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Erin Isaza
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- Program in Quantitative Biology, University of California, San Francisco, San Francisco, CA, USA
| | - Jackie Chan
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
| | - Dante D Acenas
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
| | - Jinwoo Lee
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Trisha A Macrae
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Than S Kyaw
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
| | - David Wu
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- Biomedical Sciences Graduate Program, University of California, San Francisco, San Francisco, CA, USA
| | - Dianna L Ng
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Wei Gu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Vanessa A York
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Haig Alexander Eskandarian
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Perri C Callaway
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Infectious Diseases and Immunity Graduate Group, University of California, Berkeley, Berkeley, CA, USA
| | - Lakshmi Warrier
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mary E Moreno
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Justine Levan
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Leonel Torres
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Lila A Farrington
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Rita P Loudermilk
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kanishka Koshal
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kelsey C Zorn
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Diane Yang
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Michael G Astudillo
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Bradley E Bernstein
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Jeffrey A Gelfand
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Richelle C Charles
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - A John Iafrate
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Jochen K Lennerz
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Steve Miller
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Charles Y Chiu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA
- UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA
| | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, MD, USA
| | - Michael R Wilson
- Biomedical Sciences Graduate Program, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Aashish Manglik
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, CA, USA
| | - Chun Jimmie Ye
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Institute of Computational Health Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Nevan J Krogan
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Mark S Anderson
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Jason G Cyster
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Howard Hughes Medical Institute, University of California, San Francisco, San Francisco, USA
| | - Joel D Ernst
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Alan H B Wu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kara L Lynch
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
| | - Patrick D Hsu
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, USA.
- Department of Bioengineering, University of California, Berkeley, Berkeley, CA, USA.
- Center for Computational Biology, University of California, Berkeley, Berkeley, CA, USA.
| | - Alexander Marson
- J. David Gladstone Institutes, San Francisco, CA, USA.
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA.
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, USA.
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA.
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA.
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA.
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA.
- Chan Zuckerberg Biohub, San Francisco, CA, USA.
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA.
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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47
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Kovoor JG, Tivey DR, Williamson P, Tan L, Kopunic HS, Babidge WJ, Collinson TG, Hewett PJ, Hugh TJ, Padbury RTA, Frydenberg M, Douglas RG, Kok J, Maddern GJ. Screening and testing for COVID-19 before surgery. ANZ J Surg 2020; 90:1845-1856. [PMID: 32770653 PMCID: PMC7436563 DOI: 10.1111/ans.16260] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023]
Abstract
Background Preoperative screening for coronavirus disease 2019 (COVID‐19) aims to preserve surgical safety for both patients and surgical teams. This rapid review provides an evaluation of current evidence with input from clinical experts to produce guidance for screening for active COVID‐19 in a low prevalence setting. Methods An initial search of PubMed (until 6 May 2020) was combined with targeted searches of both PubMed and Google Scholar until 1 July 2020. Findings were streamlined for clinical relevance through the advice of an expert working group that included seven senior surgeons and a senior medical virologist. Results Patient history should be examined for potential exposure to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Hyposmia and hypogeusia may present as early symptoms of COVID‐19, and can potentially discriminate from other influenza‐like illnesses. Reverse transcription‐polymerase chain reaction is the gold standard diagnostic test to confirm SARS‐CoV‐2 infection, and although sensitivity can be improved with repeated testing, the decision to retest should incorporate clinical history and the local supply of diagnostic resources. At present, routine serological testing has little utility for diagnosing acute infection. To appropriately conduct preoperative testing, the temporal dynamics of SARS‐CoV‐2 must be considered. Relative to other thoracic imaging modalities, computed tomography has the greatest utility for characterizing pulmonary involvement in COVID‐19 patients who have been diagnosed by reverse transcription‐polymerase chain reaction. Conclusion Through a rapid review of the literature and advice from a clinical expert working group, evidence‐based recommendations have been produced for the preoperative screening of surgical patients with suspected COVID‐19.
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Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia
| | - David R Tivey
- Research Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Penny Williamson
- Research Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Lorwai Tan
- Research Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Helena S Kopunic
- Research Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Wendy J Babidge
- Research Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | | | - Peter J Hewett
- University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Thomas J Hugh
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Surgical Education, Research and Training Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Robert T A Padbury
- Flinders University, Adelaide, South Australia, Australia.,Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Mark Frydenberg
- Department of Urology, Cabrini Institute, Cabrini Health, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Richard G Douglas
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Jen Kok
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology - Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - Guy J Maddern
- Research Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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48
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Norman M, Gilboa T, Ogata AF, Maley AM, Cohen L, Busch EL, Lazarovits R, Mao CP, Cai Y, Zhang J, Feldman JE, Hauser BM, Caradonna TM, Chen B, Schmidt AG, Alter G, Charles RC, Ryan ET, Walt DR. Ultrasensitive high-resolution profiling of early seroconversion in patients with COVID-19. Nat Biomed Eng 2020; 4:1180-1187. [PMID: 32948854 PMCID: PMC7498988 DOI: 10.1038/s41551-020-00611-x] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/17/2020] [Indexed: 01/19/2023]
Abstract
Sensitive assays are essential for the accurate identification of individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we report a multiplexed assay for the fluorescence-based detection of seroconversion in infected individuals from less than 1 µl of blood, and as early as the day of the first positive nucleic acid test after symptom onset. The assay uses dye-encoded antigen-coated beads to quantify the levels of immunoglobulin G (IgG), IgM and IgA antibodies against four SARS-CoV-2 antigens. A logistic regression model trained using samples collected during the pandemic and samples collected from healthy individuals and patients with respiratory infections before the first outbreak of coronavirus disease 2019 (COVID-19) was 99% accurate in the detection of seroconversion in a blinded validation cohort of samples collected before the pandemic and from patients with COVID-19 five or more days after a positive nasopharyngeal test by PCR with reverse transcription. The high-throughput serological profiling of patients with COVID-19 allows for the interrogation of interactions between antibody isotypes and viral proteins, and should help us to understand the heterogeneity of clinical presentations.
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Affiliation(s)
- Maia Norman
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA.,Tufts University School of Medicine, Boston, MA, USA
| | - Tal Gilboa
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Alana F Ogata
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Adam M Maley
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Limor Cohen
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA.,Department of Chemical Biology, Harvard University, Cambridge, MA, USA
| | - Evan L Busch
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Roey Lazarovits
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Chih-Ping Mao
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Yongfei Cai
- Division of Molecular Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Jun Zhang
- Division of Molecular Medicine, Boston Children's Hospital, Boston, MA, USA
| | | | - Blake M Hauser
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | | | - Bing Chen
- Division of Molecular Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Aaron G Schmidt
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA.,Department of Microbiology, Harvard Medical School, Boston, MA, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Richelle C Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David R Walt
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA. .,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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49
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Affiliation(s)
- Jessica Watson
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alex Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Jonathan Deeks
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, UK
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50
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Strategic Anti-SARS-CoV-2 Serology Testing in a Low Prevalence Setting: The COVID-19 Contact (CoCo) Study in Healthcare Professionals. Infect Dis Ther 2020; 9:837-849. [PMID: 32886335 PMCID: PMC7472691 DOI: 10.1007/s40121-020-00334-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Indexed: 01/06/2023] Open
Abstract
Background Serology testing is explored for epidemiological research and to inform individuals after suspected infection. During the coronavirus disease 2019 (COVID-19) pandemic, frontline healthcare professionals (HCP) may be at particular risk for infection. No longitudinal data on functional seroconversion in HCP in regions with low COVID-19 prevalence and low pre-test probability exist. Methods In a large German university hospital, we performed weekly questionnaire assessments and anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) measurements with various commercial tests, a novel surrogate virus neutralisation test, and a neutralisation assay using live SARS-CoV-2. Results From baseline to week 6, 1080 screening measurements for anti-SARS CoV-2 (S1) IgG from 217 frontline HCP (65% female) were performed. Overall, 75.6% of HCP reported at least one symptom of respiratory infection. Self-perceived infection probability declined over time (from mean 20.1% at baseline to 12.4% in week 6, p < 0.001). In sera of convalescent patients with PCR-confirmed COVID-19, we measured high anti-SARS-CoV-2 IgG levels, obtained highly concordant results from enzyme-linked immunosorbent assays (ELISA) using e.g. the spike 1 (S1) protein domain and the nucleocapsid protein (NCP) as targets, and confirmed antiviral neutralisation. However, in HCP the cumulative incidence for anti-SARS-CoV-2 (S1) IgG was 1.86% for positive and 0.93% for equivocal positive results over the study period of 6 weeks. Except for one HCP, none of the eight initial positive results were confirmed by alternative serology tests or showed in vitro neutralisation against live SARS-CoV-2. The only true seroconversion occurred without symptoms and mounted strong functional humoral immunity. Thus, the confirmed cumulative incidence for neutralizing anti-SARS-CoV-2 IgG was 0.47%. Conclusion When assessing anti-SARS-CoV-2 immune status in individuals with low pre-test probability, we suggest confirming positive results from single measurements by alternative serology tests or functional assays. Our data highlight the need for a methodical serology screening approach in regions with low SARS-CoV-2 infection rates. Trial Registration The study is registered at DRKS00021152. Electronic supplementary material The online version of this article (10.1007/s40121-020-00334-1) contains supplementary material, which is available to authorized users.
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