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Dimech W, Curley S, Cai JJ. Comprehensive, comparative evaluation of 25 automated SARS-CoV-2 serology assays. Microbiol Spectr 2024; 12:e0322823. [PMID: 38018986 PMCID: PMC10783060 DOI: 10.1128/spectrum.03228-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/26/2023] [Indexed: 11/30/2023] Open
Abstract
IMPORTANCE We have previously highlighted the fact that hundreds of SARS-CoV-2 serology tests were released months after the onset of the COVID-19 pandemic. Of the hundreds of studies investigating the test kits' performance, few were comparative reports, using the same comprehensive sample set across multiple tests. Recently, we reported a comparative assessment of 35 rapid diagnostic tests (RDTs) or microtiter plate enzyme immunoassays (EIA) for use in low- and middle-income countries, using a large sample set from individuals with a history of COVID-19. Only a few tests meet WHO Target Product Profile performance requirements. This study reports on the performance of a further 25 automated SARS-CoV-2 immunoassays using the same panel of samples. The results highlight the better analytical and clinical performance of automated serology test kits compared with RDTs, and the importance of independent comparative assessments to inform the use and procurement of these tests for both diagnostic and epidemiological investigations.
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Affiliation(s)
- Wayne Dimech
- National Serology Reference Laboratory, Fitzroy, Victoria, Australia
| | - Shannon Curley
- National Serology Reference Laboratory, Fitzroy, Victoria, Australia
| | - Jing Jing Cai
- National Serology Reference Laboratory, Fitzroy, Victoria, Australia
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Dimech W, Curley S, Subissi L, Ströher U, Perkins MD, Cunningham J. Comprehensive, Comparative Evaluation of 35 Manual SARS-CoV-2 Serological Assays. Microbiol Spectr 2023; 11:e0510122. [PMID: 37158743 PMCID: PMC10269659 DOI: 10.1128/spectrum.05101-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/14/2023] [Indexed: 05/10/2023] Open
Abstract
The onset of the coronavirus disease 2019 (COVID-19) pandemic resulted in hundreds of in vitro diagnostic devices (IVDs) coming to market, facilitated by regulatory authorities allowing "emergency use" without a comprehensive evaluation of performance. The World Health Organization (WHO) released target product profiles (TPPs) specifying acceptable performance characteristics for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) assay devices. We evaluated 26 rapid diagnostic tests and 9 enzyme immunoassays (EIAs) for anti-SARS-CoV-2, suitable for use in low- and middle-income countries (LMICs), against these TPPs and other performance characteristics. The sensitivity and specificity ranged from 60.1 to 100% and 56.0 to 100%, respectively. Five of 35 test kits reported no false reactivity for 55 samples with potentially cross-reacting substances. Six test kits reported no false reactivity for 35 samples containing interfering substances, and only one test reported no false reactivity with samples positive for other coronaviruses (not SARS-CoV-2). This study demonstrates that a comprehensive evaluation of the performance of test kits against defined specifications is essential for the selection of test kits, especially in a pandemic setting. IMPORTANCE The markets have been flooded with hundreds of SARS-CoV-2 serology tests, and although there are many published reports on their performance, comparative reports are far fewer and tend to be limited to only a few tests. In this report, we comparatively assessed 35 rapid diagnostic tests or microtiter plate enzyme immunoassays (EIAs) using a large set of samples from individuals with a history of mild to moderate COVID-19, commensurate with the target population for serosurveillance, which included serum samples from individuals previously infected, at undetermined time periods, with other seasonal human coronaviruses, Middle East respiratory syndrome coronavirus (MERS-CoV), and SARS-CoV-1. The significant heterogeneity in their performances, with only a few tests meeting WHO target product profile performance requirements, highlights the importance of independent comparative assessments to inform the use and procurement of these tests for both diagnostics and epidemiological investigations.
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Affiliation(s)
- Wayne Dimech
- National Serology Reference Laboratory, Fitzroy, Australia
| | - Shannon Curley
- National Serology Reference Laboratory, Fitzroy, Australia
| | | | - Ute Ströher
- World Health Organization, Geneva, Switzerland
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van den Beld MJC, Murk JL, Kluytmans J, Koopmans MPG, Reimerink J, van Loo IHM, Wegdam-Blans MCA, Zaaijer H, GeurtsvanKessel C, Reusken C. Increasing the Efficiency of a National Laboratory Response to COVID-19: a Nationwide Multicenter Evaluation of 47 Commercial SARS-CoV-2 Immunoassays by 41 Laboratories. J Clin Microbiol 2021; 59:e0076721. [PMID: 34191578 PMCID: PMC8373020 DOI: 10.1128/jcm.00767-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/24/2021] [Indexed: 12/01/2022] Open
Abstract
In response to the worldwide pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the subsequent antibody tests that flooded the market, a nationwide collaborative approach in the Netherlands was employed. Forty-one Dutch laboratories joined forces and shared their evaluation data to allow for the evaluation of a quantity of serological assays for SARS-CoV-2 that exceeds the capacity of each individual laboratory. As of April 2020, these performance data had been aggregated and shared in regularly updated reports with other laboratories, Dutch government, public health organizations, and the public. This frequently updated overview of assay performance increased the efficiency of our national laboratory response, supporting laboratories in their choice and implementation of assays. Aggregated performance data for 47 immunoassays for SARS-CoV-2 showed that none of the evaluated immunoassays that detect only IgM or IgA met the diagnostic criteria, indicating that they are not suitable for diagnosing acute infections. For the detection of IgG, only the Biozek Corona virus COVID rapid test, Euroimmun SARS-CoV-2 IgG, and Wantai SARS-CoV-2 antibody (Ab) ELISA met predefined performance criteria in hospitalized patients where samples were collected 14 days post-onset of symptoms (DPO), while for patients with mild or asymptomatic infections, only the Wantai SARS-CoV-2 Ab ELISA met the predefined performance criteria if samples were collected 14 days postonset. Here, we describe this unique nationwide collaboration during the onset of the COVID-19 pandemic; the collected data and their results are an example of what can be accomplished when forces are joined during a public health crisis.
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Affiliation(s)
- Maaike J. C. van den Beld
- Centre for Infectious Disease Control, WHO COVID-19 Reference Laboratory, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Jean-Luc Murk
- Microvida, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - Jan Kluytmans
- Amphia Ziekenhuis Breda, Microvida Laboratory for Microbiology, Breda, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Johan Reimerink
- Centre for Infectious Disease Control, WHO COVID-19 Reference Laboratory, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Inge H. M. van Loo
- Department of Medical Microbiology, Maastricht UMC+ and Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Marjolijn C. A. Wegdam-Blans
- Department of Medical Microbiology, Laboratory for Pathology and Medical Microbiology (PAMM), Veldhoven, the Netherlands
| | - Hans Zaaijer
- Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | - Serology Workgroup for SARS-CoV-2
- Centre for Infectious Disease Control, WHO COVID-19 Reference Laboratory, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Microvida, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
- Amphia Ziekenhuis Breda, Microvida Laboratory for Microbiology, Breda, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Viroscience, Erasmus MC, Rotterdam, the Netherlands
- Department of Medical Microbiology, Maastricht UMC+ and Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Department of Medical Microbiology, Laboratory for Pathology and Medical Microbiology (PAMM), Veldhoven, the Netherlands
- Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | | | - Chantal Reusken
- Centre for Infectious Disease Control, WHO COVID-19 Reference Laboratory, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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Plaga A, Wei R, Olson E, Payto D, Harrington J, Nwe-Kissig PT, Strizzi M, Zilka S, Ko J, Colón-Franco JM. Evaluation of the Clinical Performance of 7 Serological Assays for SARS-CoV-2 for Use in Clinical Laboratories. J Appl Lab Med 2021; 6:998-1004. [PMID: 33825844 PMCID: PMC8083591 DOI: 10.1093/jalm/jfab038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/29/2021] [Indexed: 12/21/2022]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological assays have emerged as a response to the global pandemic, warranting studies evaluating their clinical performance. This study investigated seven commercially available SARS-CoV-2 serological assays in samples from non-infected individuals and hospitalized patients. Methods SARS-CoV-2 qualitative serological assays by Abbott (IgG), Beckman (IgG), DiaSorin (IgG), EUROIMMUN (IgG and IgA), Roche and Bio-Rad (Total) were evaluated using specimens collected pre-December 2019 (n=393), from nucleic acid amplification testing (NAAT) negative patients (n=40), and from 53 patients with COVID-19 by NAAT collected 3-21 days post-onset of symptoms (POS) (N=83). Negative agreement (NA), positive agreement (PA), and positive and negative predictive values (PPV and NPV) at prevalences of 5% and 10% were calculated. Results The overall %NA;95% CI in the negative samples were: Roche 99.8%; 99.3-100.2, Beckman 99.8%; 98.7-100.0, Abbott and Bio-Rad 99.3%; 98.0-99.9, DiaSorin 98.4; 97.2-99.6, EUROIMMUN IgG 97.5%; 95.5-98.7, and EUROIMMUN IgA 79.7%; 75.9-83.5), accounting for positive/equivocal results as false positives. The %PA; 95% CI in samples collected 14+days POS (n=24) were: Bio-Rad 83.3%; 68.4-98.2, Abbott and Roche 79.2%; 62.9-95.4, EUROIMMUN IgA 70.8%; 52.6-89.0, Beckman 58.3%; 38.6-78.1, DiaSorin 54.2; 34.2-74.1, and EUROIMMUN IgG 50.0%; 30.0-70.0, accounting for negative/equivocal results as false negatives. NPVs ranged from 97.4-98.9% and 94.7-97.7% for prevalences 5% and 10%, respectively. PPVs ranged from 15.5-94.8% and 27.9-97.4% for prevalences 5% and 10%, respectively. Conclusions The Roche and Beckman assays resulted in fewer false positives followed by the Bio-Rad and Abbott assays. While the Bio-Rad assay demonstrated higher antibody detection in COVID-19-positive patients, PA claims cannot be established with a high level of confidence in our sample population.
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Affiliation(s)
- Alexis Plaga
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, OH, USA
| | - Ruhan Wei
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, OH, USA
| | - Elizabeth Olson
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, OH, USA
| | - Drew Payto
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, OH, USA
| | - John Harrington
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, OH, USA
| | | | - Michelle Strizzi
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, OH, USA
| | - Sarah Zilka
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, OH, USA
| | - Jennifer Ko
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, OH, USA
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Comparison of three serological chemiluminescence immunoassays for SARS-CoV-2, and clinical significance of antibody index with disease severity. PLoS One 2021; 16:e0253889. [PMID: 34185813 PMCID: PMC8241106 DOI: 10.1371/journal.pone.0253889] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/14/2021] [Indexed: 01/13/2023] Open
Abstract
Background The clinical significance of the quantitative value of antibodies in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains mostly unidentified. We investigated the dynamics and clinical implications of the SARS-CoV-2 antibody over time using three automated chemiluminescence immunoassays targeting either nucleocapsids or spikes. Methods A total of 126 specimens were collected from 23 patients with confirmed and indeterminate COVID-19 identified by molecular tests. SARS-CoV-2 antibody index was measured using SARS-CoV2 IgG reagent from Alinity (Abbott) and Access (Beckman Coulter) and SARS-CoV2 Total (IgG + IgM) from Atellica (Siemens). Results Three immunoassays showed strong correlations with each other (range of Pearson’ s correlation coefficient (r) = 0.700–0.854, P < 0.001). Eleven (8.7%) specimens showed inconsistencies. SARS-CoV-2 IgG showed a statistically significantly higher value in patients with severe disease than that in non-severe disease patients (P < 0.001) and was significantly associated with clinical markers of disease severity. Conclusion The quantitative value of the SARS-CoV-2 IgG antibody measured using automated immunoassays is a significant indicator of clinical severity in patients with COVID-19.
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Canhoto AI, Wei L. Stakeholders of the world, unite!: Hospitality in the time of COVID-19. INTERNATIONAL JOURNAL OF HOSPITALITY MANAGEMENT 2021; 95:102922. [PMID: 36540681 PMCID: PMC9756829 DOI: 10.1016/j.ijhm.2021.102922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/29/2021] [Accepted: 03/22/2021] [Indexed: 05/15/2023]
Abstract
The COVID-19 pandemic created a global, complex crisis, without a clear end in sight, presenting an existential threat to many hospitality businesses. Drawing on stakeholder theory, we develop a framework for recovery strategy development for COVID-19, which engages salient stakeholders in the process of recognizing challenges, rationalizing changes needed and refashioning ways of working. The framework is used to analyze the process of development of a recovery strategy for a boutique hotel in England, UK, via a case study methodology. The analysis brings to the fore the interdependencies between the hotel owners and its employees, customers, governments, suppliers and communities, at local, national and international levels. Moreover, the analysis shows how collaborating with these stakeholders leads to the identification of revenue streams for the hotel, operational modifications and even the development of new commercial partnerships.
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Affiliation(s)
- Ana Isabel Canhoto
- Brunel Business School, College of Business, Arts and Social Sciences, Brunel University, Uxbridge, Middlesex UB8 3PH, United Kingdom
| | - Liyuan Wei
- Brunel Business School, College of Business, Arts and Social Sciences, Brunel University, Uxbridge, Middlesex UB8 3PH, United Kingdom
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Robinson AV, Weaving G, Philips BJ, Eziefula AC, Shipman KE, Chevassut T. Real-world experience of SARS-CoV-2 antibody assays in UK healthcare workers. Clin Med (Lond) 2021; 21:e300-e305. [PMID: 33727368 PMCID: PMC8140713 DOI: 10.7861/clinmed.2020.1007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The seroprevalence of antibodies to SARS-CoV-2 in healthcare workers is variable throughout the world. This study compares the use of two antibody assays among large cohorts of healthcare workers in southern England. METHODS This cohort study includes data obtained from staff at Western Sussex Hospitals NHS Foundation Trust (WSHT) and Brighton and Sussex University Hospitals (BSUH) during voluntary antibody testing, using Abbott and Roche SARS-CoV-2 antibody assays at each Trust respectively. RESULTS The observed seroprevalence level was 7.9% for the WSHT/Abbott cohort versus 13% for the BSUH/Roche cohort. Based on a previous positive PCR, we find that the false-negative rate of the Abbott and Roche assays were 60.2% and 19% respectively, implying sensitivity levels of 39.8% and 81%. Within these cohorts, seropositivity was most strongly associated with those of South Asian ethnicity, allied health professionals and male sex (p<0.0001). CONCLUSIONS In this real-world study, neither antibody test performed to the specification level stated by the manufacturer. More rigorous testing of these and other assays in target populations is recommended prior to widespread usage if they are to provide data that might be useful to control the pandemic.
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Affiliation(s)
- Alyss V Robinson
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Gary Weaving
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Barbara J Philips
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK, and consultant in intensive care medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Alice C Eziefula
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK, and consultant in infectious disease, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Kate E Shipman
- Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | - Timothy Chevassut
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK, and consultant in haematology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Sweeney N, Merrick B, Pedro Galão R, Pickering S, Botgros A, Wilson HD, Signell AW, Betancor G, Tan MKI, Ramble J, Kouphou N, Acors S, Graham C, Seow J, MacMahon E, Neil SJD, Malim MH, Doores K, Douthwaite S, Batra R, Nebbia G, Edgeworth JD. Clinical utility of targeted SARS-CoV-2 serology testing to aid the diagnosis and management of suspected missed, late or post-COVID-19 infection syndromes: Results from a pilot service implemented during the first pandemic wave. PLoS One 2021; 16:e0249791. [PMID: 33826651 PMCID: PMC8026061 DOI: 10.1371/journal.pone.0249791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/24/2021] [Indexed: 01/15/2023] Open
Abstract
During the first wave of the global COVID-19 pandemic the clinical utility and indications for SARS-CoV-2 serological testing were not clearly defined. The urgency to deploy serological assays required rapid evaluation of their performance characteristics. We undertook an internal validation of a CE marked lateral flow immunoassay (LFIA) (SureScreen Diagnostics) using serum from SARS-CoV-2 RNA positive individuals and pre-pandemic samples. This was followed by the delivery of a same-day named patient SARS-CoV-2 serology service using LFIA on vetted referrals at central London teaching hospital with clinical interpretation of result provided to the direct care team. Assay performance, source and nature of referrals, feasibility and clinical utility of the service, particularly benefit in clinical decision-making, were recorded. Sensitivity and specificity of LFIA were 96.1% and 99.3% respectively. 113 tests were performed on 108 participants during three-week pilot. 44% participants (n = 48) had detectable antibodies. Three main indications were identified for serological testing; new acute presentations potentially triggered by recent COVID-19 e.g. pulmonary embolism (n = 5), potential missed diagnoses in context of a recent COVID-19 compatible illness (n = 40), and making infection control or immunosuppression management decisions in persistently SARS-CoV-2 RNA PCR positive individuals (n = 6). We demonstrate acceptable performance characteristics, feasibility and clinical utility of using a LFIA that detects anti-spike antibodies to deliver SARS-CoV-2 serology service in adults and children. Greatest benefit was seen where there is reasonable pre-test probability and results can be linked with clinical advice or intervention. Experience from this pilot can help inform practicalities and benefits of rapidly implementing new tests such as LFIAs into clinical service as the pandemic evolves.
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Affiliation(s)
- Nicola Sweeney
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Blair Merrick
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Rui Pedro Galão
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Suzanne Pickering
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Alina Botgros
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Harry D. Wilson
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Adrian W. Signell
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Gilberto Betancor
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Mark Kia Ik Tan
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - John Ramble
- Infection Sciences, Viapath LLP, St Thomas’ Hospital, London, United Kingdom
| | - Neophytos Kouphou
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Sam Acors
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Carl Graham
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Jeffrey Seow
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Eithne MacMahon
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Stuart J. D. Neil
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Michael H. Malim
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Katie Doores
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Sam Douthwaite
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Rahul Batra
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Gaia Nebbia
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Jonathan D. Edgeworth
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
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Thompson JL, Downie Ruiz Velasco A, Cardall A, Tarbox R, Richardson J, Clarke G, Lister M, Howson-Wells HC, Fleming VM, Khakh M, Sloan T, Duckworth N, Walsh S, Denning C, McClure CP, Benest AV, Seedhouse CH. Comparative effects of viral-transport-medium heat inactivation upon downstream SARS-CoV-2 detection in patient samples. J Med Microbiol 2021; 70. [PMID: 33734960 PMCID: PMC8346722 DOI: 10.1099/jmm.0.001301] [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] [Indexed: 11/18/2022] Open
Abstract
Introduction The COVID-19 pandemic, which began in 2020 is testing economic resilience and surge capacity of healthcare providers worldwide. At the time of writing, positive detection of the SARS-CoV-2 virus remains the only method for diagnosing COVID-19 infection. Rapid upscaling of national SARS-CoV-2 genome testing presented challenges: (1) Unpredictable supply chains of reagents and kits for virus inactivation, RNA extraction and PCR-detection of viral genomes. (2) Rapid time to result of <24 h is required in order to facilitate timely infection control measures. Hypothesis Extraction-free sample processing would impact commercially available SARS-CoV-2 genome detection methods. Aim We evaluated whether alternative commercially available kits provided sensitivity and accuracy of SARS-CoV-2 genome detection comparable to those used by regional National Healthcare Services (NHS). Methodology We tested several detection methods and tested whether detection was altered by heat inactivation, an approach for rapid one-step viral inactivation and RNA extraction without chemicals or kits. Results Using purified RNA, we found the CerTest VIASURE kit to be comparable to the Altona RealStar system currently in use, and further showed that both diagnostic kits performed similarly in the BioRad CFX96 and Roche LightCycler 480 II machines. Additionally, both kits were comparable to a third alternative using a combination of Quantabio qScript one-step Quantitative Reverse Transcription Polymerase Chain Reaction (qRT-PCR) mix and Centre for Disease Control and Prevention (CDC)-accredited N1 and N2 primer/probes when looking specifically at borderline samples. Importantly, when using the kits in an extraction-free protocol, following heat inactivation, we saw differing results, with the combined Quantabio-CDC assay showing superior accuracy and sensitivity. In particular, detection using the CDC N2 probe following the extraction-free protocol was highly correlated to results generated with the same probe following RNA extraction and reported clinically (n=127; R2=0.9259). Conclusion Our results demonstrate that sample treatment can greatly affect the downstream performance of SARS-CoV-2 diagnostic kits, with varying impact depending on the kit. We also showed that one-step heat-inactivation methods could reduce time from swab receipt to outcome of test result. Combined, these findings present alternatives to the protocols in use and can serve to alleviate any arising supply-chain issues at different points in the workflow, whilst accelerating testing, and reducing cost and environmental impact.
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Affiliation(s)
- Jamie L Thompson
- Division of Cancer and Stem Cells, Biodiscovery Institute, School of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK
| | | | - Alice Cardall
- Division of Child Health, Obstetrics & Gynaecology, Biodiscovery Institute, School of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Rebecca Tarbox
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital, Nottingham, DE22 3DT, UK
| | - Jaineeta Richardson
- Clinical Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Gemma Clarke
- Clinical Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Michelle Lister
- Clinical Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Hannah C Howson-Wells
- Clinical Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Vicki M Fleming
- Clinical Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Manjinder Khakh
- Clinical Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Tim Sloan
- Path Links Pathology, Northern Lincolnshire and Goole NHS Foundation Trust, Grimbsy, DN33 2BA, UK
| | - Nichola Duckworth
- Path Links Pathology, Northern Lincolnshire and Goole NHS Foundation Trust, Grimbsy, DN33 2BA, UK
| | - Sarah Walsh
- Path Links Pathology, Northern Lincolnshire and Goole NHS Foundation Trust, Grimbsy, DN33 2BA, UK
| | - Chris Denning
- Division of Cancer and Stem Cells, Biodiscovery Institute, School of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK
| | - C Patrick McClure
- NIHR Nottingham Digestive Diseases Biomedical Research Centre and School of Life Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Andrew V Benest
- Division of Cancer and Stem Cells, Biodiscovery Institute, School of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Claire H Seedhouse
- Division of Cancer and Stem Cells, Biodiscovery Institute, School of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK
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Guilger-Casagrande M, de Barros CT, Antunes VAN, de Araujo DR, Lima R. Perspectives and Challenges in the Fight Against COVID-19: The Role of Genetic Variability. Front Cell Infect Microbiol 2021; 11:598875. [PMID: 33791232 PMCID: PMC8005637 DOI: 10.3389/fcimb.2021.598875] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/15/2021] [Indexed: 12/12/2022] Open
Abstract
In the last year, the advent of the COVID-19 pandemic brought a new consideration for the multidisciplinary sciences. The unknown mechanisms of infection used by SARS-CoV-2 and the absence of effective antiviral pharmacological therapy, diagnosis methods, and vaccines evoked scientific efforts on the COVID-19 outcome. In general, COVID-19 clinical features are a result of local and systemic inflammatory processes that are enhanced by some preexistent comorbidities, such as diabetes, obesity, cardiovascular, and pulmonary diseases, and biological factors, like gender and age. However, the discrepancies in COVID-19 clinical signs observed among those patients lead to investigations about the critical factors that deeply influence disease severity and death. Herein, we present the viral infection mechanisms and its consequences after blocking the angiotensin-converting enzyme 2 (ACE2) axis in different tissues and the progression of inflammatory and immunological reactions, especially the influence of genetic features on those differential clinical responses. Furthermore, we discuss the role of genotype as an essential indicator of COVID-19 susceptibility, considering the expression profiles, polymorphisms, gene identification, and epigenetic modifications of viral entry factors and their recognition, as well as the infection effects on cell signaling molecule expression, which amplifies disease severity.
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Affiliation(s)
- Mariana Guilger-Casagrande
- Institute of Science and Technology, São Paulo State University–UNESP, Sorocaba, Brazil
- Laboratory for Evaluation of the Bioactivity and Toxicology of Nanomaterials, University of Sorocaba-UNISO, Sorocaba, Brazil
| | - Cecilia T. de Barros
- Laboratory for Evaluation of the Bioactivity and Toxicology of Nanomaterials, University of Sorocaba-UNISO, Sorocaba, Brazil
| | - Vitória A. N. Antunes
- Laboratory for Evaluation of the Bioactivity and Toxicology of Nanomaterials, University of Sorocaba-UNISO, Sorocaba, Brazil
| | - Daniele R. de Araujo
- Human and Natural Sciences Center, Federal University of ABC, Santo André, Brazil
| | - Renata Lima
- Laboratory for Evaluation of the Bioactivity and Toxicology of Nanomaterials, University of Sorocaba-UNISO, Sorocaba, Brazil
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11
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Villarreal A, Rangel G, Zhang X, Wong D, Britton G, Fernandez PL, Pérez A, Oviedo D, Restrepo C, Carreirra MB, Sambrano D, Eskildsen GA, De La Guardia C, Flores-Cuadra J, Carrera JP, Zaldivar Y, Franco D, López-Vergès S, Zhang D, Fan F, Wang B, Sáez-Llorens X, DeAntonio R, Torres-Atencio I, Blanco I, Subía FD, Mudarra L, Benzadon A, Valverde W, López L, Hurtado N, Rivas N, Jurado J, Carvallo A, Rodriguez J, Perez Y, Morris J, Luque O, Cortez D, Ortega-Barria E, Kosagisharaf R, Lleonart R, Li C, Goodridge A. Performance of a Point of Care Test for Detecting IgM and IgG Antibodies Against SARS-CoV-2 and Seroprevalence in Blood Donors and Health Care Workers in Panama. Front Med (Lausanne) 2021; 8:616106. [PMID: 33748157 PMCID: PMC7968482 DOI: 10.3389/fmed.2021.616106] [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: 10/11/2020] [Accepted: 01/28/2021] [Indexed: 12/12/2022] Open
Abstract
Novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiologic agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic, which has reached 28 million cases worldwide in 1 year. The serological detection of antibodies against the virus will play a pivotal role in complementing molecular tests to improve diagnostic accuracy, contact tracing, vaccine efficacy testing, and seroprevalence surveillance. Here, we aimed first to evaluate a lateral flow assay's ability to identify specific IgM and IgG antibodies against SARS-CoV-2 and second, to report the seroprevalence estimates of these antibodies among health care workers and healthy volunteer blood donors in Panama. We recruited study participants between April 30th and July 7th, 2020. For the test validation and performance evaluation, we analyzed serum samples from participants with clinical symptoms and confirmed positive RT-PCR for SARS-CoV-2, and a set of pre-pandemic serum samples. We used two by two table analysis to determine the test positive and negative percentage agreement as well as the Kappa agreement value with a 95% confidence interval. Then, we used the lateral flow assay to determine seroprevalence among serum samples from COVID-19 patients, potentially exposed health care workers, and healthy volunteer donors. Our results show this assay reached a positive percent agreement of 97.2% (95% CI 84.2-100.0%) for detecting both IgM and IgG. The assay showed a Kappa of 0.898 (95%CI 0.811-0.985) and 0.918 (95% CI 0.839-0.997) for IgM and IgG, respectively. The evaluation of serum samples from hospitalized COVID-19 patients indicates a correlation between test sensitivity and the number of days since symptom onset; the highest positive percent agreement [87% (95% CI 67.0-96.3%)] was observed at ≥15 days post-symptom onset (PSO). We found an overall antibody seroprevalence of 11.6% (95% CI 8.5-15.8%) among both health care workers and healthy blood donors. Our findings suggest this lateral flow assay could contribute significantly to implementing seroprevalence testing in locations with active community transmission of SARS-CoV-2.
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Affiliation(s)
- Alcibiades Villarreal
- Centro de Biología Celular y Molecular de las Enfermedades, City of Knowledge, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
| | - Giselle Rangel
- Centro de Biología Celular y Molecular de las Enfermedades, City of Knowledge, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
| | - Xu Zhang
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- Beijing Zhongke Jianlan Biotechnology Co. Ltd., Beijing, China
- Zhongke Jianlan International Medical Research Institute, Melbourne, VIC, Australia
| | - Digna Wong
- Centro de Biología Celular y Molecular de las Enfermedades, City of Knowledge, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
| | - Gabrielle Britton
- Centro de Biología Celular y Molecular de las Enfermedades, City of Knowledge, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
| | - Patricia L. Fernandez
- Centro de Biología Celular y Molecular de las Enfermedades, City of Knowledge, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
| | - Ambar Pérez
- Centro de Biología Celular y Molecular de las Enfermedades, City of Knowledge, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
| | - Diana Oviedo
- Centro de Biología Celular y Molecular de las Enfermedades, City of Knowledge, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
- Escuela de Psicología, Universidad Santa María La Antigua, Panama City, Panama
| | - Carlos Restrepo
- Centro de Biología Celular y Molecular de las Enfermedades, City of Knowledge, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
| | - María B. Carreirra
- Centro de Biología Celular y Molecular de las Enfermedades, City of Knowledge, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
| | - Dilcia Sambrano
- Centro de Biología Celular y Molecular de las Enfermedades, City of Knowledge, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
| | - Gilberto A. Eskildsen
- Centro de Biología Celular y Molecular de las Enfermedades, City of Knowledge, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
- Facultad de Medicina, Universidad de Panamá, Panama City, Panama
| | - Carolina De La Guardia
- Centro de Biología Celular y Molecular de las Enfermedades, City of Knowledge, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
| | - Julio Flores-Cuadra
- Centro de Neurociencia, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología, AIP (INDICASAT AIP), Panama City, Panama
| | - Jean-Paul Carrera
- Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama
| | - Yamitzel Zaldivar
- Department of Research in Surveillance and Biologic Risk 3, Gorgas Memorial Institute of Health Studies, Panama City, Panama
| | - Danilo Franco
- Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama
| | - Sandra López-Vergès
- Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama
| | - Dexi Zhang
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- Beijing Zhongke Jianlan Biotechnology Co. Ltd., Beijing, China
- Zhongke Jianlan International Medical Research Institute, Melbourne, VIC, Australia
| | - Fangjing Fan
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- Beijing Zhongke Jianlan Biotechnology Co. Ltd., Beijing, China
- Zhongke Jianlan International Medical Research Institute, Melbourne, VIC, Australia
| | - Baojun Wang
- Beijing Kewei Clinical Diagnostic Reagent Inc., Beijing, China
| | - Xavier Sáez-Llorens
- Centro de Vacunación e Investigación, Centro de Vacunación e Investigación Panama Clinic, Panama City, Panama
| | - Rodrigo DeAntonio
- Centro de Vacunación e Investigación, Centro de Vacunación e Investigación Panama Clinic, Panama City, Panama
| | | | - Isabel Blanco
- Medical Research Center, Pacifica Salud, Hospital Punta Pacifica, Panama City, Panama
| | - Fernando Diaz Subía
- Medical Research Center, Pacifica Salud, Hospital Punta Pacifica, Panama City, Panama
| | - Laiss Mudarra
- Departamento de Microbiología Humana/Inmunología, Facultad de Medicina, Universidad de Panamá, Panama City, Panama
| | - Aron Benzadon
- Servicio de Neurología. Complejo Hospitalario Dr. AAM, Universidad Nacional de Panamá, Panama City, Panama
| | - Walter Valverde
- Complejo Hospitalario Metropolitano Dr. Arnulfo Arias Madrid, Caja de Seguro Social, Panama City, Panama
| | - Lineth López
- Servicio de Hematología. Complejo Hospitalario Metropolitano Dr. Arnulfo Arias Madrid, Caja de Seguro Social, Panama City, Panama
| | - Nicolás Hurtado
- Compleo Hospitalario Manuel Amador Guerrero, Caja de Seguro Social, Colón, Panama
| | - Neyla Rivas
- Compleo Hospitalario Manuel Amador Guerrero, Caja de Seguro Social, Colón, Panama
| | - Julio Jurado
- Compleo Hospitalario Manuel Amador Guerrero, Caja de Seguro Social, Colón, Panama
| | - Aixa Carvallo
- Compleo Hospitalario Manuel Amador Guerrero, Caja de Seguro Social, Colón, Panama
| | - Juan Rodriguez
- Compleo Hospitalario Manuel Amador Guerrero, Caja de Seguro Social, Colón, Panama
| | - Yaseikiry Perez
- Servicio de Hematología, Banco de Sangre. Complejo Hospitalario Metropolitano Dr. Arnulfo Arias Madrid, Caja de Seguro Social, Panama City, Panama
| | - Johanna Morris
- Servicio de Hematología. Complejo Hospitalario Metropolitano Dr. Arnulfo Arias Madrid, Caja de Seguro Social, Panama City, Panama
| | - Odemaris Luque
- Compleo Hospitalario Manuel Amador Guerrero, Caja de Seguro Social, Colón, Panama
| | - David Cortez
- Dirección Nacional de Laboratorios Clínicos, Ministerio de Salud, Panama City, Panama
| | | | - Rao Kosagisharaf
- Centro de Biología Celular y Molecular de las Enfermedades, City of Knowledge, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
| | - Ricardo Lleonart
- Centro de Biología Celular y Molecular de las Enfermedades, City of Knowledge, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
| | - Chong Li
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- Beijing Zhongke Jianlan Biotechnology Co. Ltd., Beijing, China
- Zhongke Jianlan International Medical Research Institute, Melbourne, VIC, Australia
| | - Amador Goodridge
- Centro de Biología Celular y Molecular de las Enfermedades, City of Knowledge, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City, Panama
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12
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Muecksch F, Wise H, Batchelor B, Squires M, Semple E, Richardson C, McGuire J, Clearly S, Furrie E, Greig N, Hay G, Templeton K, Lorenzi JCC, Hatziioannou T, Jenks S, Bieniasz PD. Longitudinal Serological Analysis and Neutralizing Antibody Levels in Coronavirus Disease 2019 Convalescent Patients. J Infect Dis 2021; 223:389-398. [PMID: 33140086 PMCID: PMC7665595 DOI: 10.1093/infdis/jiaa659] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/15/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Understanding the longitudinal trajectory of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies is crucial for diagnosis of prior infection and predicting future immunity. METHODS We conducted a longitudinal analysis of coronavirus disease 2019 convalescent patients, with neutralizing antibody assays and SARS-CoV-2 serological assay platforms using SARS-CoV-2 spike (S) or nucleocapsid (N) antigens. RESULTS Sensitivities of serological assays in diagnosing prior SARS-CoV-2 infection changed with time. One widely used commercial platform that had an initial sensitivity of >95% declined to 71% at 81-100 days after diagnosis. The trajectories of median binding antibody titers measured over approximately 3-4 months were not dependent on the use of SARS-CoV-2 N or S proteins as antigen. The median neutralization titer decreased by approximately 45% per month. Each serological assay gave quantitative antibody titers that were correlated with SARS-CoV-2 neutralization titers, but S-based serological assay measurements better predicted neutralization potency. Correlation between S-binding and neutralization titers deteriorated with time, and decreases in neutralization titers were not predicted by changes in S-binding antibody titers. CONCLUSIONS Different SARS-CoV-2 serological assays are more or less well suited for surveillance versus prediction of serum neutralization potency. Extended follow-up should facilitate the establishment of appropriate serological correlates of protection against SARS-CoV-2 reinfection.
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Affiliation(s)
- Frauke Muecksch
- Laboratory of Retrovirology, The Rockefeller University, New York, New York, USA
| | - Helen Wise
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, Scotland
| | - Becky Batchelor
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, Scotland
| | - Maria Squires
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, Scotland
| | | | | | | | - Sarah Clearly
- University Hospital Monklands, NHS Lanarkshire, Airdrie, Scotland
| | - Elizabeth Furrie
- Ninewells Hospital and Medical School, NHS Tayside, Dundee, Scotland
| | - Neil Greig
- Ninewells Hospital and Medical School, NHS Tayside, Dundee, Scotland
| | - Gordon Hay
- Ninewells Hospital and Medical School, NHS Tayside, Dundee, Scotland
| | - Kate Templeton
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, Scotland
| | - Julio C C Lorenzi
- Laboratory of Molecular Immunology, The Rockefeller University, New York, New York, USA
| | | | - Sara Jenks
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, Scotland
| | - Paul D Bieniasz
- Laboratory of Retrovirology, The Rockefeller University, New York, New York, USA
- Howard Hughes Medical Institute, The Rockefeller University, New York, New York, USA
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13
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Berghs M. Who Gets Cured? COVID-19 and Developing a Critical Medical Sociology and Anthropology of Cure. FRONTIERS IN SOCIOLOGY 2021; 5:613548. [PMID: 33869531 PMCID: PMC8022653 DOI: 10.3389/fsoc.2020.613548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/11/2020] [Indexed: 05/05/2023]
Affiliation(s)
- Maria Berghs
- Allied Health Sciences, De Montfort University, Leicester, United Kingdom
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14
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COVID-19 zugzwang: Potential public health moves towards population (herd) immunity. PUBLIC HEALTH IN PRACTICE 2020; 1:100031. [PMID: 34173570 PMCID: PMC7361085 DOI: 10.1016/j.puhip.2020.100031] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 02/07/2023] Open
Abstract
COVID-19 is pandemic, and likely to become endemic, possibly returning with greater virulence. Outlining potential public health actions, including hygiene measures, social distancing and face masks, and realistic future advances, this paper focuses on the consequences of taking no public health action; the role of natural changes such as weather; the adverse public health consequences of lockdowns; testing for surveillance and research purposes; testing to identify cases and contacts, including the role of antibody tests; the public health value of treatments; mobilising people who have recovered; population (a synonym for herd) immunity through vaccination and through natural infection; involving the entire population; and the need for public debate. Until there is a vaccine, population immunity is going to occur only from infection. Allowing infection in those at very low risk while making it safer for them and wider society needs consideration but is currently taboo. About 40–50% population immunity is sufficient to suppress an infection with a reproduction number of about 1 or slightly more. Importantly, in children and young people COVID-19 is currently rarely fatal, roughly comparable with influenza. The balance between the damage caused by COVID-19 and that caused by lockdowns needs quantifying. Public debate, including on population immunity, informed by epidemiological data, is now urgent. The long-term solution to the COVID-19 pandemic is population immunity through natural infection or vaccination. 40-50% population immunity is sufficient to suppress and eliminate this pandemic. New vaccines may not work well in the older age groups and those with underlying conditions and may not be safer than the infection for children and youth. Immunity is currently being acquired by infection and we need safer strategies for managing this. Open, honest, factual and sensitively conducted public dialogue is now urgent.
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15
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Robbins T, Kyrou I, Laird S, Morgan N, Anderson N, Imray C, Patel K, Sankar S, Randeva H, Jones C. Healthcare staff perceptions and misconceptions regarding antibody testing in the United Kingdom: implications for the next steps for antibody screening. J Hosp Infect 2020; 111:102-106. [PMID: 33309938 PMCID: PMC7834281 DOI: 10.1016/j.jhin.2020.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Healthcare workers have been at increased risk of exposure, infection and serious complications from COVID-19. Antibody testing has been used to identify staff members who have been previously infected by SARS-CoV-2, and has been rolled out rapidly in the United Kingdom. A number of comment and editorial articles have been published that raise concerns about antibody testing in this context. We present perceptions of National Health Service (NHS) healthcare workers in relation to SARS-CoV-2 antibody testing. METHODS An electronic survey regarding perceptions towards SARS-CoV-2 antibody testing was distributed to all healthcare workers at a major NHS tertiary hospital following implementation of antibody testing. RESULTS In total, 560 healthcare workers completed the survey (80% female; 25% of Black and Minority Ethnic background; 58% from frontline clinical staff). Exploring whether they previously had COVID-19 was the primary reported reason for choosing to undergo antibody testing (85.2%). In case of a positive antibody test, 72% reported that they would feel relieved, whilst 48% felt that they would be happier to work in a patient-facing area. Moreover, 12% responded that a positive test would mean "social distancing is less important", with 34% of the responders indicating that in this case they would be both less likely to catch COVID-19 and happier to visit friends/relatives. CONCLUSIONS NHS staff members primarily seek out SARS-CoV-2 antibody testing for an appropriate reason. Based on our findings and given the lack of definite data regarding the extent of immunity protection from a positive SARS-CoV-2 antibody test, significant concerns may be raised regarding the reported interpretation by healthcare workers of positive antibody test results. This needs to be further explored and addressed to protect NHS staff and patients.
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Affiliation(s)
- T Robbins
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK.
| | - I Kyrou
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - S Laird
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - N Morgan
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - N Anderson
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - C Imray
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - K Patel
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - S Sankar
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - H Randeva
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - C Jones
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
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16
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Flower B, Brown JC, Simmons B, Moshe M, Frise R, Penn R, Kugathasan R, Petersen C, Daunt A, Ashby D, Riley S, Atchison CJ, Taylor GP, Satkunarajah S, Naar L, Klaber R, Badhan A, Rosadas C, Khan M, Fernandez N, Sureda-Vives M, Cheeseman HM, O'Hara J, Fontana G, Pallett SJC, Rayment M, Jones R, Moore LSP, McClure MO, Cherepanov P, Tedder R, Ashrafian H, Shattock R, Ward H, Darzi A, Elliot P, Barclay WS, Cooke GS. Clinical and laboratory evaluation of SARS-CoV-2 lateral flow assays for use in a national COVID-19 seroprevalence survey. Thorax 2020; 75:1082-1088. [PMID: 32796119 PMCID: PMC7430184 DOI: 10.1136/thoraxjnl-2020-215732] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Accurate antibody tests are essential to monitor the SARS-CoV-2 pandemic. Lateral flow immunoassays (LFIAs) can deliver testing at scale. However, reported performance varies, and sensitivity analyses have generally been conducted on serum from hospitalised patients. For use in community testing, evaluation of finger-prick self-tests, in non-hospitalised individuals, is required. METHODS Sensitivity analysis was conducted on 276 non-hospitalised participants. All had tested positive for SARS-CoV-2 by reverse transcription PCR and were ≥21 days from symptom onset. In phase I, we evaluated five LFIAs in clinic (with finger prick) and laboratory (with blood and sera) in comparison to (1) PCR-confirmed infection and (2) presence of SARS-CoV-2 antibodies on two 'in-house' ELISAs. Specificity analysis was performed on 500 prepandemic sera. In phase II, six additional LFIAs were assessed with serum. FINDINGS 95% (95% CI 92.2% to 97.3%) of the infected cohort had detectable antibodies on at least one ELISA. LFIA sensitivity was variable, but significantly inferior to ELISA in 8 out of 11 assessed. Of LFIAs assessed in both clinic and laboratory, finger-prick self-test sensitivity varied from 21% to 92% versus PCR-confirmed cases and from 22% to 96% versus composite ELISA positives. Concordance between finger-prick and serum testing was at best moderate (kappa 0.56) and, at worst, slight (kappa 0.13). All LFIAs had high specificity (97.2%-99.8%). INTERPRETATION LFIA sensitivity and sample concordance is variable, highlighting the importance of evaluations in setting of intended use. This rigorous approach to LFIA evaluation identified a test with high specificity (98.6% (95%CI 97.1% to 99.4%)), moderate sensitivity (84.4% with finger prick (95% CI 70.5% to 93.5%)) and moderate concordance, suitable for seroprevalence surveys.
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Affiliation(s)
- Barnaby Flower
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- NIHR BRC, Imperial College NHS Trust, London, UK
| | - Jonathan C Brown
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Bryony Simmons
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Maya Moshe
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Rebecca Frise
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Rebecca Penn
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Ruthiran Kugathasan
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | | | - Anna Daunt
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Deborah Ashby
- Department of Epidemiology and Public Health, Imperial College London, London, UK
| | - Steven Riley
- Department of Epidemiology and Public Health, Imperial College London, London, UK
| | - Christina Joanne Atchison
- NIHR BRC, Imperial College NHS Trust, London, UK
- Department of Epidemiology and Public Health, Imperial College London, London, UK
| | - Graham P Taylor
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Sutha Satkunarajah
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Lenny Naar
- Institute of Global Health Innovation, Imperial College London, London, UK
| | | | - Anjna Badhan
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Carolina Rosadas
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Maryam Khan
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Natalia Fernandez
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Macià Sureda-Vives
- Synthetic Biology Group, MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Hannah M Cheeseman
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Jessica O'Hara
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Gianluca Fontana
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Scott J C Pallett
- Centre for Defence Pathology, British Army, Birmingham, UK
- Chelsea and Westminster Healthcare NHS Trust, London, UK
| | | | - Rachael Jones
- Chelsea and Westminster Healthcare NHS Trust, London, UK
| | - Luke S P Moore
- Chelsea and Westminster Healthcare NHS Trust, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Myra O McClure
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Peter Cherepanov
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Richard Tedder
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Robin Shattock
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Helen Ward
- NIHR BRC, Imperial College NHS Trust, London, UK
- Department of Epidemiology and Public Health, Imperial College London, London, UK
| | - Ara Darzi
- NIHR BRC, Imperial College NHS Trust, London, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Paul Elliot
- NIHR BRC, Imperial College NHS Trust, London, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Wendy S Barclay
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Graham S Cooke
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- NIHR BRC, Imperial College NHS Trust, London, UK
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17
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Affiliation(s)
- Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Mark J Ponsford
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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18
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Wiencek JR, Head CL, Sifri CD, Parsons AS. Clinical Ordering Practices of the SARS-CoV-2 Antibody Test at a Large Academic Medical Center. Open Forum Infect Dis 2020; 7:ofaa406. [PMID: 33072813 PMCID: PMC7553244 DOI: 10.1093/ofid/ofaa406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/28/2020] [Indexed: 11/12/2022] Open
Abstract
Background The novel severe acute respiratory coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) originated in December 2019 and has now infected almost 5 million people in the United States. In the spring of 2020, private laboratories and some hospitals began antibody testing despite limited evidence-based guidance. Methods We conducted a retrospective chart review of patients who received SARS-CoV-2 antibody testing from May 14, 2020, to June 15, 2020, at a large academic medical center, 1 of the first in the United States to provide antibody testing capability to individual clinicians in order to identify clinician-described indications for antibody testing compared with current expert-based guidance from the Infectious Diseases Society of America (IDSA) and the Centers for Disease Control and Prevention (CDC). Results Of 444 individual antibody test results, the 2 most commonly described testing indications, apart from public health epidemiology studies (n = 223), were for patients with a now resolved COVID-19-compatible illness (n = 105) with no previous molecular testing and for asymptomatic patients believed to have had a past exposure to a person with COVID-19-compatible illness (n = 60). The rate of positive SARS-CoV-2 antibody testing among those indications consistent with current IDSA and CDC guidance was 17% compared with 5% (P < .0001) among those indications inconsistent with such guidance. Testing inconsistent with current expert-based guidance accounted for almost half of testing costs. Conclusions Our findings demonstrate a dissociation between clinician-described indications for testing and expert-based guidance and a significantly different rate of positive testing between these 2 groups. Clinical curiosity and patient preference appear to have played a significant role in testing decisions and substantially contributed to testing costs.
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Affiliation(s)
- Joesph R Wiencek
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, Virginia, USA.,Laboratory Stewardship Committee, University of Virginia Health, Charlottesville, Virginia, USA
| | - Carter L Head
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Costi D Sifri
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA.,Office of Hospital Epidemiology, University of Virginia Health, Charlottesville, Virginia, USA
| | - Andrew S Parsons
- Department of Medicine, Section Hospital Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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19
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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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20
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Muecksch F, Wise H, Batchelor B, Squires M, Semple E, Richardson C, McGuire J, Clearly S, Furrie E, Neil G, Hay G, Templeton K, Lorenzi JC, Hatziioannou T, Jenks S, Bieniasz PD. Longitudinal analysis of clinical serology assay performance and neutralising antibody levels in COVID19 convalescents. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.08.05.20169128. [PMID: 32793928 PMCID: PMC7418752 DOI: 10.1101/2020.08.05.20169128] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate longitudinal trajectory of SARS-CoV-2 neutralising antibodies and the performance of serological assays in diagnosing prior infection and predicting serum neutralisation titres with time Design Retrospective longitudinal analysis of a COVID19 case cohort . Setting NHS outpatient clinics Participants Individuals with RT-PCR diagnosed SARS-CoV-2 infection that did not require hospitalization Main outcome measures The sensitivity with which prior infection was detected and quantitative antibody titres were assessed using four SARS-CoV-2 serologic assay platforms. Two platforms employed SARS-CoV-2 spike (S) based antigens and two employed nucleocapsid (N) based antigens. Serum neutralising antibody titres were measured using a validated pseudotyped virus SARS-CoV-2 neutralisation assay. The ability of the serological assays to predict neutralisation titres at various times after PCR diagnosis was assessed. Results The three of the four serological assays had sensitivities of 95 to100% at 21-40 days post PCR-diagnosis, while a fourth assay had a lower sensitivity of 85%. The relative sensitivities of the assays changed with time and the sensitivity of one assay that had an initial sensitivity of >95% declined to 85% at 61-80 post PCR diagnosis, and to 71% at 81-100 days post diagnosis. Median antibody titres decreased in one serologic assay but were maintained over the observation period in other assays. The trajectories of median antibody titres measured in serologic assays over this time period were not dependent on whether the SARS-CoV-2 N or S proteins were used as antigen source. A broad range of SARS-CoV-2 neutralising titres were evident in individual sera, that decreased over time in the majority of participants; the median neutralisation titre in the cohort decreased by 45% over 4 weeks. Each of the serological assays gave quantitative measurements of antibody titres that correlated with SARS-CoV-2 neutralisation titres, but, the S-based serological assay measurements better predicted serum neutralisation potency. The strength of correlation between serologic assay results and neutralisation titres deteriorated with time and decreases in neutralisation titres in individual participants were not well predicted by changes in antibody titres measured using serologic assays. CONCLUSIONS SARS-CoV-2 serologic assays differed in their comparative diagnostic performance over time. Different assays are more or less well suited for surveillance of populations for prior infection versus prediction of serum neutralisation potency. Continued monitoring of declining neutralisation titres during extended follow up should facilitate the establishment of appropriate serologic correlates of protection against SARS-CoV-2 reinfection.
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Affiliation(s)
- Frauke Muecksch
- Laboratory of Retrovirology, The Rockefeller University, 1230 York Avenue, New York NY 10065
| | - Helen Wise
- Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh EH16 4SA
| | - Becky Batchelor
- Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh EH16 4SA
| | - Maria Squires
- Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh EH16 4SA
| | - Elizabeth Semple
- Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh EH16 4SA
| | | | | | - Sarah Clearly
- University Hospital Monklands, NHS Lanarkshire, Airdrie ML6 0JS
| | - Elizabeth Furrie
- Ninewells Hospital and Medical School, NHS Tayside, Dundee DD1 9SY
| | - Greig Neil
- Ninewells Hospital and Medical School, NHS Tayside, Dundee DD1 9SY
| | - Gordon Hay
- Ninewells Hospital and Medical School, NHS Tayside, Dundee DD1 9SY
| | - Kate Templeton
- Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh EH16 4SA
| | - Julio C.C. Lorenzi
- Laboratory of Molecular Immunology, The Rockefeller University, 1230 York Avenue, New York NY 10065
| | - Theodora Hatziioannou
- Laboratory of Retrovirology, The Rockefeller University, 1230 York Avenue, New York NY 10065
| | - Sara Jenks
- Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh EH16 4SA
| | - Paul D. Bieniasz
- Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh EH16 4SA
- University Hospital Monklands, NHS Lanarkshire, Airdrie ML6 0JS
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21
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Gruer L, Bhopal R. Rapid roll out of SARS-CoV-2 antibody testing: even at high levels of specificity, an important proportion of test results will be false positives. BMJ 2020; 370:m2910. [PMID: 32699002 DOI: 10.1136/bmj.m2910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Laurence Gruer
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Raj Bhopal
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
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22
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Affiliation(s)
- Yen T Duong
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Connor G Wright
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jessica Justman
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY, USA
- Departments of Epidemiology and Medicine, Columbia University, New York, NY, USA
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23
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Bhopal R. Patients who have recovered from covid-19: issuing certificates and offering voluntary registration. BMJ 2020; 370:m2590. [PMID: 32611552 DOI: 10.1136/bmj.m2590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Raj Bhopal
- Usher Institute, University of Edinburgh, Edinburgh EH3 9AG, UK
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25
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26
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27
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Riley S, Atchison C, Ashby D, Donnelly CA, Barclay W, Cooke GS, Ward H, Darzi A, Elliott P. REal-time Assessment of Community Transmission (REACT) of SARS-CoV-2 virus: Study protocol. Wellcome Open Res 2020; 5:200. [PMID: 33997297 PMCID: PMC8095190 DOI: 10.12688/wellcomeopenres.16228.1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 01/21/2023] Open
Abstract
Background: England, UK has one of the highest rates of confirmed COVID-19 mortality globally. Until recently, testing for the SARS-CoV-2 virus focused mainly on healthcare and care home settings. As such, there is far less understanding of community transmission. Protocol: The REal-time Assessment of Community Transmission (REACT) programme is a major programme of home testing for COVID-19 to track progress of the infection in the community. REACT-1 involves cross-sectional surveys of viral detection (virological swab for RT-PCR) tests in repeated samples of 100,000 to 150,000 randomly selected individuals across England. This examines how widely the virus has spread and how many people are currently infected. The age range is 5 years and above. Individuals are sampled from the England NHS patient list. REACT-2 is a series of five sub-studies towards establishing the seroprevalence of antibodies to SARS-CoV-2 in England as an indicator of historical infection. The main study (study 5) uses the same design and sampling approach as REACT-1 using a self-administered lateral flow immunoassay (LFIA) test for IgG antibodies in repeated samples of 100,000 to 200,000 adults aged 18 years and above. To inform study 5, studies 1-4 evaluate performance characteristics of SARS-CoV-2 LFIAs (study 1) and different aspects of feasibility, usability and application of LFIAs for home-based testing in different populations (studies 2-4). Ethics and dissemination: The study has ethical approval. Results are reported using STROBE guidelines and disseminated through reports to public health bodies, presentations at scientific meetings and open access publications. Conclusions: This study provides robust estimates of the prevalence of both virus (RT-PCR, REACT-1) and seroprevalence (antibody, REACT-2) in the general population in England. We also explore acceptability and usability of LFIAs for self-administered testing for SARS-CoV-2 antibody in a home-based setting, not done before at such scale in the general population.
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Affiliation(s)
- Steven Riley
- School of Public Health, Imperial College London, London, UK
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Christina Atchison
- School of Public Health, Imperial College London, London, UK
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Deborah Ashby
- School of Public Health, Imperial College London, London, UK
| | - Christl A. Donnelly
- School of Public Health, Imperial College London, London, UK
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
- Department of Statistics, University of Oxford, Oxford, UK
| | - Wendy Barclay
- Department of Statistics, University of Oxford, Oxford, UK
| | - Graham S. Cooke
- Imperial College Healthcare NHS Trust, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London, London, UK
| | - Helen Ward
- School of Public Health, Imperial College London, London, UK
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London, London, UK
| | - Ara Darzi
- Imperial College Healthcare NHS Trust, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London, London, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Paul Elliott
- School of Public Health, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
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28
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Riley S, Atchison C, Ashby D, Donnelly CA, Barclay W, Cooke GS, Ward H, Darzi A, Elliott P. REal-time Assessment of Community Transmission (REACT) of SARS-CoV-2 virus: Study protocol. Wellcome Open Res 2020; 5:200. [PMID: 33997297 PMCID: PMC8095190 DOI: 10.12688/wellcomeopenres.16228.2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 01/18/2023] Open
Abstract
Background: England, UK has one of the highest rates of confirmed COVID-19 mortality globally. Until recently, testing for the SARS-CoV-2 virus focused mainly on healthcare and care home settings. As such, there is far less understanding of community transmission. Protocol: The REal-time Assessment of Community Transmission (REACT) programme is a major programme of home testing for COVID-19 to track progress of the infection in the community. REACT-1 involves cross-sectional surveys of viral detection (virological swab for RT-PCR) tests in repeated samples of 100,000 to 150,000 randomly selected individuals across England. This examines how widely the virus has spread and how many people are currently infected. The age range is 5 years and above. Individuals are sampled from the England NHS patient list. REACT-2 is a series of five sub-studies towards establishing the seroprevalence of antibodies to SARS-CoV-2 in England as an indicator of historical infection. The main study (study 5) uses the same design and sampling approach as REACT-1 using a self-administered lateral flow immunoassay (LFIA) test for IgG antibodies in repeated samples of 100,000 to 200,000 adults aged 18 years and above. To inform study 5, studies 1-4 evaluate performance characteristics of SARS-CoV-2 LFIAs (study 1) and different aspects of feasibility, usability and application of LFIAs for home-based testing in different populations (studies 2-4). Ethics and dissemination: The study has ethical approval. Results are reported using STROBE guidelines and disseminated through reports to public health bodies, presentations at scientific meetings and open access publications. Conclusions: This study provides robust estimates of the prevalence of both virus (RT-PCR, REACT-1) and seroprevalence (antibody, REACT-2) in the general population in England. We also explore acceptability and usability of LFIAs for self-administered testing for SARS-CoV-2 antibody in a home-based setting, not done before at such scale in the general population.
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Affiliation(s)
- Steven Riley
- School of Public Health, Imperial College London, London, UK
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Christina Atchison
- School of Public Health, Imperial College London, London, UK
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Deborah Ashby
- School of Public Health, Imperial College London, London, UK
| | - Christl A. Donnelly
- School of Public Health, Imperial College London, London, UK
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
- Department of Statistics, University of Oxford, Oxford, UK
| | - Wendy Barclay
- Department of Statistics, University of Oxford, Oxford, UK
| | - Graham S. Cooke
- Imperial College Healthcare NHS Trust, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London, London, UK
| | - Helen Ward
- School of Public Health, Imperial College London, London, UK
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London, London, UK
| | - Ara Darzi
- Imperial College Healthcare NHS Trust, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London, London, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Paul Elliott
- School of Public Health, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
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