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Risch M, Grossmann K, Aeschbacher S, Weideli OC, Kovac M, Pereira F, Wohlwend N, Risch C, Hillmann D, Lung T, Renz H, Twerenbold R, Rothenbühler M, Leibovitz D, Kovacevic V, Markovic A, Klaver P, Brakenhoff TB, Franks B, Mitratza M, Downward GS, Dowling A, Montes S, Grobbee DE, Cronin M, Conen D, Goodale BM, Risch L. Investigation of the use of a sensor bracelet for the presymptomatic detection of changes in physiological parameters related to COVID-19: an interim analysis of a prospective cohort study (COVI-GAPP). BMJ Open 2022; 12:e058274. [PMID: 35728900 PMCID: PMC9240454 DOI: 10.1136/bmjopen-2021-058274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/04/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES We investigated machinelearningbased identification of presymptomatic COVID-19 and detection of infection-related changes in physiology using a wearable device. DESIGN Interim analysis of a prospective cohort study. SETTING, PARTICIPANTS AND INTERVENTIONS Participants from a national cohort study in Liechtenstein were included. Nightly they wore the Ava-bracelet that measured respiratory rate (RR), heart rate (HR), HR variability (HRV), wrist-skin temperature (WST) and skin perfusion. SARS-CoV-2 infection was diagnosed by molecular and/or serological assays. RESULTS A total of 1.5 million hours of physiological data were recorded from 1163 participants (mean age 44±5.5 years). COVID-19 was confirmed in 127 participants of which, 66 (52%) had worn their device from baseline to symptom onset (SO) and were included in this analysis. Multi-level modelling revealed significant changes in five (RR, HR, HRV, HRV ratio and WST) device-measured physiological parameters during the incubation, presymptomatic, symptomatic and recovery periods of COVID-19 compared with baseline. The training set represented an 8-day long instance extracted from day 10 to day 2 before SO. The training set consisted of 40 days measurements from 66 participants. Based on a random split, the test set included 30% of participants and 70% were selected for the training set. The developed long short-term memory (LSTM) based recurrent neural network (RNN) algorithm had a recall (sensitivity) of 0.73 in the training set and 0.68 in the testing set when detecting COVID-19 up to 2 days prior to SO. CONCLUSION Wearable sensor technology can enable COVID-19 detection during the presymptomatic period. Our proposed RNN algorithm identified 68% of COVID-19 positive participants 2 days prior to SO and will be further trained and validated in a randomised, single-blinded, two-period, two-sequence crossover trial. Trial registration number ISRCTN51255782; Pre-results.
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Affiliation(s)
- Martin Risch
- Dr Risch Medical Laboratory, Vaduz, Liechtenstein
- Central Laboratory, Canton Hospital Graubünden, Chur, Switzerland
- Dr Risch Medical Laboratory, Buchs, Switzerland
| | - Kirsten Grossmann
- Dr Risch Medical Laboratory, Vaduz, Liechtenstein
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Stefanie Aeschbacher
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Marc Kovac
- Dr Risch Medical Laboratory, Buchs, Switzerland
| | - Fiona Pereira
- Department of Metabolism, Digestive Diseases and Reproduction, Imperial College London, London, UK
| | | | | | | | - Thomas Lung
- Dr Risch Medical Laboratory, Buchs, Switzerland
| | - Harald Renz
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg, Marburg, Germany
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Cardiology and University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | | | | | - Andjela Markovic
- Ava AG, Zurich, Switzerland
- Department of Psychology, University of Fribourg, Fribourg, Switzerland
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | - Marianna Mitratza
- UMC Utrecht, Utrecht, The Netherlands
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - George S Downward
- UMC Utrecht, Utrecht, The Netherlands
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - Ariel Dowling
- Takeda Pharmaceuticals, Digital Clinical Devices, Cambridge, UK
| | | | - Diederick E Grobbee
- UMC Utrecht, Utrecht, The Netherlands
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | | | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | | | - Lorenz Risch
- Dr Risch Medical Laboratory, Vaduz, Liechtenstein
- Dr Risch Medical Laboratory, Buchs, Switzerland
- Center of Laboratory Medicine, University Institute of Clinical Chemistry, University of Bern, Bern, Switzerland
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Kumar G, Sterrett S, Hall L, Tabengwa E, Honjo K, Larimer M, Davis RS, Goepfert PA, Larimer BM. Comprehensive mapping of SARS-CoV-2 peptide epitopes for development of a highly sensitive serological test for total and neutralizing antibodies. Protein Eng Des Sel 2022; 35:6529796. [PMID: 35174857 PMCID: PMC9005051 DOI: 10.1093/protein/gzab033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/30/2021] [Accepted: 06/16/2021] [Indexed: 11/12/2022] Open
Abstract
Quantification of the anti-SARS-CoV-2 antibody response has proven to be a prominent diagnostic tool during the COVID-19 pandemic. Antibody measurements have aided in the determination of humoral protection following infection or vaccination and will likely be essential for predicting the prevalence of population level immunity over the next several years. Despite widespread use, current tests remain limited in part, because antibody capture is accomplished through the use of complete spike and nucleocapsid proteins that contain significant regions of overlap with common circulating coronaviruses. To address this limitation, a unique epitope display platform utilizing monovalent display and protease-driven capture of peptide epitopes was used to select high affinity peptides. A single round of selection using this strategy with COVID-19 positive patient plasma samples revealed surprising differences and specific patterns in the antigenicity of SARS-CoV-2 proteins, especially the spike protein. Putative epitopes were assayed for specificity with convalescent and control samples, and the individual binding kinetics of peptides were also determined. A subset of prioritized peptides was used to develop an antibody diagnostic assay that showed low cross reactivity while detecting 37% more positive antibody cases than a gold standard FDA EUA test. Finally, a subset of peptides were compared with serum neutralization activity to establish a 2 peptide assay that strongly correlates with neutralization. Together, these data demonstrate a novel phage display method that is capable of comprehensively and rapidly mapping patient viral antibody responses and selecting high affinity public epitopes for the diagnosis of humoral immunity.
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Affiliation(s)
- Garima Kumar
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Sarah Sterrett
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Lucinda Hall
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Edlue Tabengwa
- Multidisciplinary Molecular Interaction Core, Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Kazuhito Honjo
- Department of Medicine, Microbiology, and Biochemistry & Molecular Genetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | - Randall S Davis
- Department of Medicine, Microbiology, and Biochemistry & Molecular Genetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Paul A Goepfert
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Bui LM, Thi Thu Phung H, Ho Thi TT, Singh V, Maurya R, Khambhati K, Wu CC, Uddin MJ, Trung DM, Chu DT. Recent findings and applications of biomedical engineering for COVID-19 diagnosis: a critical review. Bioengineered 2021; 12:8594-8613. [PMID: 34607509 PMCID: PMC8806999 DOI: 10.1080/21655979.2021.1987821] [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] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/28/2021] [Indexed: 12/23/2022] Open
Abstract
COVID-19 is one of the most severe global health crises that humanity has ever faced. Researchers have restlessly focused on developing solutions for monitoring and tracing the viral culprit, SARS-CoV-2, as vital steps to break the chain of infection. Even though biomedical engineering (BME) is considered a rising field of medical sciences, it has demonstrated its pivotal role in nurturing the maturation of COVID-19 diagnostic technologies. Within a very short period of time, BME research applied to COVID-19 diagnosis has advanced with ever-increasing knowledge and inventions, especially in adapting available virus detection technologies into clinical practice and exploiting the power of interdisciplinary research to design novel diagnostic tools or improve the detection efficiency. To assist the development of BME in COVID-19 diagnosis, this review highlights the most recent diagnostic approaches and evaluates the potential of each research direction in the context of the pandemic.
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Affiliation(s)
- Le Minh Bui
- NTT Hi-Tech Institute, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
- Department of Biology, Faculty of Science and Technology, Universitas Airlangga, Surabaya, Indonesia
| | - Huong Thi Thu Phung
- NTT Hi-Tech Institute, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Thuy-Tien Ho Thi
- Center for Biomedicine and Community Health, International School, Vietnam National University, Hanoi, Vietnam
| | - Vijai Singh
- Department of Biosciences, School of Science, Indrashil University, Mehsana, Gujarat, India
| | - Rupesh Maurya
- Department of Biosciences, School of Science, Indrashil University, Mehsana, Gujarat, India
| | - Khushal Khambhati
- Department of Biosciences, School of Science, Indrashil University, Mehsana, Gujarat, India
| | - Chia-Ching Wu
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Md Jamal Uddin
- ABEx Bio-Research Center, East Azampur, Dhaka, Bangladesh
- Graduate School of Pharmaceutical Sciences, College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea
| | - Do Minh Trung
- Institute of Biomedicine and Pharmacy, Vietnam Military Medical University, Hanoi, Vietnam
| | - Dinh Toi Chu
- Center for Biomedicine and Community Health, International School, Vietnam National University, Hanoi, Vietnam
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Montague BT, Wipperman MF, Hooper AT, Hamon SC, Crow R, Elemo F, Hersh L, Langdon S, Hamilton JD, O'Brien MP, Simões EAF. Anti-SARS-CoV-2 IgA Identifies Asymptomatic Infection in First Responders. J Infect Dis 2021; 225:578-586. [PMID: 34636907 PMCID: PMC8549282 DOI: 10.1093/infdis/jiab524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022] Open
Abstract
Background IgA is an important component of the early immune response to SARS-CoV-2. Prior serosurveys in high-risk groups employing IgG testing alone have provided discordant estimates. The potential added benefit of IgA in serosurveys has not been established. Methods Longitudinal serosurvey of first responders (police, emergency medical service providers, fire fighters, and other staff) employing three serologic tests: anti-spike IgA, anti-spike IgG, and anti-nucleocapsid IgG correlated with surveys assessing occupational and non-occupational risk, exposure to COVID-19 and illnesses consistent with COVID-19. Results Twelve percent of first responders in Colorado at baseline and 22% at follow-up were assessed as having SARS-CoV-2 infection. Five percent at baseline and 6% at follow-up were seropositive only for IgA. Among those IgA positive only at baseline, the majority 69% had a positive antibody at follow-up. 45% of those infected at baseline and 33% at follow-up were asymptomatic. At all time points, the estimated cumulative incidence in our study was higher than that in the general population. Conclusions First responders are at high risk of infection with SARS-CoV-2. IgA testing identified a significant portion of cases missed by IgG testing and its use as part of serologic surveys may improve retrospective identification of asymptomatic infection.
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Affiliation(s)
| | | | | | | | - Rowena Crow
- University of Colorado School of Medicine, Aurora, CO USA
| | - Femi Elemo
- Regeneron Pharmaceuticals, Tarrytown, NY USA
| | - Lisa Hersh
- Regeneron Pharmaceuticals, Tarrytown, NY USA
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Toropov N, Osborne E, Joshi LT, Davidson J, Morgan C, Page J, Pepperell J, Vollmer F. SARS-CoV-2 Tests: Bridging the Gap between Laboratory Sensors and Clinical Applications. ACS Sens 2021; 6:2815-2837. [PMID: 34392681 PMCID: PMC8386036 DOI: 10.1021/acssensors.1c00612] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/28/2021] [Indexed: 12/15/2022]
Abstract
This review covers emerging biosensors for SARS-CoV-2 detection together with a review of the biochemical and clinical assays that are in use in hospitals and clinical laboratories. We discuss the gap in bridging the current practice of testing laboratories with nucleic acid amplification methods, and the robustness of assays the laboratories seek, and what emerging SARS-CoV-2 sensors have currently addressed in the literature. Together with the established nucleic acid and biochemical tests, we review emerging technology and antibody tests to determine the effectiveness of vaccines on individuals.
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Affiliation(s)
- Nikita Toropov
- Living
Systems Institute, University of Exeter, Exeter EX4 4QD, United Kingdom
| | - Eleanor Osborne
- Living
Systems Institute, University of Exeter, Exeter EX4 4QD, United Kingdom
| | | | - James Davidson
- Somerset
Lung Centre, Musgrove Park Hospital, Parkfield Drive, Taunton TA1 5DA, United Kingdom
| | - Caitlin Morgan
- Somerset
Lung Centre, Musgrove Park Hospital, Parkfield Drive, Taunton TA1 5DA, United Kingdom
| | - Joseph Page
- Somerset
Lung Centre, Musgrove Park Hospital, Parkfield Drive, Taunton TA1 5DA, United Kingdom
| | - Justin Pepperell
- Somerset
Lung Centre, Musgrove Park Hospital, Parkfield Drive, Taunton TA1 5DA, United Kingdom
| | - Frank Vollmer
- Living
Systems Institute, University of Exeter, Exeter EX4 4QD, United Kingdom
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SARS-CoV-2 infection in general practice in Ireland: a seroprevalence study. BJGP Open 2021; 5:BJGPO.2021.0038. [PMID: 34006528 PMCID: PMC8450885 DOI: 10.3399/bjgpo.2021.0038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/18/2021] [Indexed: 12/23/2022] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody testing in community settings may help us better understand the immune response to this virus and, therefore, help guide public health efforts. Aim To conduct a seroprevalence study of immunoglobulin G (IgG) antibodies in Irish GP clinics. Design & setting Participants were 172 staff and 799 patients from 15 general practices in the Midwest region of Ireland. Method This seroprevalence study utilised two manufacturers’ point-of-care (POC) SARS-CoV-2 immunoglobulin M (IgM)—IgG combined antibody tests, which were offered to patients and staff in general practice from 15 June to 10 July 2020. Results IgG seroprevalence was 12.6% in patients attending general practice and 11.1% in staff working in general practice, with administrative staff having the lowest seroprevalence at 2.5% and nursing staff having the highest at 17.6%. Previous symptoms suggestive of COVID-19 and history of a polymerase chain reaction (PCR) test were associated with higher seroprevalence. IgG antibodies were detected in approximately 80% of participants who had a previous PCR-confirmed infection. Average length of time between participants’ positive PCR test and positive IgG antibody test was 83 days. Conclusion Patients and healthcare staff in general practice in Ireland had relatively high rates of IgG to SARS-CoV-2 compared with the national average between 15 June and 10 July 2020 (1.7%). Four-fifths of participants with a history of confirmed COVID-19 disease still had detectable antibodies an average of 12 weeks post-infection. While not proof of immunity, SARS-CoV-2 POC testing can be used to estimate IgG seroprevalence in general practice settings.
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Nedelcu I, Jipa R, Vasilescu R, Băicuș C, Popescu CI, Manea E, Stoichițoiu LE, Pinte L, Damalan A, Simulescu O, Stoica I, Stoica M, Hristea A. Long-Term Longitudinal Evaluation of Six Commercial Immunoassays for the Detection of IgM and IgG Antibodies against SARS CoV-2. Viruses 2021; 13:1244. [PMID: 34206895 PMCID: PMC8310110 DOI: 10.3390/v13071244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 01/28/2023] Open
Abstract
The number of serological assays for SARS-CoV-2 has skyrocketed in the past year. Concerns have been raised regarding their performance characteristics, depending on the disease severity and the time of the analysis post-symptom onset (PSO). Thus, independent validations using an unbiased sample selection are required for meaningful serology data interpretation. We aimed to assess the clinical performance of six commercially available assays, the seroconversion, and the dynamics of the humoral response to SARS-CoV-2 infection. The study included 528 serum samples from 156 patients with follow-up visits up to six months PSO and 161 serum samples from healthy people. The IgG/total antibodies positive percentage increased and remained above 95% after six months when chemiluminescent immunoassay (CLIA) IgG antiS1/S2 and electro-chemiluminescent assay (ECLIA) total antiNP were used. At early time points PSO, chemiluminescent microparticle immunoassay (CMIA) IgM antiS achieved the best sensitivity. IgM and IgG appear simultaneously in most circumstances, and when performed in parallel the sensitivity increases. The severe and the moderate clinical forms were significantly associated with higher seropositivity percentage and antibody levels. High specificity was found in all evaluated assays, but the sensitivity was variable depending on the time PSO, severity of disease, detection method and targeted antigen.
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Affiliation(s)
- Iulia Nedelcu
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania; (I.N.); (C.B.); (E.M.); (L.P.); (A.H.)
- Department of Infectious Diseases Adults 4, National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, 1 Dr. Calistrat Grozovici Street, 021105 Bucharest, Romania;
| | - Raluca Jipa
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania; (I.N.); (C.B.); (E.M.); (L.P.); (A.H.)
- Department of Infectious Diseases Adults 4, National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, 1 Dr. Calistrat Grozovici Street, 021105 Bucharest, Romania;
| | - Roxana Vasilescu
- Medlife Laboratory, 365 Calea Grivitei Street, 010719 Bucharest, Romania; (R.V.); (O.S.); (I.S.); (M.S.)
| | - Cristian Băicuș
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania; (I.N.); (C.B.); (E.M.); (L.P.); (A.H.)
- Department of Internal Medicine, Colentina Clinical Hospital, 19-21 Stefan cel Mare Street, 72202 Bucharest, Romania;
| | - Costin-Ioan Popescu
- Institute of Biochemistry of the Romanian Academy, 296 Splaiul Independentei, 060031 Bucharest, Romania;
| | - Eliza Manea
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania; (I.N.); (C.B.); (E.M.); (L.P.); (A.H.)
- Department of Infectious Diseases Adults 4, National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, 1 Dr. Calistrat Grozovici Street, 021105 Bucharest, Romania;
| | - Laura E. Stoichițoiu
- Department of Internal Medicine, Colentina Clinical Hospital, 19-21 Stefan cel Mare Street, 72202 Bucharest, Romania;
| | - Larisa Pinte
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania; (I.N.); (C.B.); (E.M.); (L.P.); (A.H.)
- Department of Internal Medicine, Colentina Clinical Hospital, 19-21 Stefan cel Mare Street, 72202 Bucharest, Romania;
| | - Anca Damalan
- Department of Infectious Diseases Adults 4, National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, 1 Dr. Calistrat Grozovici Street, 021105 Bucharest, Romania;
| | - Oana Simulescu
- Medlife Laboratory, 365 Calea Grivitei Street, 010719 Bucharest, Romania; (R.V.); (O.S.); (I.S.); (M.S.)
| | - Irina Stoica
- Medlife Laboratory, 365 Calea Grivitei Street, 010719 Bucharest, Romania; (R.V.); (O.S.); (I.S.); (M.S.)
| | - Madalina Stoica
- Medlife Laboratory, 365 Calea Grivitei Street, 010719 Bucharest, Romania; (R.V.); (O.S.); (I.S.); (M.S.)
| | - Adriana Hristea
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania; (I.N.); (C.B.); (E.M.); (L.P.); (A.H.)
- Department of Infectious Diseases Adults 4, National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, 1 Dr. Calistrat Grozovici Street, 021105 Bucharest, Romania;
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Barreiro P, Candel FJ, Sanz JC, San Román J, del Mar Carretero M, Pérez-Abeledo M, Ramos B, Viñuela-Prieto JM, Canora J, Martínez-Peromingo FJ, Zapatero A. Virological Correlates of IgM-IgG Patterns of Response to SARS-CoV-2 Infection According to Targeted Antigens. Viruses 2021; 13:874. [PMID: 34068703 PMCID: PMC8151912 DOI: 10.3390/v13050874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/17/2022] Open
Abstract
The virological meaning of the different patterns of serology in COVID-19 has been little examined in clinical settings. Asymptomatic subjects with IgM-spike (S) and IgG-nucleocapsid (N) determinations by chemiluminescence were studied for SARS-CoV-2 shedding in respiratory secretions by transcription-mediated amplification (TMA). In subjects showing IgM-S positive and IgG-N negative, IgG-S was determined by lateral flow assay. A total of 712 individuals were tested: 30.0% presented IgM-S(+)/IgG-N(-), 25.8% had IgM-S(+)/IgG-N(+) and 44.2% had IgM-S(-)/IgG-N(+); the proportion with TMA(+) were comparable in these three groups: 12.1, 8.7 and 10.5%, respectively. In individuals with IgM-S(+)/IgG-N(-), IgG-S(+) was detected in 66.5%. The frequency of IgM-S(+)/IgG-S(-) in the total population was 10.0%, of whom 24.1% had TMA(+); the chances for TMA(+) in subjects with an IgM-S(+) alone pattern were 2.4%. Targeting of the same SARS-CoV-2 antigen seems to be better for the characterization of IgM/IgG patterns of response. IgM-S(+) alone reactivity is rare, and a small proportion is associated with viral shedding.
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Affiliation(s)
- Pablo Barreiro
- Public Health Regional Laboratory, Hospital Isabel Zendal, Av. Manuel Fraga Iribarne, 2, 28055 Madrid, Spain; (F.J.C.); (J.C.S.); (J.S.R.); (M.d.M.C.); (M.P.-A.); (B.R.); (J.M.V.-P.)
- Council of Public Health, Community of Madrid, Calle O’Donnell, 50, 28009 Madrid, Spain; (J.C.); (F.J.M.-P.); (A.Z.)
| | - Francisco Javier Candel
- Public Health Regional Laboratory, Hospital Isabel Zendal, Av. Manuel Fraga Iribarne, 2, 28055 Madrid, Spain; (F.J.C.); (J.C.S.); (J.S.R.); (M.d.M.C.); (M.P.-A.); (B.R.); (J.M.V.-P.)
- Council of Public Health, Community of Madrid, Calle O’Donnell, 50, 28009 Madrid, Spain; (J.C.); (F.J.M.-P.); (A.Z.)
| | - Juan Carlos Sanz
- Public Health Regional Laboratory, Hospital Isabel Zendal, Av. Manuel Fraga Iribarne, 2, 28055 Madrid, Spain; (F.J.C.); (J.C.S.); (J.S.R.); (M.d.M.C.); (M.P.-A.); (B.R.); (J.M.V.-P.)
| | - Jesús San Román
- Public Health Regional Laboratory, Hospital Isabel Zendal, Av. Manuel Fraga Iribarne, 2, 28055 Madrid, Spain; (F.J.C.); (J.C.S.); (J.S.R.); (M.d.M.C.); (M.P.-A.); (B.R.); (J.M.V.-P.)
- Council of Public Health, Community of Madrid, Calle O’Donnell, 50, 28009 Madrid, Spain; (J.C.); (F.J.M.-P.); (A.Z.)
| | - María del Mar Carretero
- Public Health Regional Laboratory, Hospital Isabel Zendal, Av. Manuel Fraga Iribarne, 2, 28055 Madrid, Spain; (F.J.C.); (J.C.S.); (J.S.R.); (M.d.M.C.); (M.P.-A.); (B.R.); (J.M.V.-P.)
- Council of Public Health, Community of Madrid, Calle O’Donnell, 50, 28009 Madrid, Spain; (J.C.); (F.J.M.-P.); (A.Z.)
| | - Marta Pérez-Abeledo
- Public Health Regional Laboratory, Hospital Isabel Zendal, Av. Manuel Fraga Iribarne, 2, 28055 Madrid, Spain; (F.J.C.); (J.C.S.); (J.S.R.); (M.d.M.C.); (M.P.-A.); (B.R.); (J.M.V.-P.)
| | - Belén Ramos
- Public Health Regional Laboratory, Hospital Isabel Zendal, Av. Manuel Fraga Iribarne, 2, 28055 Madrid, Spain; (F.J.C.); (J.C.S.); (J.S.R.); (M.d.M.C.); (M.P.-A.); (B.R.); (J.M.V.-P.)
| | - José Manuel Viñuela-Prieto
- Public Health Regional Laboratory, Hospital Isabel Zendal, Av. Manuel Fraga Iribarne, 2, 28055 Madrid, Spain; (F.J.C.); (J.C.S.); (J.S.R.); (M.d.M.C.); (M.P.-A.); (B.R.); (J.M.V.-P.)
| | - Jesús Canora
- Council of Public Health, Community of Madrid, Calle O’Donnell, 50, 28009 Madrid, Spain; (J.C.); (F.J.M.-P.); (A.Z.)
| | | | - Antonio Zapatero
- Council of Public Health, Community of Madrid, Calle O’Donnell, 50, 28009 Madrid, Spain; (J.C.); (F.J.M.-P.); (A.Z.)
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Irsara C, Egger AE, Prokop W, Nairz M, Loacker L, Sahanic S, Pizzini A, Sonnweber T, Holzer B, Mayer W, Schennach H, Loeffler-Ragg J, Bellmann-Weiler R, Hartmann B, Tancevski I, Weiss G, Binder CJ, Anliker M, Griesmacher A, Hoermann G. Clinical validation of the Siemens quantitative SARS-CoV-2 spike IgG assay (sCOVG) reveals improved sensitivity and a good correlation with virus neutralization titers. Clin Chem Lab Med 2021; 59:1453-1462. [PMID: 33837679 DOI: 10.1515/cclm-2021-0214] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/24/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections cause coronavirus disease 2019 (COVID-19) and induce a specific antibody response. Serological assays detecting IgG against the receptor binding domain (RBD) of the spike (S) protein are useful to monitor the immune response after infection or vaccination. The objective of our study was to evaluate the clinical performance of the Siemens SARS-CoV-2 IgG (sCOVG) assay. METHODS Sensitivity and specificity of the Siemens sCOVG test were evaluated on 178 patients with SARS-CoV-2-infection and 160 pre-pandemic samples in comparison with its predecessor test COV2G. Furthermore, correlation with virus neutralization titers was investigated on 134 samples of convalescent COVID-19 patients. RESULTS Specificity of the sCOVG test was 99.4% and sensitivity was 90.5% (COV2G assay 78.7%; p<0.0001). S1-RBD antibody levels showed a good correlation with virus neutralization titers (r=0.843; p<0.0001) and an overall qualitative agreement of 98.5%. Finally, median S1-RBD IgG levels increase with age and were significantly higher in hospitalized COVID-19 patients (median levels general ward: 25.7 U/mL; intensive care: 59.5 U/mL) than in outpatients (3.8 U/mL; p<0.0001). CONCLUSIONS Performance characteristics of the sCOVG assay have been improved compared to the predecessor test COV2G. Quantitative SARS-CoV-2 S1-RBD IgG levels could be used as a surrogate for virus neutralization capacity. Further harmonization of antibody quantification might assist to monitor the humoral immune response after COVID-19 disease or vaccination.
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Affiliation(s)
- Christian Irsara
- Central Institute of Clinical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria
| | - Alexander E Egger
- Central Institute of Clinical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria
| | - Wolfgang Prokop
- Central Institute of Clinical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria
| | - Manfred Nairz
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lorin Loacker
- Central Institute of Clinical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria
| | - Sabina Sahanic
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alex Pizzini
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Sonnweber
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Holzer
- Department for Animal Health, Austrian Agency for Health and Food Safety (AGES), Moedling, Austria
| | - Wolfgang Mayer
- Central Institute for Blood Transfusion and Immunology (ZIB), University Hospital of Innsbruck, Innsbruck, Austria
| | - Harald Schennach
- Central Institute for Blood Transfusion and Immunology (ZIB), University Hospital of Innsbruck, Innsbruck, Austria
| | - Judith Loeffler-Ragg
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Boris Hartmann
- Department for Animal Health, Austrian Agency for Health and Food Safety (AGES), Moedling, Austria
| | - Ivan Tancevski
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph J Binder
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Anliker
- Central Institute of Clinical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria
| | - Andrea Griesmacher
- Central Institute of Clinical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria
| | - Gregor Hoermann
- Central Institute of Clinical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria.,MLL Munich Leukemia Laboratory, Munich, Germany
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10
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Orner EP, Rodgers MA, Hock K, Tang MS, Taylor R, Gardiner M, Olivo A, Fox A, Prostko J, Cloherty G, Farnsworth CW. Comparison of SARS-CoV-2 IgM and IgG seroconversion profiles among hospitalized patients in two US cities. Diagn Microbiol Infect Dis 2021; 99:115300. [PMID: 33388575 PMCID: PMC7759125 DOI: 10.1016/j.diagmicrobio.2020.115300] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 01/05/2023]
Abstract
The clinical and public health utility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serologic testing requires a better understanding of the dynamics of the humoral response to infection. To track seroconversion of IgG and IgM antibodies in patients with SARS-CoV-2 infection and its association with patient and clinical factors and outcomes. Residual patient specimens were analyzed on the Abbott ARCHITECT i2000 instrument using the Abbott SARS-CoV-2 IgG assay and prototype SARS-CoV-2 IgM assay. Age, sex, comorbidities, symptom onset date, mortality, and specimen collection date were obtained from electronic medical records. Three hundred fifty-nine longitudinal samples were collected from 89 hospitalized patients 0 to 82 days postsymptom onset. Of all, 51.7% of the patients developed IgG and IgM antibodies simultaneously; 32.8% seroconverted for IgM before IgG. On average, patients seroconverted for IgG by 8 days and for IgM by 7 days postsymptom onset. All patients achieved IgG seropositivity by 19 days and IgM seropositivity by 17 days. Median time to IgG and IgM seroconversion was prolonged and initial levels of IgG were lower in immunocompromised patients and patients <65 years of age compared to immune competent patients and those ≥65 years of age. Immunocompromised patients also had persistently lower levels of IgM that peaked on day 17.6 and decreased thereafter compared to immune competent patients. IgM seroconversion in patients who died reached significantly higher levels later after symptom onset than in those who recovered. SARS-CoV-2 infected patients have similar time to seroconversion for IgG and IgM. However, differences in immune status and age alter time to seroconversion. These results may help guide serologic testing application in COVID-19 management.
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Affiliation(s)
- Erika P Orner
- Department of Pathology, Montefiore Medical Center, Bronx, NY, USA
| | | | - Karl Hock
- Department of Pathology and Immunology, Washington University Medical School, St. Louis, MO, USA
| | - Mei San Tang
- Department of Pathology and Immunology, Washington University Medical School, St. Louis, MO, USA
| | | | | | | | - Amy Fox
- Department of Pathology, Montefiore Medical Center, Bronx, NY, USA
| | | | | | - Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University Medical School, St. Louis, MO, USA.
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11
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Irsara C, Egger AE, Prokop W, Nairz M, Loacker L, Sahanic S, Pizzini A, Sonnweber T, Mayer W, Schennach H, Loeffler-Ragg J, Bellmann-Weiler R, Tancevski I, Weiss G, Anliker M, Griesmacher A, Hoermann G. Evaluation of four commercial, fully automated SARS-CoV-2 antibody tests suggests a revision of the Siemens SARS-CoV-2 IgG assay. Clin Chem Lab Med 2021; 59:1143-1154. [PMID: 33554557 DOI: 10.1515/cclm-2020-1758] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/05/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Serological tests detect antibodies against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the ongoing coronavirus disease-19 (COVID-19) pandemic. Independent external clinical validation of performance characteristics is of paramount importance. METHODS Four fully automated assays, Roche Elecsys Anti-SARS-CoV-2, Abbott SARS-CoV-2 IgG, Siemens SARS-CoV-2 total (COV2T) and SARS-CoV-2 IgG (COV2G) were evaluated using 350 pre-pandemic samples and 700 samples from 245 COVID-19 patients (158 hospitalized, 87 outpatients). RESULTS All tests showed very high diagnostic specificity. Sensitivities in samples collected at least 14 days after disease onset were slightly lower than manufacturers' claims for Roche (93.0%), Abbott (90.8%), and Siemens COV2T (90.3%), and distinctly lower for Siemens COV2G (78.8%). Concordantly negative results were enriched for immunocompromised patients. ROC curve analyses suggest a lowering of the cut-off index for the Siemens COV2G assay. Finally, the combination of two anti-SARS-CoV-2 antibody assays is feasible when considering borderline reactive results. CONCLUSIONS Thorough on-site evaluation of commercially available serologic tests for detection of antibodies against SARS-CoV-2 remains imperative for laboratories. The potentially impaired sensitivity of the Siemens COV2G necessitates a switch to the company's newly filed SARS-CoV-2 IgG assay for follow-up studies. A combination of tests could be considered in clinical practice.
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Affiliation(s)
- Christian Irsara
- Central Institute of Clinical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria
| | - Alexander E Egger
- Central Institute of Clinical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria
| | - Wolfgang Prokop
- Central Institute of Clinical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria
| | - Manfred Nairz
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lorin Loacker
- Central Institute of Clinical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria
| | - Sabina Sahanic
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alex Pizzini
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Sonnweber
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Mayer
- Central Institute for Blood Transfusion and Immunology (ZIB), University Hospital of Innsbruck, Innsbruck, Austria
| | - Harald Schennach
- Central Institute for Blood Transfusion and Immunology (ZIB), University Hospital of Innsbruck, Innsbruck, Austria
| | - Judith Loeffler-Ragg
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ivan Tancevski
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Anliker
- Central Institute of Clinical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria
| | - Andrea Griesmacher
- Central Institute of Clinical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria
| | - Gregor Hoermann
- Central Institute of Clinical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria.,MLL Munich Leukemia Laboratory, Munich, Germany
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12
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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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13
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Humble RM, Merrill AE, Ford BA, Diekema DJ, Krasowski MD. Practical Considerations for Implementation of SARS-CoV-2 Serological Testing in the Clinical Laboratory: Experience at an Academic Medical Center. Acad Pathol 2021; 8:23742895211002802. [PMID: 33889715 PMCID: PMC8040556 DOI: 10.1177/23742895211002802] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 01/16/2021] [Accepted: 02/06/2021] [Indexed: 12/19/2022] Open
Abstract
Molecular techniques, especially reverse transcriptase polymerase chain reaction (RT-PCR), have been the gold standard for the diagnosis of acute severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Serological tests for SARS-CoV-2 have been widely used for serosurveys, epidemiology, and identification of potential convalescent plasma donors. However, the clinical role of serologic testing is still limited and evolving. In this report, we describe the experience of selecting, validating, and implementing SARS-CoV-2 serologic testing for clinical purposes at an academic medical center in a rural state. Successful implementation involved close collaboration between pathology, infectious diseases, and outpatient clinics. The most common clinician concerns were appropriateness/utility of testing, patient charges/insurance coverage, and assay specificity. In analyzing test utilization, serologic testing in the first month after go-live was almost entirely outpatient and appeared to be strongly driven by patient interest (including health care workers and others in high-risk occupations for exposure to SARS-CoV-2), with little evidence that the results impacted clinical decision-making. Test volumes for serology declined steadily through October 31, 2020, with inpatient ordering assuming a steadily higher percentage of the total. In a 5-month period, SARS-CoV-2 serology test volumes amounted to only 1.3% of that of reverse transcriptase polymerase chain reaction. Unlike reverse transcriptase polymerase chain reaction, supply chain challenges and reagent availability were not major issues for serology testing. We also discuss the most recent challenge of requirements for SARS-CoV-2 testing in international travel protocols. Overall, our experience at an academic medical center shows that SARS-CoV-2 serology testing assumed a limited clinical role.
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Affiliation(s)
- Robert M. Humble
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Anna E. Merrill
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Bradley A. Ford
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Daniel J. Diekema
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Matthew D. Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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14
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Imborek KL, Krasowski MD, Natvig P, Merrill AE, Diekema DJ, Ford BA. Experience With Pretravel Testing for SARS-CoV-2 at an Academic Medical Center. Acad Pathol 2021; 8:23742895211010247. [PMID: 33997275 PMCID: PMC8110896 DOI: 10.1177/23742895211010247] [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: 02/21/2021] [Revised: 03/16/2021] [Accepted: 03/21/2021] [Indexed: 12/13/2022] Open
Abstract
International travel has been a significant factor in the coronavirus disease 2019 pandemic. Many countries and airlines have implemented travel restrictions to limit the spread of the causative agent, severe acute respiratory syndrome coronavirus-2. A common requirement has been a negative reverse-transcriptase polymerase chain reaction performed by a clinical laboratory within 48 to 72 hours of departure. A more recent travel mandate for severe acute respiratory syndrome coronavirus-2 immunoglobulin M serology testing was instituted by the Chinese government on October 29, 2020. Pretravel testing for severe acute respiratory syndrome coronavirus-2 raises complications in terms of cost, turnaround time, and follow-up of positive results. In this report, we describe the experience of a multidisciplinary collaboration to develop a workflow for pretravel severe acute respiratory syndrome coronavirus-2 reverse-transcriptase polymerase chain reaction and immunoglobulin M serology testing at an academic medical center. The workflow primarily involved self-payment by patients and preferred retrieval of results by the patient through the electronic health record patient portal (Epic MyChart). A total of 556 unique patients underwent pretravel reverse-transcriptase polymerase chain reaction testing, with 13 (2.4%) having one or more positive results, a rate similar to that for reverse-transcriptase polymerase chain reaction testing performed for other protocol-driven asymptomatic screening (eg, inpatient admissions, preprocedural) at our medical center. For 5 of 13 reverse-transcriptase polymerase chain reaction positive samples, the traveler had clinical history, prior reverse-transcriptase polymerase chain reaction positive, and high cycle thresholds values on pretravel testing consistent with remote infection and minimal transmission risk. Severe acute respiratory syndrome coronavirus-2 immunoglobulin M was performed on only 24 patients but resulted in 2 likely false positives. Overall, our experience at an academic medical center shows the challenge with pretravel severe acute respiratory syndrome coronavirus-2 testing.
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Affiliation(s)
- Katherine L. Imborek
- Department of Family Medicine, University of Iowa Hospitals and
Clinics, IA, USA
| | | | - Paul Natvig
- Division of Student Life, Student Health, University of Iowa, IA,
USA
| | - Anna E. Merrill
- Department of Pathology, University of Iowa Hospitals and
Clinics, IA, USA
| | - Daniel J. Diekema
- Department of Pathology, University of Iowa Hospitals and
Clinics, IA, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and
Clinics, IA, USA
| | - Bradley A. Ford
- Department of Pathology, University of Iowa Hospitals and
Clinics, IA, USA
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15
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Schaffner A, Risch L, Aeschbacher S, Risch C, Weber MC, Thiel SL, Jüngert K, Pichler M, Grossmann K, Wohlwend N, Lung T, Hillmann D, Bigler S, Bodmer T, Imperiali M, Renz H, Kohler P, Vernazza P, Kahlert CR, Twerenbold R, Paprotny M, Conen D, Risch M. Characterization of a Pan-Immunoglobulin Assay Quantifying Antibodies Directed against the Receptor Binding Domain of the SARS-CoV-2 S1-Subunit of the Spike Protein: A Population-Based Study. J Clin Med 2020; 9:E3989. [PMID: 33317059 PMCID: PMC7764650 DOI: 10.3390/jcm9123989] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 12/23/2022] Open
Abstract
Pan-immunoglobulin assays can simultaneously detect IgG, IgM and IgA directed against the receptor binding domain (RBD) of the S1 subunit of the spike protein (S) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 S1-RBD Ig). In this work, we aim to evaluate a quantitative SARS-CoV-2 S1-RBD Ig electrochemiluminescence immunoassay (ECLIA) regarding analytical, diagnostic, operational and clinical characteristics. Our work takes the form of a population-based study in the principality of Liechtenstein, including 125 cases with clinically well-described and laboratory confirmed SARS-CoV-2 infection and 1159 individuals without evidence of coronavirus disease 2019 (COVID-19). SARS-CoV-2 cases were tested for antibodies in sera taken with a median of 48 days (interquartile range, IQR, 43-52) and 139 days (IQR, 129-144) after symptom onset. Sera were also tested with other assays targeting antibodies against non-RBD-S1 and -S1/S2 epitopes. Sensitivity was 97.6% (95% confidence interval, CI, 93.2-99.1), whereas specificity was 99.8% (95% CI, 99.4-99.9). Antibody levels linearly decreased from hospitalized patients to symptomatic outpatients and SARS-CoV-2 infection without symptoms (p < 0.001). Among cases with SARS-CoV-2 infection, smokers had lower antibody levels than non-smokers (p = 0.04), and patients with fever had higher antibody levels than patients without fever (p = 0.001). Pan-SARS-CoV-2 S1-RBD Ig in SARS-CoV-2 infection cases significantly increased from first to second follow-up (p < 0.001). A substantial proportion of individuals without evidence of past SARS-CoV-2 infection displayed non-S1-RBD antibody reactivities (248/1159, i.e., 21.4%, 95% CI, 19.1-23.4). In conclusion, a quantitative SARS-CoV-2 S1-RBD Ig assay offers favorable and sustained assay characteristics allowing the determination of quantitative associations between clinical characteristics (e.g., disease severity, smoking or fever) and antibody levels. The assay could also help to identify individuals with antibodies of non-S1-RBD specificity with potential clinical cross-reactivity to SARS-CoV-2.
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Affiliation(s)
- Anna Schaffner
- Landesspital Liechtenstein, Heiligkreuz, 9490 Vaduz, Liechtenstein; (A.S.); (M.C.W.); (S.L.T.); (K.J.); (M.P.); (M.P.)
| | - Lorenz Risch
- Labormedizinisches Zentrum Dr Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein; (L.R.); (C.R.); (K.G.); (N.W.); (T.L.); (D.H.)
- Faculty of Medical Sciences, Private Universität im Fürstentum Liechtenstein, Dorfstrasse 24, 9495 Triesen, Liechtenstein
- Center of Laboratory Medicine, University Institute of Clinical Chemistry, University of Bern, Inselspital, 3010 Bern, Switzerland
| | - Stefanie Aeschbacher
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland; (S.A.); (R.T.)
| | - Corina Risch
- Labormedizinisches Zentrum Dr Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein; (L.R.); (C.R.); (K.G.); (N.W.); (T.L.); (D.H.)
| | - Myriam C. Weber
- Landesspital Liechtenstein, Heiligkreuz, 9490 Vaduz, Liechtenstein; (A.S.); (M.C.W.); (S.L.T.); (K.J.); (M.P.); (M.P.)
| | - Sarah L. Thiel
- Landesspital Liechtenstein, Heiligkreuz, 9490 Vaduz, Liechtenstein; (A.S.); (M.C.W.); (S.L.T.); (K.J.); (M.P.); (M.P.)
| | - Katharina Jüngert
- Landesspital Liechtenstein, Heiligkreuz, 9490 Vaduz, Liechtenstein; (A.S.); (M.C.W.); (S.L.T.); (K.J.); (M.P.); (M.P.)
| | - Michael Pichler
- Landesspital Liechtenstein, Heiligkreuz, 9490 Vaduz, Liechtenstein; (A.S.); (M.C.W.); (S.L.T.); (K.J.); (M.P.); (M.P.)
| | - Kirsten Grossmann
- Labormedizinisches Zentrum Dr Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein; (L.R.); (C.R.); (K.G.); (N.W.); (T.L.); (D.H.)
- Faculty of Medical Sciences, Private Universität im Fürstentum Liechtenstein, Dorfstrasse 24, 9495 Triesen, Liechtenstein
| | - Nadia Wohlwend
- Labormedizinisches Zentrum Dr Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein; (L.R.); (C.R.); (K.G.); (N.W.); (T.L.); (D.H.)
| | - Thomas Lung
- Labormedizinisches Zentrum Dr Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein; (L.R.); (C.R.); (K.G.); (N.W.); (T.L.); (D.H.)
| | - Dorothea Hillmann
- Labormedizinisches Zentrum Dr Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein; (L.R.); (C.R.); (K.G.); (N.W.); (T.L.); (D.H.)
| | - Susanna Bigler
- Labormedizinisches Zentrum Dr Risch, Waldeggstrasse 37, 3097 Liebefeld, Switzerland; (S.B.); (T.B.)
| | - Thomas Bodmer
- Labormedizinisches Zentrum Dr Risch, Waldeggstrasse 37, 3097 Liebefeld, Switzerland; (S.B.); (T.B.)
| | - Mauro Imperiali
- Centro Medicina di Laboratorio Dr Risch, Via Arbostra 2, 6963 Pregassona, Switzerland;
| | - Harald Renz
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35043 Marburg, Germany;
| | - Philipp Kohler
- Department of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Rohrschacherstrasse 95, 9007 St. Gallen, Switzerland; (P.K.); (P.V.); (C.R.K.)
| | - Pietro Vernazza
- Department of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Rohrschacherstrasse 95, 9007 St. Gallen, Switzerland; (P.K.); (P.V.); (C.R.K.)
| | - Christian R. Kahlert
- Department of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Rohrschacherstrasse 95, 9007 St. Gallen, Switzerland; (P.K.); (P.V.); (C.R.K.)
- Department of Infectious Diseases and Hospital Epidemiology, Children’s Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006 St. Gallen, Switzerland
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland; (S.A.); (R.T.)
- Clinic of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Matthias Paprotny
- Landesspital Liechtenstein, Heiligkreuz, 9490 Vaduz, Liechtenstein; (A.S.); (M.C.W.); (S.L.T.); (K.J.); (M.P.); (M.P.)
| | - David Conen
- Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada;
| | - Martin Risch
- Central Laboratory, Kantonsspital Graubünden, Loësstrasse 170, 7000 Chur, Switzerland
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