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Whitman JD, Hiatt J, Mowery CT, Shy BR, Yu R, Yamamoto TN, Rathore U, Goldgof GM, Whitty C, Woo JM, Gallman AE, Miller TE, Levine AG, Nguyen DN, Bapat SP, Balcerek J, Bylsma SA, Lyons AM, Li S, Wong AWY, Gillis-Buck EM, Steinhart ZB, Lee Y, Apathy R, Lipke MJ, Smith JA, Zheng T, Boothby IC, Isaza E, Chan J, Acenas DD, Lee J, Macrae TA, Kyaw TS, Wu D, Ng DL, Gu W, York VA, Eskandarian HA, Callaway PC, Warrier L, Moreno ME, Levan J, Torres L, Farrington LA, Loudermilk R, Koshal K, Zorn KC, Garcia-Beltran WF, Yang D, Astudillo MG, Bernstein BE, Gelfand JA, Ryan ET, Charles RC, Iafrate AJ, Lennerz JK, Miller S, Chiu CY, Stramer SL, Wilson MR, Manglik A, Ye CJ, Krogan NJ, Anderson MS, Cyster JG, Ernst JD, Wu AHB, Lynch KL, Bern C, Hsu PD, Marson A. Test performance evaluation of SARS-CoV-2 serological assays. medRxiv 2020. [PMID: 32511497 PMCID: PMC7273265 DOI: 10.1101/2020.04.25.20074856] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Serological tests are crucial tools for assessments of SARS-CoV-2 exposure, infection and potential immunity. Their appropriate use and interpretation require accurate assay performance data. Method: We conducted an evaluation of 10 lateral flow assays (LFAs) and two ELISAs to detect anti-SARS-CoV-2 antibodies. The specimen set comprised 128 plasma or serum samples from 79 symptomatic SARS-CoV-2 RT-PCR-positive individuals; 108 pre-COVID-19 negative controls; and 52 recent samples from individuals who underwent respiratory viral testing but were not diagnosed with Coronavirus Disease 2019 (COVID-19). Samples were blinded and LFA results were interpreted by two independent readers, using a standardized intensity scoring system. Results: Among specimens from SARS-CoV-2 RT-PCR-positive individuals, the percent seropositive increased with time interval, peaking at 81.8–100.0% in samples taken >20 days after symptom onset. Test specificity ranged from 84.3–100.0% in pre-COVID-19 specimens. Specificity was higher when weak LFA bands were considered negative, but this decreased sensitivity. IgM detection was more variable than IgG, and detection was highest when IgM and IgG results were combined. Agreement between ELISAs and LFAs ranged from 75.7–94.8%. No consistent cross-reactivity was observed. Conclusion: Our evaluation showed heterogeneous assay performance. Reader training is key to reliable LFA performance, and can be tailored for survey goals. Informed use of serology will require evaluations covering the full spectrum of SARS-CoV-2 infections, from asymptomatic and mild infection to severe disease, and later convalescence. Well-designed studies to elucidate the mechanisms and serological correlates of protective immunity will be crucial to guide rational clinical and public health policies.
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Affiliation(s)
- Jeffrey D Whitman
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Joseph Hiatt
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,Biomedical Sciences Graduate Program, University of California, San Francisco, CA 94143, USA.,J. David Gladstone Institutes, San Francisco, CA 94158, USA.,Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Innovative Genomics Institute, University of California, Berkeley, CA 94720, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Cody T Mowery
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,Biomedical Sciences Graduate Program, University of California, San Francisco, CA 94143, USA.,Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Innovative Genomics Institute, University of California, Berkeley, CA 94720, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Brian R Shy
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Ruby Yu
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Tori N Yamamoto
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Innovative Genomics Institute, University of California, Berkeley, CA 94720, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Ujjwal Rathore
- J. David Gladstone Institutes, San Francisco, CA 94158, USA.,Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Innovative Genomics Institute, University of California, Berkeley, CA 94720, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Gregory M Goldgof
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Caroline Whitty
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Jonathan M Woo
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Innovative Genomics Institute, University of California, Berkeley, CA 94720, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Antonia E Gallman
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Howard Hughes Medical Institute, University of California, San Francisco
| | - Tyler E Miller
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Andrew G Levine
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - David N Nguyen
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Innovative Genomics Institute, University of California, Berkeley, CA 94720, USA.,Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Sagar P Bapat
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Joanna Balcerek
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Sophia A Bylsma
- Department of Bioengineering, University of California, Berkeley, Berkeley CA 94720 USA
| | - Ana M Lyons
- Department of Integrative Biology, University of California, Berkeley, Berkeley CA 94720 USA
| | - Stacy Li
- Department of Integrative Biology, University of California, Berkeley, Berkeley CA 94720 USA
| | - Allison Wai-Yi Wong
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA
| | - Eva Mae Gillis-Buck
- Department of Surgery, University of California, San Francisco, CA 94143, USA
| | - Zachary B Steinhart
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Youjin Lee
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA
| | - Ryan Apathy
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Innovative Genomics Institute, University of California, Berkeley, CA 94720, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Mitchell J Lipke
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Jennifer Anne Smith
- Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Tina Zheng
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,Biomedical Sciences Graduate Program, University of California, San Francisco, CA 94143, USA.,Department of Neurology, University of California, San Francisco, CA 94158, USA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Ian C Boothby
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,Department of Dermatology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Erin Isaza
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,Program in Quantitative Biology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Jackie Chan
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA
| | - Dante D Acenas
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA
| | - Jinwoo Lee
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,School of Medicine, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Trisha A Macrae
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,School of Medicine, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Than S Kyaw
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA
| | - David Wu
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,Biomedical Sciences Graduate Program, University of California, San Francisco, CA 94143, USA
| | - Dianna L Ng
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94158, USA.,Department of Pathology, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Wei Gu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Vanessa A York
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Haig Alexander Eskandarian
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Perri C Callaway
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco CA, USA.,Infectious Diseases and Immunity Graduate Group, University of California Berkeley, Berkeley, CA, USA
| | - Lakshmi Warrier
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Mary E Moreno
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Justine Levan
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Leonel Torres
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Lila A Farrington
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Rita Loudermilk
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Kanishka Koshal
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Kelsey C Zorn
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA 94158, USA
| | | | - Diane Yang
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Michael G Astudillo
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Bradley E Bernstein
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Jeffrey A Gelfand
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Richelle C Charles
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - A John Iafrate
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Jochen K Lennerz
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Steve Miller
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Charles Y Chiu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA 94143, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA
| | | | - Michael R Wilson
- Biomedical Sciences Graduate Program, University of California, San Francisco, CA 94143, USA.,Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Aashish Manglik
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, CA 94158
| | - Chun Jimmie Ye
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA.,Chan Zuckerberg Biohub, San Francisco, CA, USA.,Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA.,Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Institute of Computational Health Sciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Nevan J Krogan
- J. David Gladstone Institutes, San Francisco, CA 94158, USA.,Department of Cellular and Molecular Pharmacology, University of California, San Francisco, CA 94158, USA.,Quantitative Biosciences Institute, University of California, San Francisco, CA 94158, USA
| | - Mark S Anderson
- Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Jason G Cyster
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Howard Hughes Medical Institute, University of California, San Francisco
| | - Joel D Ernst
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Alan H B Wu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Kara L Lynch
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Patrick D Hsu
- Innovative Genomics Institute, University of California, Berkeley, CA 94720, USA.,Department of Bioengineering, University of California, Berkeley, Berkeley CA 94720 USA
| | - Alexander Marson
- J. David Gladstone Institutes, San Francisco, CA 94158, USA.,Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Innovative Genomics Institute, University of California, Berkeley, CA 94720, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94158, USA.,Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA.,Chan Zuckerberg Biohub, San Francisco, CA, USA.,Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
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