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Hashem AM, Algaissi A, Almahboub SA, Alfaleh MA, Abujamel TS, Alamri SS, Alluhaybi KA, Hobani HI, AlHarbi RH, Alsulaiman RM, ElAssouli MZ, Hala S, Alharbi NK, Alhabbab RY, AlSaieedi AA, Abdulaal WH, Bukhari A, AL-Somali AA, Alofi FS, Khogeer AA, Pain A, Alkayyal AA, Almontashiri NAM, Ahmad BM, Li X. Early Humoral Response Correlates with Disease Severity and Outcomes in COVID-19 Patients. Viruses 2020; 12:E1390. [PMID: 33291713 PMCID: PMC7761967 DOI: 10.3390/v12121390] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 12/18/2022] Open
Abstract
The Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, continues to spread globally with significantly high morbidity and mortality rates. Antigen-specific responses are of unquestionable value for clinical management of COVID-19 patients. Here, we investigated the kinetics of IgM, IgG against the spike (S) and nucleoproteins (N) proteins and their neutralizing capabilities in hospitalized COVID-19 patients with different disease presentations (i.e., mild, moderate or severe), need for intensive care units (ICU) admission or outcomes (i.e., survival vs death). We show that SARS-CoV-2 specific IgG, IgM and neutralizing antibodies (nAbs) were readily detectable in almost all COVID-19 patients with various clinical presentations. Interestingly, significantly higher levels of nAbs as well as anti-S1 and -N IgG and IgM antibodies were found in patients with more severe symptoms, patients requiring admission to ICU or those with fatal outcomes. More importantly, early after symptoms onset, we found that the levels of anti-N antibodies correlated strongly with disease severity. Collectively, these findings provide new insights into the kinetics of antibody responses in COVID-19 patients with different disease severity.
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Affiliation(s)
- Anwar M. Hashem
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (S.A.A.); (M.A.A.); (T.S.A.); (S.S.A.); (K.A.A.); (H.I.H.); (R.H.A.); (R.M.A.); (M-Z.E.); (R.Y.A.); (A.A.A.)
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Abdullah Algaissi
- Department of Medical Laboratories Technology, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia;
- Medical Research Center, Jazan University, Jazan 45142, Saudi Arabia
| | - Sarah A. Almahboub
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (S.A.A.); (M.A.A.); (T.S.A.); (S.S.A.); (K.A.A.); (H.I.H.); (R.H.A.); (R.M.A.); (M-Z.E.); (R.Y.A.); (A.A.A.)
| | - Mohamed A. Alfaleh
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (S.A.A.); (M.A.A.); (T.S.A.); (S.S.A.); (K.A.A.); (H.I.H.); (R.H.A.); (R.M.A.); (M-Z.E.); (R.Y.A.); (A.A.A.)
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Turki S. Abujamel
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (S.A.A.); (M.A.A.); (T.S.A.); (S.S.A.); (K.A.A.); (H.I.H.); (R.H.A.); (R.M.A.); (M-Z.E.); (R.Y.A.); (A.A.A.)
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Sawsan S. Alamri
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (S.A.A.); (M.A.A.); (T.S.A.); (S.S.A.); (K.A.A.); (H.I.H.); (R.H.A.); (R.M.A.); (M-Z.E.); (R.Y.A.); (A.A.A.)
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Khalid A. Alluhaybi
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (S.A.A.); (M.A.A.); (T.S.A.); (S.S.A.); (K.A.A.); (H.I.H.); (R.H.A.); (R.M.A.); (M-Z.E.); (R.Y.A.); (A.A.A.)
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Haya I. Hobani
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (S.A.A.); (M.A.A.); (T.S.A.); (S.S.A.); (K.A.A.); (H.I.H.); (R.H.A.); (R.M.A.); (M-Z.E.); (R.Y.A.); (A.A.A.)
| | - Rahaf H. AlHarbi
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (S.A.A.); (M.A.A.); (T.S.A.); (S.S.A.); (K.A.A.); (H.I.H.); (R.H.A.); (R.M.A.); (M-Z.E.); (R.Y.A.); (A.A.A.)
| | - Reem M. Alsulaiman
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (S.A.A.); (M.A.A.); (T.S.A.); (S.S.A.); (K.A.A.); (H.I.H.); (R.H.A.); (R.M.A.); (M-Z.E.); (R.Y.A.); (A.A.A.)
| | - M-Zaki ElAssouli
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (S.A.A.); (M.A.A.); (T.S.A.); (S.S.A.); (K.A.A.); (H.I.H.); (R.H.A.); (R.M.A.); (M-Z.E.); (R.Y.A.); (A.A.A.)
| | - Sharif Hala
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Jeddah 11426, Saudi Arabia;
| | - Naif K. Alharbi
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh 14611, Saudi Arabia;
| | - Rowa Y. Alhabbab
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (S.A.A.); (M.A.A.); (T.S.A.); (S.S.A.); (K.A.A.); (H.I.H.); (R.H.A.); (R.M.A.); (M-Z.E.); (R.Y.A.); (A.A.A.)
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ahdab A. AlSaieedi
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (S.A.A.); (M.A.A.); (T.S.A.); (S.S.A.); (K.A.A.); (H.I.H.); (R.H.A.); (R.M.A.); (M-Z.E.); (R.Y.A.); (A.A.A.)
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Wesam H. Abdulaal
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Abdullah Bukhari
- Department of Medicine, Faculty of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia;
| | - Afrah A. AL-Somali
- Infectious Diseases Department, King Abdullah Medical Complex, Jeddah 24246, Saudi Arabia;
| | - Fadwa S. Alofi
- Infectious Diseases Department, King Fahad Hospital, Almadinah Almunwarah 11525, Saudi Arabia;
| | - Asim A. Khogeer
- Plan and Research Department, General Directorate of Health Affairs Makkah Region, Ministry of Health, Makkah 11176, Saudi Arabia;
| | - Arnab Pain
- Pathogen Genomics Laboratory, Division of Biological and Environmental Sciences and Engineering (BESE), Thuwal 23955, Saudi Arabia;
- Research Center for Zoonosis Control, Hokkaido University, N20 W10, Kita-ku, Sapporo 001-0030, Japan
- Nuffield Division of Clinical Laboratory Sciences (NDCLS), University of Oxford, Oxford OX3 9DU, UK
| | - Almohanad A. Alkayyal
- Department of Medical Laboratory Technology, University of Tabuk, Tabuk 71491, Saudi Arabi;
- Immunology Research Program, King Abdullah International Medical Research Center, Riyadh 14611, Saudi Arabia;
| | - Naif A. M. Almontashiri
- Center for Genetics and Inherited Diseases, Taibah University, Almadinah Almunwarah 71491, Saudi Arabia;
| | - Bakur Mahmoud Ahmad
- Immunology Research Program, King Abdullah International Medical Research Center, Riyadh 14611, Saudi Arabia;
- College of Applied Medical Sciences, Taibah University, Almadinah Almunwarah 71491, Saudi Arabia
| | - Xuguang Li
- Centre for Biologics Evaluation, Biologics and Genetic Therapies Directorate, Health Products and Food Branch (HPFB), Health Canada and WHO Collaborating Center for Standardization and Evaluation of Biologicals, Ottawa, ON K1A 0K9, Canada;
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
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Hashem AM, Algaissi A, Almahboub SA, Alfaleh MA, Abujamel TS, Alamri SS, Alluhaybi KA, Hobani HI, AlHarbi RH, Alsulaiman RM, ElAssouli MZ, Hala S, Alharbi NK, Alhabbab RY, AlSaieedi AA, Abdulaal WH, Bukhari A, Al-Somali AA, Alofi FS, Khogeer AA, Pain A, Alkayyal AA, Almontashiri NAM, Ahmad BM, Li X. Early Humoral Response Correlates with Disease Severity and Outcomes in COVID-19 Patients. Viruses 2020. [PMID: 33291713 DOI: 10.1101/2020.09.21.20198309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, continues to spread globally with significantly high morbidity and mortality rates. Antigen-specific responses are of unquestionable value for clinical management of COVID-19 patients. Here, we investigated the kinetics of IgM, IgG against the spike (S) and nucleoproteins (N) proteins and their neutralizing capabilities in hospitalized COVID-19 patients with different disease presentations (i.e., mild, moderate or severe), need for intensive care units (ICU) admission or outcomes (i.e., survival vs death). We show that SARS-CoV-2 specific IgG, IgM and neutralizing antibodies (nAbs) were readily detectable in almost all COVID-19 patients with various clinical presentations. Interestingly, significantly higher levels of nAbs as well as anti-S1 and -N IgG and IgM antibodies were found in patients with more severe symptoms, patients requiring admission to ICU or those with fatal outcomes. More importantly, early after symptoms onset, we found that the levels of anti-N antibodies correlated strongly with disease severity. Collectively, these findings provide new insights into the kinetics of antibody responses in COVID-19 patients with different disease severity.
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Affiliation(s)
- Anwar M Hashem
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia.,Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Abdullah Algaissi
- Department of Medical Laboratories Technology, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia.,Medical Research Center, Jazan University, Jazan 45142, Saudi Arabia
| | - Sarah A Almahboub
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mohamed A Alfaleh
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia.,Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Turki S Abujamel
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Sawsan S Alamri
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia.,Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Khalid A Alluhaybi
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia.,Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Haya I Hobani
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Rahaf H AlHarbi
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Reem M Alsulaiman
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - M-Zaki ElAssouli
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Sharif Hala
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Jeddah 11426, Saudi Arabia
| | - Naif K Alharbi
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh 14611, Saudi Arabia
| | - Rowa Y Alhabbab
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ahdab A AlSaieedi
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Wesam H Abdulaal
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Abdullah Bukhari
- Department of Medicine, Faculty of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia
| | - Afrah A Al-Somali
- Infectious Diseases Department, King Abdullah Medical Complex, Jeddah 24246, Saudi Arabia
| | - Fadwa S Alofi
- Infectious Diseases Department, King Fahad Hospital, Almadinah Almunwarah 11525, Saudi Arabia
| | - Asim A Khogeer
- Plan and Research Department, General Directorate of Health Affairs Makkah Region, Ministry of Health, Makkah 11176, Saudi Arabia
| | - Arnab Pain
- Pathogen Genomics Laboratory, Division of Biological and Environmental Sciences and Engineering (BESE), Thuwal 23955, Saudi Arabia.,Research Center for Zoonosis Control, Hokkaido University, N20 W10, Kita-ku, Sapporo 001-0030, Japan.,Nuffield Division of Clinical Laboratory Sciences (NDCLS), University of Oxford, Oxford OX3 9DU, UK
| | - Almohanad A Alkayyal
- Department of Medical Laboratory Technology, University of Tabuk, Tabuk 71491, Saudi Arabi.,Immunology Research Program, King Abdullah International Medical Research Center, Riyadh 14611, Saudi Arabia
| | - Naif A M Almontashiri
- Center for Genetics and Inherited Diseases, Taibah University, Almadinah Almunwarah 71491, Saudi Arabia
| | - Bakur Mahmoud Ahmad
- Immunology Research Program, King Abdullah International Medical Research Center, Riyadh 14611, Saudi Arabia.,College of Applied Medical Sciences, Taibah University, Almadinah Almunwarah 71491, Saudi Arabia
| | - Xuguang Li
- Centre for Biologics Evaluation, Biologics and Genetic Therapies Directorate, Health Products and Food Branch (HPFB), Health Canada and WHO Collaborating Center for Standardization and Evaluation of Biologicals, Ottawa, ON K1A 0K9, Canada.,Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
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Algaissi A, Alfaleh MA, Hala S, Abujamel TS, Alamri SS, Almahboub SA, Alluhaybi KA, Hobani HI, Alsulaiman RM, AlHarbi RH, ElAssouli MZA, Alhabbab RY, AlSaieedi AA, Abdulaal WH, Al-Somali AA, Alofi FS, Khogeer AA, Alkayyal AA, Mahmoud AB, Almontashiri NAM, Pain A, Hashem AM. SARS-CoV-2 S1 and N-based serological assays reveal rapid seroconversion and induction of specific antibody response in COVID-19 patients. Sci Rep 2020; 10:16561. [PMID: 33024213 PMCID: PMC7538990 DOI: 10.1038/s41598-020-73491-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/27/2020] [Indexed: 12/23/2022] Open
Abstract
As the Coronavirus Disease 2019 (COVID-19), which is caused by the novel SARS-CoV-2, continues to spread rapidly around the world, there is a need for well validated serological assays that allow the detection of viral specific antibody responses in COVID-19 patients or recovered individuals. In this study, we established and used multiple indirect Enzyme Linked Immunosorbent Assay (ELISA)-based serological assays to study the antibody response in COVID-19 patients. In order to validate the assays we determined the cut off values, sensitivity and specificity of the assays using sera collected from pre-pandemic healthy controls, COVID-19 patients at different time points after disease-onset, and seropositive sera to other human coronaviruses (CoVs). The developed SARS-CoV-2 S1 subunit of the spike glycoprotein and nucleocapsid (N)-based ELISAs not only showed high specificity and sensitivity but also did not show any cross-reactivity with other CoVs. We also show that all RT-PCR confirmed COVID-19 patients tested in our study developed both virus specific IgM and IgG antibodies as early as week one after disease onset. Our data also suggest that the inclusion of both S1 and N in serological testing would capture as many potential SARS-CoV-2 positive cases as possible than using any of them alone. This is specifically important for tracing contacts and cases and conducting large-scale epidemiological studies to understand the true extent of virus spread in populations.
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Affiliation(s)
- Abdullah Algaissi
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Laboratories Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
- Medical Research Center, Jazan University, Jazan, Saudi Arabia
| | - Mohamed A Alfaleh
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sharif Hala
- Pathogen Genomics Laboratory, Division of Biological and Environmental Sciences and Engineering (BESE), King Abdullah University of Science and Technology, Thuwa, Saudi Arabia
- King Abdullah International Medical Research Centre, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Turki S Abujamel
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sawsan S Alamri
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sarah A Almahboub
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khalid A Alluhaybi
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Haya I Hobani
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Reem M Alsulaiman
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rahaf H AlHarbi
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Biology, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - M-Z Aki ElAssouli
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rowa Y Alhabbab
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahdab A AlSaieedi
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wesam H Abdulaal
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Afrah A Al-Somali
- Infectious Diseases Department, King Abdullah Medical Complex, Jeddah, Saudi Arabia
| | - Fadwa S Alofi
- Infectious Diseases Department, King Fahad Hospital, Almadinah Almunwarah, Saudi Arabia
| | - Asim A Khogeer
- Plan and Research Department, General Directorate of Health Affairs Makkah Region, Ministry of Health, Makkah, Saudi Arabia
| | - Almohanad A Alkayyal
- Department of Medical Laboratory Technology, University of Tabuk, Tabuk, Saudi Arabia
| | - Ahmad Bakur Mahmoud
- College of Applied Medical Sciences, Taibah University, Almadinah Almunwarah, Saudi Arabia
| | - Naif A M Almontashiri
- Center for Genetics and Inherited Diseases, Taibah University, Almadinah Almunwarah, Saudi Arabia
| | - Arnab Pain
- Pathogen Genomics Laboratory, Division of Biological and Environmental Sciences and Engineering (BESE), King Abdullah University of Science and Technology, Thuwa, Saudi Arabia
- Research Center for Zoonosis Control, Hokkaido University, Kita-ku, Sapporo, Japan
- Nuffield Division of Clinical Laboratory Sciences (NDCLS), University of Oxford, Oxford, UK
| | - Anwar M Hashem
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
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