Serology for SARS-CoV-2: Apprehensions, opportunities, and the path forward

Bryant, Juliet E.; Azman, Andrew S.; Ferrari, Matthew J.; Arnold, Benjamin F.; Boni, Maciej F.; Boum, Yap; Hayford, Kyla; Luquero, Francisco J.; Mina, Michael J.; Rodríguez-Barraquer, Isabel; Wu, Joseph T.; Wade, Djibril; Vernet, Guy; Leung, Daniel T.

doi:10.1126/sciimmunol.abc6347

Cited by 149 publications

(154 citation statements)

References 10 publications

(7 reference statements)

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“…However, use of such tests for large-scale, population-based, seroprevalence studies is less controversial, provided that sensitivity and specificity are sufficiently high and appropriately corrected for. 37 , 38 The test we used is one of the most precise lateral-flow tests. 16 We used two sets of sensitivity and specificity parameters for correction, and the largest prevalence difference between the two approaches was 1·1 percentage point.…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 antibody prevalence in Brazil: results from two successive nationwide serological household surveys

Hallal

Hartwig

Silveira

et al. 2020

The Lancet Global Health

344

341

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Background Population-based data on COVID-19 are essential for guiding policies. There are few such studies, particularly from low or middle-income countries. Brazil is currently a hotspot for COVID-19 globally. We aimed to investigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody prevalence by city and according to sex, age, ethnicity group, and socioeconomic status, and compare seroprevalence estimates with official statistics on deaths and cases. Methods In this repeated cross-sectional study, we did two seroprevalence surveys in 133 sentinel cities in all Brazilian states. We randomly selected households and randomly selected one individual from all household members. We excluded children younger than 1 year. Presence of antibodies against SARS-CoV-2 was assessed using a lateral flow point-of-care test, the WONDFO SARS-CoV-2 Antibody Test (Wondfo Biotech, Guangzhou, China), using two drops of blood from finger prick samples. This lateral-flow assay detects IgG and IgM isotypes that are specific to the SARS-CoV-2 receptor binding domain of the spike protein. Participants also answered short questionnaires on sociodemographic information (sex, age, education, ethnicity, household size, and household assets) and compliance with physical distancing measures. Findings We included 25 025 participants in the first survey (May 14–21) and 31 165 in the second (June 4–7). For the 83 (62%) cities with sample sizes of more than 200 participants in both surveys, the pooled seroprevalence increased from 1·9% (95% CI 1·7–2·1) to 3·1% (2·8–3·4). City-level prevalence ranged from 0% to 25·4% in both surveys. 11 (69%) of 16 cities with prevalence above 2·0% in the first survey were located in a stretch along a 2000 km of the Amazon river in the northern region. In the second survey, we found 34 cities with prevalence above 2·0%, which included the same 11 Amazon cities plus 14 from the northeast region, where prevalence was increasing rapidly. Prevalence levels were lower in the south and centre-west, and intermediate in the southeast, where the highest level was found in Rio de Janeiro (7·5% [4·2–12·2]). In the second survey, prevalence was similar in men and women, but an increased prevalence was observed in participants aged 20–59 years and those living in crowded conditions (4·4% [3·5–5·6] for those living with households with six or more people). Prevalence among Indigenous people was 6·4% (4·1–9·4) compared with 1·4% (1·2–1·7) among White people. Prevalence in the poorest socioeconomic quintile was 3·7% (3·2–4·3) compared with 1·7% (1·4–2·2) in the wealthiest quintile. Interpretation Antibody prevalence was highly heterogeneous by country region, with rapid initial escalation in Brazil's north and northeast. Prevalence is strongly associated with Indigenous ancestry and low socioeconomic status. These population subgroups are unlikely to be protected if the policy response to the pandemic by th...

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Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 antibody prevalence in Brazil: results from two successive nationwide serological household surveys

Hallal

Hartwig

Silveira

et al. 2020

The Lancet Global Health

344

341

View full text Add to dashboard Cite

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“…Cross-reactivity with other coronaviruses and other viral pathogens causing false positivity is a potential concern [ 59 , 60 ], especially when the pre-test probability of infection is expected to be very low [ 61 ]. To improve the diagnostic accuracy of serology assays, the US CDC suggests an alternative strategy of using a two-step testing algorithm using two different antibody assays, in which an initial positive test is confirmed by a second, independent antibody assay [ 62 ].…”

Section: Laboratory Testing Techniquementioning

confidence: 99%

Laboratory testing for the diagnosis of COVID-19

Lai

Lam

2021

Biochemical and Biophysical Research Communications

103

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Rapid and accurate laboratory diagnosis of active COVID-19 infection is one of the cornerstones of pandemic control. With the myriad of tests available in the market, the use of correct specimen type and laboratory-testing technique in the right clinical scenario could be challenging for non-specialists. In this mini-review, we will discuss the difference in diagnostic performance for different upper and lower respiratory tract specimens, and the role of blood and fecal specimens. We will analyze the performance characteristics of laboratory testing techniques of nucleic acid amplification tests, antigen detection tests, antibody detection tests, and point-of-care tests. Finally, the dynamics of viral replication and antibody production, and laboratory results interpretation in conjunction with clinical scenarios will be discussed.

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“…Serology – the measurement of serum antibodies – provides crucial data for understanding key aspects of infection and epidemiology ( Weitz et al, 2020 ). At the level of populations, serologic data can provide insights into virus spread by enabling estimation of the overall attack rate, and seroprevalence estimates can elucidate the potential for herd immunity ( Stringhini et al, 2020 ; Bryant et al, 2020 ). In addition, these estimates are essential for developing accurate mathematical models of virus transmission dynamics, which provide the foundation for policies to reopen societies ( Krsak et al, 2020 ; Angulo et al, 2020 ; Kissler et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

“…These applications of serologic data depend critically on knowing when different antibodies against the pathogen become detectable (seroconversion time), how their concentrations change over time (antibody level kinetics) and how long they last (antibody decay) ( Lipsitch et al, 2020 ). When these key factors are known, serologic data become a powerful tool for inferring infection attack rate and transmission dynamics in the population ( Bryant et al, 2020 ; Winter and Hegde, 2020 ). Five months into the pandemic, a remarkable number of serologic studies on the initial immune response against SARS-CoV-2 had been published.…”

Section: Introductionmentioning

confidence: 99%

Quantifying antibody kinetics and RNA detection during early-phase SARS-CoV-2 infection by time since symptom onset

Borremans

Gamble

Prager

et al. 2020

eLife

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Understanding and mitigating SARS-CoV-2 transmission hinges on antibody and viral RNA data that inform exposure and shedding, but extensive variation in assays, study group demographics and laboratory protocols across published studies confounds inference of true biological patterns. Our meta-analysis leverages 3,214 datapoints from 516 individuals in 21 studies to reveal that seroconversion of both IgG and IgM occurs around 12 days post symptom onset (range 1-40), with extensive individual variation that is not significantly associated with disease severity. IgG and IgM detection probabilities increase from roughly 10% at symptom onset to 98-100% by day 22, after which IgM wanes while IgG remains reliably detectable. RNA detection probability decreases from roughly 90% to zero by day 30, and is highest in faeces and lower respiratory tract samples. Our findings provide a coherent evidence base for interpreting clinical diagnostics, and for the mathematical models and serological surveys that underpin public health policies.

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Serology for SARS-CoV-2: Apprehensions, opportunities, and the path forward

Abstract: Serological testing for SARS-CoV-2 has enormous potential to contribute to COVID-19 pandemic response efforts. However, the required performance characteristics of antibody tests will critically depend on the use case (individual-level vs. population-level).

Cited by 149 publications

References 10 publications

SARS-CoV-2 antibody prevalence in Brazil: results from two successive nationwide serological household surveys

SARS-CoV-2 antibody prevalence in Brazil: results from two successive nationwide serological household surveys

Laboratory testing for the diagnosis of COVID-19

Quantifying antibody kinetics and RNA detection during early-phase SARS-CoV-2 infection by time since symptom onset

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