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Abstract

Introduction

Immunoassays targeting different SARS-CoV-2-specific antibodies are employed for seroprevalence studies. The degree of variability between immunoassays targeting anti-nucleocapsid (anti-NP; the majority) vs the potentially neutralising anti-spike antibodies (including anti-receptor-binding domain; anti-RBD), particularly in mild or asymptomatic disease, remains unclear.

Aims

We aimed to explore variability in anti-NP and anti-RBD antibody detectability following mild symptomatic or asymptomatic SARS-CoV-2 infection and analyse antibody response for correlation with symptomatology.

Methods

A multicentre prospective cross-sectional study was undertaken (April–July 2020). Paired serum samples were tested for anti-NP and anti-RBD IgG antibodies and reactivity expressed as binding ratios (BR). Multivariate linear regression was performed analysing age, sex, time since onset, symptomatology, anti-NP and anti-RBD antibody BR.

Results

We included 906 adults. Antibody results (793/906; 87.5%; 95% confidence interval: 85.2–89.6) and BR strongly correlated (ρ = 0.75). PCR-confirmed cases were more frequently identified by anti-RBD (129/130) than anti-NP (123/130). Anti-RBD testing identified 83 of 325 (25.5%) cases otherwise reported as negative for anti-NP. Anti-NP presence (+1.75/unit increase; p < 0.001), fever (≥ 38°C; +1.81; p < 0.001) or anosmia (+1.91; p < 0.001) were significantly associated with increased anti-RBD BR. Age (p = 0.85), sex (p = 0.28) and cough (p = 0.35) were not. When time since symptom onset was considered, we did not observe a significant change in anti-RBD BR (p = 0.95) but did note decreasing anti-NP BR (p < 0.001).

Conclusion

SARS-CoV-2 anti-RBD IgG showed significant correlation with anti-NP IgG for absolute seroconversion and BR. Higher BR were seen in symptomatic individuals, particularly those with fever. Inter-assay variability (12.5%) was evident and raises considerations for optimising seroprevalence testing strategies/studies.

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2022-01-27
2024-12-26
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Variability in detection of SARS-CoV-2-specific antibody responses following mild infection: a prospective multicentre cross-sectional study, London, United Kingdom, 17 April to 17 July 2020
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Scott+JC+Pallett&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pallett Scott JC</a>, <a href="/search?value1=Rachael+Jones&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jones Rachael</a>, <a href="/search?value1=Ahmed+Abdulaal&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Abdulaal Ahmed</a>, <a href="/search?value1=Mitchell+A+Pallett&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pallett Mitchell A</a>, <a href="/search?value1=Michael+Rayment&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rayment Michael</a>, <a href="/search?value1=Aatish+Patel&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Patel Aatish</a>, <a href="/search?value1=Sarah+J+Denny&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Denny Sarah J</a>, <a href="/search?value1=Nabeela+Mughal&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mughal Nabeela</a>, <a href="/search?value1=Maryam+Khan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Khan Maryam</a>, <a href="/search?value1=Carolina+Rosadas+de+Oliveira&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rosadas de Oliveira Carolina</a>, <a href="/search?value1=Panagiotis+Pantelidis&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pantelidis Panagiotis</a>, <a href="/search?value1=Paul+Randell&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Randell Paul</a>, <a href="/search?value1=Christofer+Toumazou&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Toumazou Christofer</a>, <a href="/search?value1=Matthew+K+O%E2%80%99Shea&option1=author&noRedirect=true" class="nonDisambigAuthorLink">O’Shea Matthew K</a>, <a href="/search?value1=Richard+Tedder&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Tedder Richard</a>, <a href="/search?value1=Myra+O+McClure&option1=author&noRedirect=true" class="nonDisambigAuthorLink">McClure Myra O</a>, <a href="/search?value1=Gary+W+Davies&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Davies Gary W</a>, <a href="/search?value1=Luke+SP+Moore&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Moore Luke SP</a></span>. Variability in detection of SARS-CoV-2-specific antibody responses following mild infection: a prospective multicentre cross-sectional study, London, United Kingdom, 17 April to 17 July 2020. <a href="/content/ecdc">Euro Surveill.</a> 2022;27(4):pii=2002076. <a href="https://doi.org/10.2807/1560-7917.ES.2022.27.4.2002076" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2022.27.4.2002076</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 10 Dec 2020;&nbsp;&nbsp; <span class="generated">Accepted</span>: 03 Jul 2021 </span> </p>
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