Science and Research

Strategic Anti-SARS-CoV-2 Serology Testing in a Low Prevalence Setting: The COVID-19 Contact (CoCo) Study in Healthcare Professionals

BACKGROUND: Serology testing is explored for epidemiological research and to inform individuals after suspected infection. During the coronavirus disease 2019 (COVID-19) pandemic, frontline healthcare professionals (HCP) may be at particular risk for infection. No longitudinal data on functional seroconversion in HCP in regions with low COVID-19 prevalence and low pre-test probability exist. METHODS: In a large German university hospital, we performed weekly questionnaire assessments and anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) measurements with various commercial tests, a novel surrogate virus neutralisation test, and a neutralisation assay using live SARS-CoV-2. RESULTS: From baseline to week 6, 1080 screening measurements for anti-SARS CoV-2 (S1) IgG from 217 frontline HCP (65% female) were performed. Overall, 75.6% of HCP reported at least one symptom of respiratory infection. Self-perceived infection probability declined over time (from mean 20.1% at baseline to 12.4% in week 6, p < 0.001). In sera of convalescent patients with PCR-confirmed COVID-19, we measured high anti-SARS-CoV-2 IgG levels, obtained highly concordant results from enzyme-linked immunosorbent assays (ELISA) using e.g. the spike 1 (S1) protein domain and the nucleocapsid protein (NCP) as targets, and confirmed antiviral neutralisation. However, in HCP the cumulative incidence for anti-SARS-CoV-2 (S1) IgG was 1.86% for positive and 0.93% for equivocal positive results over the study period of 6 weeks. Except for one HCP, none of the eight initial positive results were confirmed by alternative serology tests or showed in vitro neutralisation against live SARS-CoV-2. The only true seroconversion occurred without symptoms and mounted strong functional humoral immunity. Thus, the confirmed cumulative incidence for neutralizing anti-SARS-CoV-2 IgG was 0.47%. CONCLUSION: When assessing anti-SARS-CoV-2 immune status in individuals with low pre-test probability, we suggest confirming positive results from single measurements by alternative serology tests or functional assays. Our data highlight the need for a methodical serology screening approach in regions with low SARS-CoV-2 infection rates. TRIAL REGISTRATION: The study is registered at DRKS00021152.
  • Behrens, G. M. N.
  • Cossmann, A.
  • Stankov, M. V.
  • Schulte, B.
  • Streeck, H.
  • Forster, R.
  • Bosnjak, B.
  • Willenzon, S.
  • Boeck, A. L.
  • Thu Tran, A.
  • Thiele, T.
  • Graalmann, T.
  • Kayser, M. Z.
  • Zychlinsky Scharff, A.
  • Dopfer, C.
  • Horke, A.
  • Pink, I.
  • Witte, T.
  • Wetzke, M.
  • Ernst, D.
  • Jablonka, A.
  • Happle, C.

Keywords

  • Covid-19
  • Coronavirus
  • Healthcare professionals
  • Humoral immunity
  • Infection
  • Pandemic
  • SARS-CoV-2
  • Serological testing
  • Virus
Publication details
DOI: 10.1007/s40121-020-00334-1
Journal: Infect Dis Ther
Work Type: Original
Location: BREATH
Disease Area: PALI
Partner / Member: MHH
Access-Number: 32886335
See publication on PubMed

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