Antibody response using six different serological assays in a completely PCR-tested community after a coronavirus disease 2019 outbreak—the CoNAN study

Due to a substantial proportion of asymptomatic and mild courses, many severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections remain unreported. Therefore, assessment of seroprevalence may detect the real burden of disease. We aimed to determine and characterize the rate of SARS-CoV...

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Published in:	Clinical microbiology and infection Vol. 27; no. 3; pp. 470.e1 - 470.e9
Main Authors:	Weis, Sebastian, Scherag, André, Baier, Michael, Kiehntopf, Michael, Kamradt, Thomas, Kolanos, Steffi, Ankert, Juliane, Glöckner, Stefan, Makarewicz, Oliwia, Hagel, Stefan, Bahrs, Christina, Kimmig, Aurelia, Proquitté, Hans, Guerra, Joel, Rimek, Dagmar, Löffler, Bettina, Pletz, Mathias W., Hotz, Thomas, Local Cooperation Partners, Enders, Petra, Koch, Renate, Mai, Steffen, Ullrich, Matthias, Richert, Cora, Eibner, Cornelius, Meinung, Bettina, Stötzer, Kay, Köhler, Julia, Cipowicz, Hans, Pinkwart, Christine, Bauer, Michael, Dickmann, Petra, Licht, Annika, Scholz, Juliane, Wetzker, Wibke, Hartung, Anita, Weiss, Daniel, Thieme, Lara, Hanf, Gabi, Schnizer, Clara, Müller, Jasmin, Kosenkow, Jennifer, Röstel, Franziska, Andreas, Nico, Marquardt, Raphaela, Deinhardt-Emmer, Stefanie, Kuhn, Sebastian
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-03-2021 The Author(s). Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases
Subjects:	Adolescent Adult Aged Aged, 80 and over Antibodies, Viral - blood Antibody response Asymptomatic Infections - epidemiology Child Child, Preschool Cohort Studies COVID-19 - diagnosis COVID-19 - epidemiology COVID-19 - immunology COVID-19 - prevention & control COVID-19 Nucleic Acid Testing COVID-19 Serological Testing Female Germany - epidemiology Humans Immunity Immunoglobulin G - blood Infant Male Middle Aged Original Quarantine RNA, Viral - genetics SARS-CoV-2 - genetics SARS-CoV-2 - immunology SARS-CoV-2 - isolation & purification Seroepidemiologic Studies Severe acute respiratory syndrome coronavirus 2 Young Adult Germany Severe acute respiratory syndrome coronavirus 2 Quarantine Immunity Antibody response
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Summary:	Due to a substantial proportion of asymptomatic and mild courses, many severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections remain unreported. Therefore, assessment of seroprevalence may detect the real burden of disease. We aimed to determine and characterize the rate of SARS-CoV-2 infections and the resulting seroprevalence in a defined population. The primary objective of the study was to assess SARS-CoV-2 antibody seroprevalence using six different IgG-detecting immunoassays. Secondary objectives of the study were: (a) to determine potential risk factors for symptomatic versus asymptomatic coronavirus disease 2019 courses, and (b) to investigate the rate of virus RNA-persistence. CoNAN is a population-based cohort study performed in the community Neustadt am Rennsteig, Germany, which was quarantined from 22 March to 5 April after six SARS-CoV-2 cases were detected in the village's population. The SARS-CoV-2 outbreak comprised 51 cases and 3 deaths. The CoNAN study was performed from 13 May to 22 May 2020, 6 weeks after a SARS-CoV-2 outbreak. We enrolled a total of 626 participants (71% of the community population) for PCR and antibody testing in the study. All actual SARS-CoV-2 PCR tests were negative. Fifty-two out of 620 (8.4%) participants had antibodies against SARS-CoV-2 in at least two different assays. There were 38 participants with previously PCR-confirmed SARS-CoV-2 infection. Of those, only 19 (50%) displayed anti-SARS-CoV-2 antibodies. We also show that antibody-positive participants with symptoms compatible with a respiratory tract infection had significantly higher antibody levels then asymptomatic participants (EU-assay: median 2.9 versus 7.2 IgG-index, p 0.002; DS-assay: median 45.2 versus 143 AU/mL, p 0.002). Persisting viral replication was not detected. Our data question the relevance and reliability of IgG antibody testing to detect past SARS-CoV-2 infections 6 weeks after an outbreak. We conclude that assessing immunity for SARS-CoV-2 infection should not rely on antibody tests alone.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1198-743X 1469-0691
DOI:	10.1016/j.cmi.2020.11.009