How to interpret and use COVID-19 serology and immunology tests.
Antibodies
COVID-19
Immunity
SARS-CoV-2
Serology
T cell
Journal
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
ISSN: 1469-0691
Titre abrégé: Clin Microbiol Infect
Pays: England
ID NLM: 9516420
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
received:
08
03
2021
revised:
27
04
2021
accepted:
01
05
2021
pubmed:
12
5
2021
medline:
20
7
2021
entrez:
11
5
2021
Statut:
ppublish
Résumé
Although molecular tests are considered the reference standard for coronavirus disease 2019 (COVID-19) diagnostics, serological and immunological tests may be useful in specific settings. This review summarizes the underlying principles and performance of COVID-19 serological and immunological testing. Selected peer-reviewed publications on COVID-19 related serology and immunology published between December 2019 and March 2021. Serological tests are highly specific but heterogeneous in their sensitivity for the diagnosis of COVID-19. For certain indications, including delayed disease presentations, serological tests can have added value. The presence of antibodies against SARS-CoV-2 may indicate a recent or past COVID-19 infection. Lateral flow immunoassay (LFIA) antibody tests have the advantages of being easy and fast to perform, but many have a low sensitivity in acute settings. Enzyme-linked immunosorbent assay (ELISA) and chemiluminescence immunoassays (CLIAs) have higher sensitivities. Besides humoral immunity, cellular immunity is also essential for successful host defences against viruses. Enzyme-linked immunospot (ELISpot) assays can be used to measure T-cell responses against SARS-CoV-2. The presence of cross-reactive SARS-CoV-2-specific T cells in never exposed patients suggests the possibility of cellular immunity induced by other circulating coronaviruses. T-cell responses against SARS-CoV-2 have also been detected in recovered COVID-19 patients with no detectable antibodies. Serological and immunological tests are primarily applied for population-based seroprevalence studies to evaluate the effectiveness of COVID-19 control measures and increase our understanding of the immunology behind COVID-19. Combining molecular diagnostics with serological tests may optimize the detection of COVID-19. As not all infected patients will develop antibodies against SARS-CoV-2, assessment of cellular immunity may provide complementary information on whether a patient has been previously infected with COVID-19. More studies are needed to understand the correlations of these serological and immunological parameters with protective immunity, taking into account the different circulating virus variants.
Sections du résumé
BACKGROUND
BACKGROUND
Although molecular tests are considered the reference standard for coronavirus disease 2019 (COVID-19) diagnostics, serological and immunological tests may be useful in specific settings.
OBJECTIVES
OBJECTIVE
This review summarizes the underlying principles and performance of COVID-19 serological and immunological testing.
SOURCES
METHODS
Selected peer-reviewed publications on COVID-19 related serology and immunology published between December 2019 and March 2021.
CONTENT
BACKGROUND
Serological tests are highly specific but heterogeneous in their sensitivity for the diagnosis of COVID-19. For certain indications, including delayed disease presentations, serological tests can have added value. The presence of antibodies against SARS-CoV-2 may indicate a recent or past COVID-19 infection. Lateral flow immunoassay (LFIA) antibody tests have the advantages of being easy and fast to perform, but many have a low sensitivity in acute settings. Enzyme-linked immunosorbent assay (ELISA) and chemiluminescence immunoassays (CLIAs) have higher sensitivities. Besides humoral immunity, cellular immunity is also essential for successful host defences against viruses. Enzyme-linked immunospot (ELISpot) assays can be used to measure T-cell responses against SARS-CoV-2. The presence of cross-reactive SARS-CoV-2-specific T cells in never exposed patients suggests the possibility of cellular immunity induced by other circulating coronaviruses. T-cell responses against SARS-CoV-2 have also been detected in recovered COVID-19 patients with no detectable antibodies.
IMPLICATIONS
CONCLUSIONS
Serological and immunological tests are primarily applied for population-based seroprevalence studies to evaluate the effectiveness of COVID-19 control measures and increase our understanding of the immunology behind COVID-19. Combining molecular diagnostics with serological tests may optimize the detection of COVID-19. As not all infected patients will develop antibodies against SARS-CoV-2, assessment of cellular immunity may provide complementary information on whether a patient has been previously infected with COVID-19. More studies are needed to understand the correlations of these serological and immunological parameters with protective immunity, taking into account the different circulating virus variants.
Identifiants
pubmed: 33975005
pii: S1198-743X(21)00221-4
doi: 10.1016/j.cmi.2021.05.001
pmc: PMC8106522
pii:
doi:
Substances chimiques
Antibodies, Viral
0
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
981-986Informations de copyright
Copyright © 2021 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Références
J Clin Microbiol. 2020 Oct 21;58(11):
pubmed: 32826322
Nat Biotechnol. 2020 Sep;38(9):1073-1078
pubmed: 32704169
J Immunol. 2008 Oct 15;181(8):5490-500
pubmed: 18832706
Clin Microbiol Infect. 2020 Aug;26(8):1094.e7-1094.e10
pubmed: 32502646
Clin Transl Immunology. 2020 Dec 23;9(12):e1217
pubmed: 33376594
N Engl J Med. 2021 Apr 8;384(14):1372-1374
pubmed: 33691060
Rev Med Virol. 2021 Mar;31(2):e2170
pubmed: 33350017
J Immunol. 2020 Nov 1;205(9):2342-2350
pubmed: 32887754
Lancet. 2021 Mar 27;397(10280):1178-1181
pubmed: 33640037
Clin Infect Dis. 2020 Nov 19;71(16):2027-2034
pubmed: 32221519
Nature. 2020 Aug;584(7821):437-442
pubmed: 32555388
Rev Med Virol. 2021 May;31(3):e2181
pubmed: 33152146
Nature. 2020 Aug;584(7821):457-462
pubmed: 32668444
N Engl J Med. 2020 Jul 23;383(4):334-346
pubmed: 32598831
Sci Rep. 2021 Feb 26;11(1):4792
pubmed: 33637823
EClinicalMedicine. 2020 Dec;29:100651
pubmed: 33235985
Lancet. 2020 Aug 15;396(10249):467-478
pubmed: 32702298
N Engl J Med. 2020 Oct 29;383(18):1724-1734
pubmed: 32871063
Cell. 2020 Oct 1;183(1):158-168.e14
pubmed: 32979941
Nat Med. 2020 Jun;26(6):842-844
pubmed: 32398875
Nat Med. 2020 Aug;26(8):1200-1204
pubmed: 32555424
Cell. 2020 Jun 25;181(7):1489-1501.e15
pubmed: 32473127
Euro Surveill. 2021 Feb;26(6):
pubmed: 33573712
J Clin Microbiol. 2021 Apr 20;59(5):
pubmed: 33318065
Cell. 2020 Nov 12;183(4):996-1012.e19
pubmed: 33010815
Nat Immunol. 2020 Oct;21(10):1293-1301
pubmed: 32807944
Sci Immunol. 2017 Aug 4;2(14):
pubmed: 28778905
Cell Rep Med. 2020 Sep 22;1(6):100092
pubmed: 32904468
Nat Med. 2020 Jun;26(6):845-848
pubmed: 32350462
Nat Commun. 2020 Jul 6;11(1):3436
pubmed: 32632160
Lancet Infect Dis. 2020 Sep;20(9):e245-e249
pubmed: 32687805
Sci Immunol. 2020 Jun 26;5(48):
pubmed: 32591408
Clin Microbiol Infect. 2021 Jan 20;:
pubmed: 33482352
Immunity. 2020 Nov 17;53(5):925-933.e4
pubmed: 33129373
Expert Rev Vaccines. 2011 Mar;10(3):299-306
pubmed: 21434798
N Engl J Med. 2021 Feb 11;384(6):533-540
pubmed: 33369366
Immunity. 2020 Jun 16;52(6):910-941
pubmed: 32505227
Nature. 2021 Apr;592(7855):616-622
pubmed: 33567448
Biochem Biophys Res Commun. 2021 Jan 29;538:211-217
pubmed: 33190827
Nature. 2020 Nov;587(7833):270-274
pubmed: 32726801
Science. 2021 Feb 5;371(6529):
pubmed: 33408181
N Engl J Med. 2020 Dec 17;383(25):2427-2438
pubmed: 32991794
J Med Virol. 2020 Sep;92(9):1518-1524
pubmed: 32104917
Sci Immunol. 2020 Dec 23;5(54):
pubmed: 33361161
Euro Surveill. 2021 Feb;26(5):
pubmed: 33541486
Auto Immun Highlights. 2017 Dec;8(1):9
pubmed: 28647912
Nat Rev Immunol. 2020 Aug;20(8):457-458
pubmed: 32636479
Lancet. 2021 Dec 19;396(10267):1979-1993
pubmed: 33220855
Clin Transl Immunology. 2020 Sep 26;9(9):e1182
pubmed: 33005417
Sci Immunol. 2020 Oct 8;5(52):
pubmed: 33033173
Emerg Infect Dis. 2020 Jul;26(7):1478-1488
pubmed: 32267220
JCI Insight. 2020 Sep 3;5(17):
pubmed: 32687484
Commun Biol. 2020 Dec 11;3(1):780
pubmed: 33311543
Immunity. 2020 Jun 16;52(6):971-977.e3
pubmed: 32413330
Cell Host Microbe. 2020 Jun 10;27(6):992-1000.e3
pubmed: 32320677
Trends Immunol. 2021 Jan;42(1):18-30
pubmed: 33277181
Nat Immunol. 2020 Nov;21(11):1336-1345
pubmed: 32887977
Lancet. 2020 Nov 14;396(10262):1595-1606
pubmed: 33065034
Methods. 2013 May 15;61(1):30-8
pubmed: 23583887
ACS Cent Sci. 2020 May 27;6(5):591-605
pubmed: 32382657
N Engl J Med. 2021 May 20;384(20):1885-1898
pubmed: 33725432
N Engl J Med. 2020 Dec 17;383(25):2439-2450
pubmed: 33053279