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Abstract
Performance of three automated commercial serological IgG-based assays was investigated for assessing SARS-CoV-2 “ever” (past or current) infection in a population-based sample in a high exposure setting. PCR and serological testing was performed on 394 individuals. SARS-CoV-2-IgG seroprevalence was 42.9% (95% CI 38.1–47.8%), 40.6% (95% CI 35.9–45.5%), and 42.4% (95% CI 37.6–47.3%) using the CL-900i, VidasIII, and Elecsys assays, respectively. Between the three assays, overall, positive, and negative percent agreements ranged between 93.2–95.7%, 89.3–92.8%, and 93.8–97.8%, respectively; Cohen’s kappa statistic ranged from 0.86 to 0.91; and 35 specimens (8.9%) showed discordant results. Among all individuals, 12.5% (95% CI 9.6–16.1%) had current infection, as assessed by PCR. Of these, only 34.7% (95% CI 22.9–48.7%) were seropositive by at least one assay. A total of 216 individuals (54.8%; 95% CI 49.9–59.7%) had evidence of ever infection using antibody testing and/or PCR during or prior to this study. Of these, only 78.2%, 74.1%, and 77.3% were seropositive in the CL-900i, VidasIII, and Elecsys assays, respectively. All three assays had comparable performance and excellent agreement, but missed at least 20% of individuals with past or current infection. Commercial antibody assays can substantially underestimate ever infection, more so when infection rates are high.
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1 Qatar University, Biomedical Research Center, QU Health, Doha, Qatar (GRID:grid.412603.2) (ISNI:0000 0004 0634 1084); Qatar University, Department of Biomedical Science, College of Health Sciences, QU Health, Doha, Qatar (GRID:grid.412603.2) (ISNI:0000 0004 0634 1084)
2 Cornell University, Infectious Disease Epidemiology Group, Weill Cornell Medicine - Qatar, Qatar Foundation - Education City, Doha, Qatar (GRID:grid.418818.c) (ISNI:0000 0001 0516 2170); Cornell University, World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine – Qatar, Qatar Foundation – Education City, Doha, Qatar (GRID:grid.418818.c) (ISNI:0000 0001 0516 2170)
3 Hamad Medical Corporation, Doha, Qatar (GRID:grid.413548.f) (ISNI:0000 0004 0571 546X)
4 Qatar University, College of Health Sciences, QU Health, Doha, Qatar (GRID:grid.412603.2) (ISNI:0000 0004 0634 1084)
5 Primary Health Care Corporation, Doha, Qatar (GRID:grid.498624.5) (ISNI:0000 0004 4676 5308)
6 Ministry of Public Health, Doha, Qatar (GRID:grid.498619.b)
7 Sidra Medicine, Department of Pathology, Doha, Qatar (GRID:grid.498619.b)
8 Cornell University, Infectious Disease Epidemiology Group, Weill Cornell Medicine - Qatar, Qatar Foundation - Education City, Doha, Qatar (GRID:grid.418818.c) (ISNI:0000 0001 0516 2170); Cornell University, World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine – Qatar, Qatar Foundation – Education City, Doha, Qatar (GRID:grid.418818.c) (ISNI:0000 0001 0516 2170); Cornell University, Department of Population Health Sciences, Weill Cornell Medicine, New York, USA (GRID:grid.5386.8) (ISNI:000000041936877X)