Limited specificity of commercially available SARS‐CoV‐2 IgG ELISAs in serum samples of African origin

Emmerich, Petra; Murawski, Carolin; Ehmen, Christa; Possel, Ronald von; Pekarek, Neele; Oestereich, Lisa; Duraffour, Sophie; Pahlmann, Meike; Struck, Nicole S.; Eibach, Daniel; Krumkamp, Ralf; Amuasi, John; Maïga-Ascofaré, Oumou; Rakotozandrindrainy, Raphäel; Asogun, Danny; Ighodalo, Yemisi; Kann, Simone; May, Jürgen; Tannich, Egbert; Deschermeier, Christina

doi:10.1111/tmi.13569

Cited by 71 publications

(76 citation statements)

References 20 publications

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“…Postinfection antibody kinetics vary by infection severity, patient age, and prior exposure, as can test performance. When we tested prepandemic samples from Juba, we found that background SARS-CoV-2 antibody reactivity was higher in Juba than in Boston, which was consistent with findings from studies conducted in other sites in sub-Saharan Africa ( 11 , 13 , 30 , 31 ). We used these negative controls to estimate test specificity, but we lacked data on the post SARS-CoV-2 infection antibody kinetics and the proportion of infections that were mild or asymptomatic in the Juba population, which led to wide variation in plausible estimates of seroprevalence, as shown in our sensitivity analyses.…”

Section: Discussionsupporting

confidence: 88%

Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 IgG in Juba, South Sudan, 20201

Wiens¹,

Mawien²,

Rumunu³

et al. 2021

Emerg. Infect. Dis.

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G lobally, >100 million cases and >2.6 million deaths had been attributed to coronavirus disease (COVID-19) as of March 14, 2021 (1). Most cases have been reported in Europe and the Americas. In Africa, >2.9 million cases and ≈75,000 deaths have been reported (1). Reasons for the lower reported incidence and death associated with COVID-19 in Africa during the fi rst 6-8 months of the pandemic are unclear but may include differences in age distribution, immune history, climate, early mitigation measures, and epidemiologic connectivity between geographic regions (2,3). However, our understanding of the true spread of severe acute respiratory virus coronavirus 2 (SARS-CoV-2) has been obscured by limited testing capabilities, underreported deaths, and undetected mild or asymptomatic infections (4). Populationbased serological surveys, hundreds of which have been conducted worldwide, can help shed light on the extent of this underestimation of SARS-CoV-2 infections (5,6). As of March 18, 2021, only 16 studies published or available in preprint had been conducted in sub-Saharan Africa (7)(8)(9)(10)(11)(12)(13)(14)(15)(16) H. Majiya et al., unpub. data,

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Section: Discussionsupporting

confidence: 88%

Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 IgG in Juba, South Sudan, 20201

Wiens¹,

Mawien²,

Rumunu³

et al. 2021

Emerg. Infect. Dis.

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show abstract

“…Interpretation of SARS-CoV-2 serologic test results, except pan Igs Wanti ELISA, has been reported to be very challenging in Africa due to pre-existing cross-reactive antibodies induced by other pathogens such as non-SARS-CoV-2 human coronaviruses and malaria parasites [13]. Given the rapid decline of anti-SARS-CoV-2 nucleocapsid antibodies as compared to the anti-RBD IgG antibody 13 , we developed and optimized an in-house ELISA that detects anti-SARS-CoV-2 IgG antibodies. Our assay, unlike other commercially available serologic assays, is affordable and has been validated with a large number of Ethiopian sera from both pre-COVID-19 and COVID-19 patients from the same regions.…”

Section: Discussionmentioning

confidence: 99%

High Seroprevalence of Anti-SARS-CoV-2 Antibodies Among Ethiopian Healthcare Workers

Gelanew

Seyoum

Mulu

et al. 2021

Preprint

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BackgroundCOVID-19 pandemic has a devastating impact on the economies and health care system of sub-Saharan Africa. Healthcare workers (HWs), the main actors of the health system, are at higher-risk because of their occupation. Serology-based estimates of SARS-CoV-2 infection among HWs represent a measure of HWs’ exposure to the virus and a guide to the prevalence of SARS-CoV-2 in the community. This information is currently lacking in Ethiopia and other African countries. This study aimed to develop an in-house antibody testing assay, assess the prevalence of SARS-CoV-2 antibodies among Ethiopian high-risk frontline HWs.MethodsA cross-sectional seroprevalence study was conducted among HWs in five public hospitals located in different geographic regions of Ethiopia. Socio-demographic and clinical data were collected using questionnaire-based interviews. From consenting HWs, blood samples were collected between December 2020 and February 2021, the period between the two peaks of COVID-19 in Ethiopia. The collected sera were tested using an in-house immunoglobin G (IgG) enzyme-linked immunosorbent assay (ELISA) for SARS-CoV-2 specific antibodies on sera collected from HWs. Results Of 1,997 HWs who provided a blood sample, demographic and clinical data, 50.5% were female, 74.0% had no symptoms compatible with COVID-19, and 29.0% had history of contact with suspected or confirmed patient with SARS-CoV-2 infection. The overall seroprevalence was 39.6%. The lowest (24.5%) and the highest (48.0%) seroprevalence rates were found in Hiwot Fana Specialized Hospital in Harar and ALERT Hospital in Addis Ababa, respectively. Of the 821 seropositive HWs, 224(27.3%) had history of symptoms consistent with COVID-19. A history of close contact with suspected/confirmed COVID-19 cases was strongly associated with seropositivity (Adjusted odds Ratio (AOR) =1.4, 95% CI 1.1-1.8; p=0.015). ConclusionHigh SARS-CoV-2 seroprevalence levels were observed in the five Ethiopian hospitals. These findings highlight the significant burden of asymptomatic infection in Ethiopia, and may reflect the scale of transmission in the general population.

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“…Cross-reactivity has also been found in recent studies in malaria-endemic countries; two SARS-CoV-2 serological assays targeting the nucleocapsid protein had cross-reactivity among pre-pandemic samples from Nigeria with higher levels of malaria antibodies 13 . A high rate of false positives was also seen in pre-pandemic samples using commercially available ELISAs from Benin 14 and from Ghana and Nigeria 15 .…”

Section: Mainmentioning

confidence: 95%

Plasmodium infection induces cross-reactive antibodies to carbohydrate epitopes on the SARS-CoV-2 Spike protein

Lapidus

Liu

Casanovas‐Massana

et al. 2021

Preprint

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Individuals with acute malaria infection generated high levels of antibodies that cross-react with the SARS-CoV-2 Spike protein. Cross-reactive antibodies specifically recognized the sialic acid moiety on N-linked glycans of the Spike protein and do not neutralize in vitro SARS-CoV-2. Sero-surveillance is critical for monitoring and projecting disease burden and risk during the pandemic; however, routine use of Spike protein-based assays may overestimate SARS-CoV-2 exposure and population-level immunity in malaria-endemic countries.

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Limited specificity of commercially available SARS‐CoV‐2 IgG ELISAs in serum samples of African origin

Cited by 71 publications

References 20 publications

Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 IgG in Juba, South Sudan, 20201

Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 IgG in Juba, South Sudan, 20201

High Seroprevalence of Anti-SARS-CoV-2 Antibodies Among Ethiopian Healthcare Workers

Plasmodium infection induces cross-reactive antibodies to carbohydrate epitopes on the SARS-CoV-2 Spike protein

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