Reliability of dried blood spot (DBS) cards in antibody measurement: A systematic review

Abstract

Background Increasingly, vaccine efficacy studies are being recommended in low-and-middle-income countries (LMIC), yet often facilities are unavailable to take and store infant blood samples correctly. Dried blood spots (DBS), are useful for collecting blood from infants for diagnostic purposes, especially in low-income settings, as the amount of blood required is miniscule and no refrigeration is required. Little is known about their utility for antibody studies in children. This systematic review aims to investigate the correlation of antibody concentrations against infectious diseases in DBS in comparison to serum or plasma samples that might inform their use in vaccine clinical trials. Methods and findings We searched MEDLINE, Embase and the Cochrane library for relevant studies between January 1990 to October 2020 with no language restriction, using PRISMA guidelines, investigating the correlation between antibody concentrations in DBS and serum or plasma samples, and the effect of storage temperature on DBS diagnostic performance. We included 40 studies in this systematic review. The antibody concentration in DBS and serum/plasma samples reported a good pooled correlation, (r2 = 0.86 (ranged 0.43 to 1.00)). Ten studies described a decline of antibody after 28 days at room temperature compared to optimal storage at -20°C, where antibodies were stable for up to 200 days. There were only five studies of anti-bacterial antibodies. Conclusions There is a good correlation between antibody concentrations in DBS and serum/plasma samples, supporting the wider use of DBS in vaccine and sero-epidemiological studies, but there is limited data on anti-bacterial antibodies. The correct storage of DBS is critical and may be a consideration for longer term storage.

Feasibility of a dried blood spot strategy for serological screening and surveillance to monitor elimination of Human African Trypanosomiasis in the Democratic Republic of the Congo

“…However, for prolonged storage, longer than 28 days, the systematic review by Amini et al . indicated that storage at -20°C is the optimal solution [ 23 ]. In g-iELISA, work is ongoing to overcome stability problems (short shelve life of 8 months on 2–8°C) with an impact on storage conditions and on looking for alternatives for filter paper to collect DBS as the number of discs required for testing is high [ 19 ].…”

Precision Public Health Through Serological Biomarkers: An Integrated Surveillance Platform to Inform Public Health Interventions

“…Collecting capillary blood through dried blood spots (DBS) provide a more scalable alternative. DBS show comparable antibody measurements to serum samples for falciparum malaria, some bacterial and protozoal pathogens, and numerous viral pathogens, including vaccine-preventable diseases (63).…”

“…DBS can be transported to remote sites for testing with more resource-intensive methods such as multiplex immunoassays. They can be kept at cool or ambient temperatures for several weeks before they are frozen for long-term storage (63), as long as high temperatures are avoided. Serum Separator cards can be used to automatically separate serum from DBS, further reducing the effort required to process these samples (64).…”

Protection to Six Vaccinable Pathogens in Paired Plasma/DBS and HIV Impact in Infected and Uninfected Children From Kinshasa

“…In these circumstances, dried blood samples (DBS) could represent a convenient sample for antibody detection [13], being easy to collect, store and transport without cold chain [14]. DBS have been used in the surveillance and monitoring of numerous infectious diseases [13][14][15][16][17][18][19]. The good correlation between antibody concentrations in DBS and serum/plasma samples support the wider use of DBS in post-vaccination and seroepidemiological studies [13].…”