How to interpret and use COVID-19 serology and immunology tests

David S Y Ong; Paraskevi C Fragkou; Valentijn A Schweitzer; Roy F Chemaly; Charalampos D Moschopoulos; Chrysanthi Skevaki

doi:10.1016/j.cmi.2021.05.001

How to interpret and use COVID-19 serology and immunology tests

David S Y Ong^*
, Paraskevi C Fragkou
, Valentijn A Schweitzer
, Roy F Chemaly
, Charalampos D Moschopoulos
, Chrysanthi Skevaki
,

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

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Abstract

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: This review summarizes the underlying principles and performance of COVID-19 serological and immunological testing.

SOURCES: Selected peer-reviewed publications on COVID-19 related serology and immunology published between December 2019 and March 2021.

CONTENT: 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: 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.

Original language	English
Pages (from-to)	981-986
Number of pages	6
Journal	Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
Volume	27
Issue number	7
DOIs	https://doi.org/10.1016/j.cmi.2021.05.001
Publication status	Published - Jul 2021

Keywords

Antibodies
COVID-19
Immunity
SARS-CoV-2
Serology
T cell

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10.1016/j.cmi.2021.05.001

PIIS1198743X21002214Final published version, 430 KBLicence: Taverne

Cite this

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title = "How to interpret and use COVID-19 serology and immunology tests",

abstract = "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: This review summarizes the underlying principles and performance of COVID-19 serological and immunological testing.SOURCES: Selected peer-reviewed publications on COVID-19 related serology and immunology published between December 2019 and March 2021.CONTENT: 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: 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.",

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year = "2021",

month = jul,

doi = "10.1016/j.cmi.2021.05.001",

language = "English",

volume = "27",

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journal = "Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases",

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How to interpret and use COVID-19 serology and immunology tests. / Ong, David S Y; Fragkou, Paraskevi C; Schweitzer, Valentijn A et al.
In: Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, Vol. 27, No. 7, 07.2021, p. 981-986.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - How to interpret and use COVID-19 serology and immunology tests

AU - Ong, David S Y

AU - Fragkou, Paraskevi C

AU - Schweitzer, Valentijn A

AU - Chemaly, Roy F

AU - Moschopoulos, Charalampos D

AU - Skevaki, Chrysanthi

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N2 - 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: This review summarizes the underlying principles and performance of COVID-19 serological and immunological testing.SOURCES: Selected peer-reviewed publications on COVID-19 related serology and immunology published between December 2019 and March 2021.CONTENT: 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: 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.

AB - 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: This review summarizes the underlying principles and performance of COVID-19 serological and immunological testing.SOURCES: Selected peer-reviewed publications on COVID-19 related serology and immunology published between December 2019 and March 2021.CONTENT: 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: 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.

KW - Antibodies

KW - COVID-19

KW - Immunity

KW - SARS-CoV-2

KW - Serology

KW - T cell

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How to interpret and use COVID-19 serology and immunology tests

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