Journal
JOURNAL OF INFECTION
Volume 84, Issue 1, Pages 48-55Publisher
W B SAUNDERS CO LTD
DOI: 10.1016/j.jinf.2021.08.049
Keywords
SARS-cov-2; Nucleocapsid; ELISA; Diagnosis; Test
Categories
Funding
- Rosetrees Trust
- John Black Charitable Foundation
- University Hospitals Southampton NHS Foundation Trust
- Crick African Network fellowships [CAN/A00004/1, CAN/A00003/1]
- Cambridge Alborada Grant [G109329]
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Controlling the spread of SARS-CoV-2 is challenging due to asymptomatic transmission. Low-cost ELISA assays show promise in community screening with good sensitivity and specificity, warranting further investigation.
Background Controlling the spread of SARS-CoV-2 is problematic because of transmission driven by asymptomatic and pre-symptomatic individuals. Community screening can help identify these individuals but is often too expensive for countries with limited health care resources. Low-cost ELISA assays may address this problem, but their use has not yet been widely reported. Methods We developed a SARS-CoV-2 nucleocapsid ELISA and assessed its diagnostic performance on nose and throat swab samples from UK hospitalised patients and sputum samples from patients in Ghana. Results The ELISA had a limit of detection of 8.4 pg/ml antigen and 16 pfu/ml virus. When tested on UK samples (128 positive and 10 negative patients), sensitivity was 58.6% (49.6-67.2) rising to 78.3% (66.7-87.3) if real-time PCR Ct values > 30 were excluded, while specificity was 100% (69.2-100). In a second trial using the Ghanaian samples (121 positive, 96 negative), sensitivity was 52% (42.8-61.2) rising to 72.6% (61.8-81.2) when a > 30 Ct cut-off was applied, while specificity was 100% (96.2-100). Conclusions: Our data show that nucleocapsid ELISAs can test a variety of patient sample types while achieving levels of sensitivity and specificity required for effective community screening. Further investigations into the opportunities that this provides are warranted.
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