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COVID-19 Serology at Population Scale: SARS-CoV-2-Specific Antibody Responses in Saliva.

  • Author(s): Pisanic, Nora;
  • Randad, Pranay R;
  • Kruczynski, Kate;
  • Manabe, Yukari C;
  • Thomas, David L;
  • Pekosz, Andrew;
  • Klein, Sabra L;
  • Betenbaugh, Michael J;
  • Clarke, William A;
  • Laeyendecker, Oliver;
  • Caturegli, Patrizio P;
  • Larman, H Benjamin;
  • Detrick, Barbara;
  • Fairley, Jessica K;
  • Sherman, Amy C;
  • Rouphael, Nadine;
  • Edupuganti, Srilatha;
  • Granger, Douglas A;
  • Granger, Steve W;
  • Collins, Matthew H;
  • Heaney, Christopher D
  • et al.
Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of an ongoing pandemic that has infected over 36 million and killed over 1 million people. Informed implementation of government public health policies depends on accurate data on SARS-CoV-2 immunity at a population scale. We hypothesized that detection of SARS-CoV-2 salivary antibodies could serve as a noninvasive alternative to serological testing for monitoring of SARS-CoV-2 infection and seropositivity at a population scale. We developed a multiplex SARS-CoV-2 antibody immunoassay based on Luminex technology that comprised 12 CoV antigens, mostly derived from SARS-CoV-2 nucleocapsid (N) and spike (S). Saliva and sera collected from confirmed coronavirus disease 2019 (COVID-19) cases and from the pre-COVID-19 era were tested for IgG, IgA, and IgM to the antigen panel. Matched saliva and serum IgG responses (n = 28) were significantly correlated. The salivary anti-N IgG response resulted in the highest sensitivity (100%), exhibiting a positive response in 24/24 reverse transcription-PCR (RT-PCR)-confirmed COVID-19 cases sampled at >14 days post-symptom onset (DPSO), whereas the salivary anti-receptor binding domain (RBD) IgG response yielded 100% specificity. Temporal kinetics of IgG in saliva were consistent with those observed in blood and indicated that most individuals seroconvert at around 10 DPSO. Algorithms employing a combination of the IgG responses to N and S antigens result in high diagnostic accuracy (100%) by as early as 10 DPSO. These results support the use of saliva-based antibody testing as a noninvasive and scalable alternative to blood-based antibody testing.

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