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EDITORIAL
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 1-3

Caution on the use of rapid antibody testing for 2019 novel coronavirus disease


Department of Oral and Maxillofacial Surgery, People’s College of Dental Sciences & Research Centre, People’s University, Bhopal, Madhya Pradesh, India

Date of Submission15-May-2020
Date of Decision10-Jun-2020
Date of Acceptance11-Jun-2020
Date of Web Publication23-Oct-2020

Correspondence Address:
Dr. Darpan Bhargava
Consultant Oral and Maxillofacial Surgery, TMJ Consultancy Services South East Asia, H-3/2, B.D.A Colony, Nayapura, Lalghati, Airport Road, Bhopal (M.P).
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jhrr.JHRR_18_20

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How to cite this article:
Bhargava D. Caution on the use of rapid antibody testing for 2019 novel coronavirus disease. J Health Res Rev 2020;7:1-3

How to cite this URL:
Bhargava D. Caution on the use of rapid antibody testing for 2019 novel coronavirus disease. J Health Res Rev [serial online] 2020 [cited 2020 Nov 30];7:1-3. Available from: https://www.jhrr.org/text.asp?2020/7/1/1/298894



Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing COVID-19 or the 2019 novel coronavirus disease is affecting the world in an enormous way, and the medical fraternity is out to investigate diagnostic methods and treatment modalities, in a haste. As clinicians, we should judge as to what is apt in the benefit of the patients at this point in time instead of executing under research modalities on them.[1],[2]

An antibody (generally denoted as, Ab), also referred to as immunoglobulin (denoted as, Ig), a Y-shaped protein, is produced mainly by plasma cells that contribute to the host immune system to combat pathogens. Antibodies are produced as a response or exposure to the antigen (recognizable component of the pathogen by the immune mechanism).

IgM is the first antibody to appear in the response to initial exposure to an antigen. IgG molecules are created and released by plasma B cells, and they participate predominantly in the secondary immune response.[1],[2]

It is reported that after SARS infection, IgM antibody could be detected in patient’s blood after 3–6 days and IgG, 8 days after exposure. As highlighted by Li et al.[1] that because coronavirus belongs to the identical family of viruses as those that caused the Middle East Respiratory Syndrome (MERS) and SARS in the past, its antibody generation process may follow a comparable pattern.

The IgM and IgG antibodies may be detected as positive as early as “on the 4th day after onset of symptoms” for COVID-19 in specific. The timeline about initial seroconversion of IgM and IgG antibodies needs to be highlighted for appropriate conduction and interpretation of results,[2] which is as follows:

  • IgM cumulative seroconversion increases from the ninth day after symptom onset.


  • IgG cumulative seroconversion increases from the 11th day after symptom onset.


  • IgG shows sharp increase on the 12th day after onset. Specific IgM antibodies against SARS-CoV-2 from 216 serum samples of 85 confirmed COVID-19 pneumonia cases when tested with enzyme-linked immunosorbent assay (ELISA) showed highest (93.8%) seropositivity for IgM at approximately 18–19th day during the course of the disease with a rage of 44.4%–93.8% (only 60% positive in less or equal to day 5 of the course of the disease, and 85.7% at 30 days or more, with variable percentage of IgM detection from ≤5 to ≥30 days from the start of symptoms) [Graph 1].[2]
  • Graph 1: Detection of IgM and IgG antibodies in different periods (based on enzyme-linked immunosorbent assay from 216 serum sample of 85 confirmed COVID-19)[2]

    Click here to view


    Specific IgG antibodies against SARS-CoV-2 from 216 serum samples of 85 confirmed COVID-19 pneumonia cases when tested with ELISA showed highest (100%) seropositivity sampled patients for IgG, which was found at 30 days or more in the course of the disease with a range of 39.1%–100% (only 40% positive in less or equal to day 5 in the course of the disease and 100% at 30 days or more, with variable percentage of IgM detection from ≤5 to ≥30 days from the start of symptoms) [Table 1], [Graph 1].[2] The limitation with rapid antibody testing for COVID-19 is summarized in [Figure 1].
    Table 1: Summary of 2019 novel coronavirus disease–specific IgM and IgG seroconversion

    Click here to view
    Figure 1: Limitation with rapid antibody testing for COVID-19

    Click here to view



      Conclusion Top


    With the variability seen in the available data, it may not be appropriate to use antibody detection as a reliable marker for disease detection or evidence of antibody-mediated immunity detection. Presence of IgG against SARS-CoV-2 in 100% serum samples from the patients confirmed for COVID-19 with reverse transcription polymerase chain reaction (RT-PCR), may be used as an indicator with consistency for endorsing previous infection. With the current evidence, clinical utility needs further exploration.[3],[4],[5]

    Acknowledgement

    I would like to acknowledge People’s University, Bhopal, Madhya Pradesh, India.

    Financial support and sponsorship

    Nil.

    Conflicts of interest

    There are no conflicts of interest.



     
      References Top

    1.
    Li Z, Yi Y, Luo X, Xiong N, Liu Y, Li S, et al. Development and clinical application of a rapid IgM-IgG combined antibody test for SARS-CoV-2 infection diagnosis [published online ahead of print, 2020 Feb 27]. J Med Virol2020 Feb 27:10.1002/jmv.25727. doi:10.1002/jmv.25727.  Back to cited text no. 1
        
    2.
    Xiang F, Wang X, He X, Peng Z, Yang B, Zhang J, et al. Antibody detection and dynamic characteristics in patients with COVID-19 [published online ahead of print, 2020 Apr 19]. Clin Infect Dis 2020 Apr 19:ciaa461. doi:10.1093/cid/ciaa461.  Back to cited text no. 2
        
    3.
    Available from: https://www.who.int/publications/i/item/immunity-passports-in-the-context-of-covid-19. [Last assessed on 2020 May 13].  Back to cited text no. 3
        
    4.
    Guo L, Ren L, Yang S, Xiao M, Chang D, Yang F, et al. Profiling early humoral response to diagnose novel coronavirus disease (COVID-19) [published online ahead of print, 2020 Mar 21]. Clin Infect Dis 2020;Mar 21:ciaa310. doi:10.1093/cid/ciaa310.  Back to cited text no. 4
        
    5.
    Tang YW, Schmitz JE, Persing DH, Stratton CW The laboratory diagnosis of COVID-19 infection: Current issues and challenges [published online ahead of print, 2020 Apr 3]. J Clin Microbiol 2020;JCM.00512-20. doi:10.1128/JCM.00512-20.  Back to cited text no. 5
        


        Figures

      [Figure 1], [Figure 2]
     
     
        Tables

      [Table 1]



     

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