Humbert, Maria, Opurum, Precious, Brendish, Nathan, Poole, Stephen, He, Peijun, Katis, Ioannis, Quaye, Jerry, Bediako, Yaw, Duriez, Patrick, Eason, R.W., Sones, Collin, Quaye, Osbourne, Awandare, Gordon, Christodoulides, Myron, Clark, Tristan, Quashie, Peter and Mccormick, Christopher (2022) A SARS-CoV-2 nucleocapsid ELISA represents a low-cost alternative to lateral flow testing for community screening in LMI countries. Journal of Infection, 84 (1), 48-55, [YJINF_YJINF-D-21-01816]. (doi:10.1016/j.jinf.2021.08.049).
Abstract
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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