Abstract
The landscape of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic testing is rapidly evolving. While serology testing has limited diagnostic capacity for acute infection, its role in providing population-based information on positivity rates and informing evidence-based decision making for public health recommendations is increasing. With the global availability of vaccines, there is increasing pressure on clinical laboratories to provide antibody screening and result interpretation for vaccinated and non-vaccinated individuals. Here we present the most up-to-date data on SARS-CoV-2 antibody timelines, including the longevity of antibodies, and the production and detection of neutralizing antibodies. Additionally, we provide practical guidance for clinical microbiology laboratories to both verify commercial serology assays and choose appropriate testing algorithms for their local populations.
Highlights
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019 resulted in a rapid global development of molecular, antigenic and serological assays for the diagnosis of acute infection and identification of past infection
While molecular testing is widely accepted as the gold standard for diagnosis of acute infection, the role of serology is limited to special clinical cases as an adjunct for diagnosis [1]
The SARS-CoV-2 antibodies are not reliably detected fewer than 7–21 days post symptom onset, making their utility in diagnosis of acute infection of limited value [2–4]. In cases such as multiple inflammatory syndrome in adults (MIS-A) or in children (MIS-C), a positive result on a serological assay can help guide clinical management in the absence of a positive molecular test result or when molecular testing is unavailable, and positive serology results have been included as part of the clinical case definition for MIS-C [5]
Summary
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019 resulted in a rapid global development of molecular, antigenic and serological assays for the diagnosis of acute infection and identification of past infection. Population-based studies linking quantitative serology results to clinical outcomes will be needed to help determine what level of antibody may correlate with immunity to infection.
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