Sensitive and Specific Detection of Low-Level Antibody Responses in Mild Middle East Respiratory Syndrome Coronavirus Infections

Sensitive and Specific Detection of Low-Level Antibody Responses in Mild Middle East Respiratory Syndrome Coronavirus Infections

Nisreen M.A. Okba, V. Stalin Raj, Ivy Widjaja, Corine H. GeurtsvanKessel, Erwin de Bruin, Felicity D. Chandler, Wan Beom Park, Nam Joong Kim, Elmoubasher A. B. A. Farag, Mohammed Al-Hajri, Berend-Jan Bosch, Myoung-don Oh, Marion P. G. Koopmans, Chantal B. E. M. Reusken, Bart L. Haagmans

Middle East respiratory syndrome coronavirus (MERS-CoV) infections in humans can cause asymptomatic to fatal lower respiratory lung disease. Despite posing a probable risk for virus transmission, asymptomatic to mild infections can go unnoticed; a lack of seroconversion among some PCR-confirmed cases has been reported. We found that a MERS-CoV spike S1 protein–based ELISA, routinely used in surveillance studies, showed low sensitivity in detecting infections among PCR-confirmed patients with mild clinical symptoms and cross-reactivity of human coronavirus OC43–positive serum samples. Using in-house S1 ELISA and protein microarray, we demonstrate that most PCR-confirmed MERS-CoV case-patients with mild infections seroconverted; nonetheless, some of these samples did not have detectable levels of virus-neutralizing antibodies. The use of a sensitive and specific serologic S1-based assay can be instrumental in the accurate estimation of MERS-CoV prevalence.

2019

Middle East respiratory syndrome coronavirus, diagnostics, Enzyme-Linked Immunosorbent Assay, Spike, MERS, S1

DOI: 10.3201/eid2510.190051

Emerging Infectious Diseases

Centers for Disease Control and Prevention

Infectious and parasitic diseases, Medicine

EN