Persistence of anti-SARS-CoV-2 antibodies: immunoassay heterogeneity and implications for serosurveillance

Abstract

\n Objectives\n Serologic studies have been critical in tracking the evolution of the COVID-19 pandemic. Data on anti-SARS-CoV-2 antibodies persistence remain sparse, especially from infected individuals with few to no symptoms. The objective of the study was to quantify the sensitivity for detecting historic SARS-COV-2 infections as a function of time since infection for 3 commercially-available SARS-COV-2 immunoassays and to explore the implications of decaying immunoassay sensitivity in estimating seroprevalence.\n \n Methods\n We followed a cohort of mostly mild/asymptomatic SARS-CoV-2-infected individuals (n=354) through 9\xa0months after their presumed infection date and tested their serum for anti-SARS-CoV-2 antibodies with three commercially available assays; Roche-N, Roche-RBD and EuroImmun S1. We developed a latent-class statistical model to infer the specificity and time-varying sensitivity of each assay and show through simulations how inappropriately accounting for test performance can lead to biased serosurvey estimates.\n \n Results\n Antibodies persisted at follow-up in 74% to 100% of participants, depending on immunoassays. Model estimates indicate that both Roche assays maintain high sensitivity with the EuroImmun assay missing 40% of infections after 9\xa0months. Simulations reveal that without appropriate adjustment for time-varying assay sensitivity, seroprevalence surveys may underestimate infection rates.\n \n Conclusions\n Antibodies persist after 9\xa0months in a cohort of mildly infected individuals with detection depending on assay choice. Appropriate assay-performance-adjustment are important for the interpretation of serologic studies in the case of decaying sensitivity after infection.\n