Authors
Amy C Thomas, Elizabeth Oliver, Holly E Baum, Kapil Gupta, Kathryn L Shelley, Anna E Long, Hayley E Jones, Joyce Smith, Benjamin Hitchings, Natalie di Bartolo, Kate Vasileiou, Fruzsina Rabi, Hanin Alamir, Malak Eghleilib, Ore Francis, Jennifer Oliver, Begonia Morales-Aza, Ulrike Obst, Debbie Shattock, Rachael Barr, Lucy Collingwood, Kaltun Duale, Niall Grace, Guillaume Gonnage Livera, Lindsay Bishop, Harriet Downing, Fernanda Rodrigues, Nicholas Timpson, Caroline L Relton, Ashley Toye, Derek N Woolfson, Imre Berger, Anu Goenka, Andrew D Davidson, Kathleen M Gillespie, Alistair JK Williams, Mick Bailey, Ellen Brooks-Pollock, Adam Finn, Alice Halliday, CoMMinS Study Team
Publication date
2022/4/17
Journal
medRxiv
Pages
2022.04. 11.22273690
Publisher
Cold Spring Harbor Laboratory Press
Description
Saliva is easily obtainable non-invasively and potentially suitable for detecting both current and previous SARS-CoV-2 infection. We established 6 standardised enzyme linked immunosorbent assays (ELISA) capable of detecting IgA and IgG antibodies to whole SARS-CoV-2 spike protein, to its receptor binding domain region and to nucleocapsid protein in saliva. In test accuracy (n=320), we found that spike IgG performed best (ROC AUC: 95.0%, 92.8-97.3%), followed by spike IgA (ROC AUC: 89.9%, 86.5-93.2%) for discriminating between pre-pandemic and post COVID-19 saliva samples. Using machine learning, diagnostic performance was improved when a combination of tests was used. As expected, salivary IgA was poorly correlated with serum, indicating an oral mucosal response whereas salivary IgG responses were predictive of those in serum. When deployed to 20 household outbreaks undergoing Delta and Omicron infection, antibody responses were heterogeneous but remained a reliable indicator of recent infection. Intriguingly, unvaccinated children showed evidence of exposure almost exclusively through specific IgA responses in the absence of evidence of viral infection. We have provided robust standardisation, evaluation, and field-testing of salivary antibody assays as tools for monitoring SARS-CoV-2 immune responses. Future work should focus on investigating salivary antibody responses following infection and vaccination to understand patterns of SARS-CoV-2 transmission and inform ongoing vaccination strategies.
Total citations
2022202312