Assessment of twenty-two SARS-CoV-2 rapid antigen tests against SARS-CoV-2: A laboratory evaluation study

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Abstract

Background

Rapid antigen testing is widely used as a way of scaling up population-level testing. To better inform antigen test deployment in Australia, we evaluated 22 commercially available antigen tests against the currently circulating delta variant, including an assessment of culture infectivity.

Methods

Analytical sensitivity was evaluated against SARS-CoV-2 B.1.617.2 (Delta), reported as TCID 50 /mL, cycle threshold (Ct) and viral load (RNA copies/mL). Specificity was assessed against non-SARS-CoV-2 viruses. Clinical sensitivity and correlation with cell culture infectivity was assessed using the Abbott PanBio™ COVID-19 Ag test.

Results

Nineteen kits consistently detected SARS-CoV-2 antigen equivalent to 1.3 × 10 6 copies/mL (5.8 × 10 3 TCID 50 /mL). Specificity for all kits was 100%. Compared to RT-PCR the Abbott PanBio™ COVID-19 Ag test was 52.6% (95% CI, 41.6% to 63.3%) concordant, with a 50% detection probability for infectious cell culture at 5.9 log 10 RNA copies/mL (95% CI, 5.3 to 6.5 log 10 copies/mL). Antigen test concordance was 97.6% (95% CI, 86.3% to 100.0%) compared to cell culture positivity.

Conclusions

Antigen test positivity correlated with positive viral culture, suggesting antigen test results may determine SARS-CoV-2 transmission risk. Analytical sensitivity varied considerably between kits highlighting the need for ongoing systematic post-market evaluation to inform test selection and deployment.

Article activity feed

  1. SciScore for 10.1101/2021.12.15.21267691: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Ethics: This study was approved by the Royal Melbourne Hospital Research Ethics Committee (QA2020085).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Cell Line Authenticationnot detected.

    Table 2: Resources

    Experimental Models: Cell Lines
    SentencesResources
    Virus was grown in Calu-3 cells (Supplementary Appendix) and inactivated by a 50kGy dose of gamma radiation.
    Calu-3
    suggested: None
    Software and Algorithms
    SentencesResources
    Samples were prepared and tested according to methods described in the ‘Guidance For Use of Alternative Protocol’ documentation provided by Abbott.
    Abbott
    suggested: (Abbott, RRID:SCR_010477)
    Analysis was performed using GraphPad Prism (v 9.0) and Stata, and data visualisation was performed using GraphPad Prism (v 9.0) and ggplot (v3.3.5) in Rstudio (v1.4.1717) (16).
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    Rstudio
    suggested: (RStudio, RRID:SCR_000432)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).


    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A limitation of our study, and indeed a limitation of several other laboratory studies assessing antigen test kits, include the use of spiked virus in VTM for kit evaluation, rather than the use of swabs directly placed in manufacturer-provided buffer. However, to try and maximise yield from samples, we tested samples without a freeze-thaw step, as freezing has been shown to reduce yield of infectious virus (18, 28). Although we assessed the analytical characteristics of over twenty assays, a further limitation is that we only evaluated the clinical sensitivity of one antigen test, namely the Abbott PanBio™ COVID-19 Ag test assay. However, recent work has highlighted the widespread use of this kit, with 39 published datasets utilising the Abbott PanBio™ COVID-19 Ag test assay (21), meaning that our findings will have broad applicability and relevance. In summary, our data describe the performance characteristics of 22 antigen test kits against the SARS-CoV-2 Delta variant using a standardised evaluation panel. We demonstrate marked variability between test kits, and variability between reported and observed sensitivities, although most (86.4%) were able to meet WHO recommended minimum standards for detection. In addition, we further corroborate the hypothesis that antigen test positivity generally correlates with positive viral culture and by extension with presence of infectious viral particles) and that a positive antigen test result could be used as an adjunct to determine...

    Results from TrialIdentifier: No clinical trial numbers were referenced.


    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.


    Results from JetFighter: We did not find any issues relating to colormaps.


    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.


    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.