Differentiation of Individuals Previously Infected with and Vaccinated for SARS-CoV-2 in an Inner-City Emergency Department

  1. Evan J. Beck
  2. Yu-Hsiang Hsieh
  3. Reinaldo E. Fernandez
  4. Gaby Dashler
  5. Emily R. Egbert
  6. Shawn A. Truelove
  7. Caroline Garliss
  8. Richard Wang
  9. Evan M. Bloch
  10. Ruchee Shrestha
  11. Joel Blankson
  12. Andrea L. Cox
  13. Yukari C. Manabe
  14. Thomas Kickler
  15. Richard E. Rothman
  16. Andrew D. Redd
  17. Aaron A. R. Tobian
  18. Aaron M. Milstone
  19. Thomas C. Quinn
  20. Oliver Laeyendecker

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Abstract

Emergency departments (EDs) can serve as surveillance sites for infectious diseases. The objective of this study was to determine the burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to monitor the prevalence of vaccination against coronavirus disease 2019 (COVID-19) among patients attending an urban ED in Baltimore City.

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  1. Version published to 10.1128/jcm.02390-21
  2. ScreenIT

    SciScore for 10.1101/2021.10.13.21264968: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: Ethics Statement: This study used samples from parent studies approved by The Johns Hopkins University School of Medicine Institutional Review Board (IRB00245545, IRB00247886, IRB00091667, IRB00250798, IRB00249350, and NA_00085477).
    Consent: For those studies, all individuals provided written informed consent.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Plasma and serum samples were analyzed using three commercially available serologic assays: the Euroimmun Anti-SARS-CoV-2 ELISA (Mountain Lakes, NJ), the CoronaCHEK™ COVID-19 IgG/IgM Rapid Test Cassette (Hangzhou Biotest Biotech Co Ltd), and the Bio-Rad Platelia SARS-CoV-2 Total Antibody ELISA (Marnes-la-Coquette, France).
    Anti-SARS-CoV-2 ELISA (Mountain Lakes, NJ)
    suggested: None
    The CoronaCHEK™ lateral flow assay (LFA) tests for the presence of both IgM and IgG antibodies to the receptor-binding domain (RBD) of the spike protein.
    IgG
    suggested: None
    Software and Algorithms
    SentencesResources
    Statistical analyses were performed using StataSE version 14.2 (StataCorp, College Station, TX) and SAS version 9.4 (SAS Institute., Cary, NC).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    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:
    One critical potential limitation to the use of anti-spike and anti-nucleocapsid antibody testing to differentiate naturally infected from vaccinated individuals is differential loss of antibody reactivity to these two targets. In a cohort of 3276 UK healthcare workers, Lumley et al. estimated that anti-nucleocapsid IgG antibodies exhibit a half-life of 85 days from the maximum titer (95% CI, 81-90)32. In contrast, the half-life of anti-spike IgG antibodies could not be measured, as 94% of healthcare workers did not exhibit significant loss during follow-up32. Additionally, anti-nucleocapsid antibody decline was more rapid in younger patients and those with milder symptoms. Thus, in the proposed algorithm, a proportion of naturally infected individuals will be misclassified as vaccinated as anti-nucleocapsid antibodies wane with time. This effect will be differential by age and initial symptomology. The time to seroreversion of spike and nucleocapsid antibodies in SARS-CoV-2 infected patients is significantly affected by both disease severity and assay platform. The effect of these variations should be considered when interpreting the results of serosurveillance studies. Our study has several additional limitations. We did not test any individuals with known breakthrough infection (vaccinated then infected), nor could we distinguish between naturally infected individuals who were and were not subsequently vaccinated. Furthermore, a lack of seroreactivity occurred in a minorit...

    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.
    • Thank you for including a protocol registration statement.

    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.

  3. Version published to 10.1101/2021.10.13.21264968v1 on medRxiv