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Volume 25, Number 10—October 2019

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, and Bart L. HaagmansComments to Author 
Author affiliations: Erasmus Medical Center, Rotterdam, the Netherlands (N.M.A. Okba, V.S. Raj, C.H. GeurtsvanKessel, E. de Bruin, F.D. Chandler, M.P.G. Koopmans, C.B.E.M. Reusken, B.L. Haagmans); Utrecht University, Utrecht, the Netherlands (I. Widjaja, B.-J. Bosch); Seoul National University College of Medicine, Seoul, South Korea (W.B. Park, N.-J. Kim, M.-D. Oh); Ministry of Public Health, Doha, Qatar (E.A.B.A. Farag, M. Al-Hajri)

Main Article

Table 3

Sensitivity and specificity results of routinely used commercial S1 ELISA and PRNT90 assays for MERS-CoV*

Assay parameter and sample source Infection No. positive/no. tested

S1 rELISA† PRNT90 (titer)
Specificity or sensitivity, %
S1-positive S1-negative S1 rELISA PRNT90
Specificity 98.97 93.33 (1:20); 99.5 (1:40)
Healthy blood donors None 0/50 NA 0/50
Non-CoV respiratory infections Adenovirus 0/5 NA 1/5(20)
Bocavirus 0/2 NA 0/2
Enterovirus 0/2 NA 0/2
HMPV 0/9 NA 1/9 (20)
Influenza A 0/13 NA 4/13 (20, 20, 20, 20)
Influenza B 0/6 NA 0/6
Rhinovirus 0/9 NA 2/9 (20, 20)
RSV 0/9 NA 1/9 (20)
PIV-1 0/4 NA 0/4
PIV-3 0/4 NA 0/4
Mycoplasma 0/1 NA 0/1
CMV 0/9 NA 0/9
EBV 0/12 NA 0/12
Recent CoV infections‡ α-CoV HCoV-229E 0/19 NA 3/19 (20, 20, 20)
α-CoV HCoV-NL63 0/18 NA 0/18

β-CoV HCoV-OC43
1/21 (80)

Persons with camel contact S1-microarray positive§ 4/19 4/4 (40, 40, 40, 20) 6/15 (40, 40, 20, 20, 20, 20) 21 52.6
S1-microarray negative 0/18 NA 1/18 (20) NA NA
RT-PCR–confirmed MERS 
cases <14 d postdiagnosis 11/21 11/11 1/10 (80) NA NA
>14 d postdiagnosis 7/7 7/7 NA 100 100
6–12 mo postdiagnosis; mild infection 5/17 5/5 NA 35.3 35.3
6–12 mo postdiagnosis; severe infection 15/15 15/15 NA 100 100

*CMV, cytomegalovirus; CoV, coronavirus; EBV, Epstein-Barr virus; ELISA, enzyme-linked immunosorbent assay; HCoV, human coronavirus; HMPV, human metapneumovirus; MERS, Middle East respiratory syndrome; NA, not applicable; PIV, parainfluenza virus; PRNT, plaque reduction neutralization test; PRNT90, 90% endpoint PRNT; rELISA, routine ELISA; RSV, respiratory syncytial virus; RT-PCR, reverse transcription PCR.
†None of the serum samples from specificity cohorts tested positive by in-house S1 ELISA or microarray.
§All 19 serum samples (protein microarray positive) tested positive by in-house S1 ELISA.

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Page created: September 17, 2019
Page updated: September 17, 2019
Page reviewed: September 17, 2019
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