Comparison of SARS-CoV-2 anti-spike IgG and anti-nucleoprotein IgG seroprevalence amongst a pre-vaccine cohort of healthcare workers at an academic medical center in Boston, Massachusetts

ABSTRACT

Background: Accurate measurement of antibodies is a necessary tool for assessing exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and facilitating an understanding of the role antibodies play in overall immunity. Most available assays are qualitative in nature and employ a threshold to determine the presence of antibodies, however some-quantitative assays are now available. Using cross-sectional data collected as part of an ongoing longitudinal cohort study, we aim to assess the seroprevalence of SARSCoV-2 antibodies using the Abbott AdviseDX SARS-CoV-2 IgG II (anti-S) assay and compare these results to previously measured seroprevalence of anti-nucleoprotein (anti-N) IgG in this cohort of health care workers (HCWs) at an academic medical center in Boston. Method(s) A total of 1,743 HCWs at Boston Medical Center (BMC) provided serum samples that were analyzed for SARS-CoV-2 anti-S IgG and IgM using the Abbott AdviseDx SARS-CoV-2 IgG II and Abbott AdviseDx SARS-CoV-2 IgM assay, respectively. These results were compared to previously assessed anti-N IgG seroprevalence. Precision, linearity, and positive and negative concordance with prior reverse transcription-polymerase chain reaction (RT-PCR) test were evaluated for the anti-S IgG II assay. Seroprevalence and its association with demographic variables was also assessed. Result(s) Linearity and precision results were clinically acceptable. The anti-S IgG positive and negative concordance with RT-PCR results were 88.2% (95% CI 79.4-94.2%) and 97.4% (95% CI 95.2-98.8%), respectively. Overall, 126 (7.2%) of 1,743 participants were positive for anti-S IgG. The original agreement in this population with the qualitative, anti-N IgG assay was 70.6%. Upon optimizing the threshold from 1.4 to 0.49 signal to cut-off ratio (S/CO) of the anti-N IgG assay, the positive agreement of the assay increased to 84.7%. Conclusion(s) The anti-S IgG II assay demonstrated reproducible and reliable measurements. Higher anti-S IgG to anti-N IgG seroprevalence highlights the present differences between serum antibodies to different epitopes of the SARS-CoV-2 virus. Further, the greater seroprevalence of anti-S IgG compared to positive RT-PCR results points to a potential for asymptomatic infection among this group of HCWs. Our results also highlight the potential utility in optimizing thresholds of the qualitative SARS-CoV-2 anti-N IgG assay for better agreement with the anti-S IgG II assay by the same vendor.Copyright © 2022 by the Author(s).