An Outbreak of Human Coronavirus OC43 Infection and Serological Cross-reactivity with SARS Coronavirus

Abstract

Background: In summer 2003, a respiratory outbreak was investigated in British Columbia, during which nucleic acid tests and serology unexpectedly indicated reactivity for severe acute respiratory syndrome coronavirus (SARS-CoV).

Methods: Cases at a care facility were epidemiologically characterized and sequentially investigated for conventional agents of respiratory infection, SARS-CoV and other human CoVs. Serological cross-reactivity between SARS-CoV and human CoV-OC43 (HCoV-OC43) was investigated by peptide spot assay.

Results: Ninety-five of 142 residents (67%) and 53 of 160 staff members (33%) experienced symptoms of respiratory infection. Symptomatic residents experienced cough (66%), fever (21%) and pneumonia (12%). Eight residents died, six with pneumonia. No staff members developed pneumonia. Findings on reverse transcriptase-polymerase chain reaction assays for SARS-CoV at a national reference laboratory were suspected to represent false positives, but this was confounded by concurrent identification of antibody to N protein on serology. Subsequent testing by reverse transcriptase-polymerase chain reaction confirmed HCoV-OC43 infection. Convalescent serology ruled out SARS. Notably, sera demonstrated cross-reactivity against nucleocapsid peptide sequences common to HCoV-OC43 and SARS-CoV.

Conclusions: These findings underscore the virulence of human CoV-OC43 in elderly populations and confirm that cross-reactivity to antibody against nucleocapsid proteins from these viruses must be considered when interpreting serological tests for SARS-CoV.

Keywords: Coronavirus; Human coronavirus OC43; Outbreak; Respiratory infection; SARS coronavirus; SARS-CoV; Severe acute respiratory syndrome.

Figure 1

Epidemic curve: Onset of respiratory illness in a long-term care facility. *Onset dates for two staff members are missing

Figure 2

Phylogenetic tree from sequencing of the pancoronavirus polymerase 1b gene region. Image reproduced with permission from the University of British Columbia Centre for Disease Control Molecular Services