SARS-CoV-2-IgG response is different in COVID-19 outpatients and asymptomatic contact persons

Abstract

Commercially available immunoassays have been developed for sensitive and specific detection of antibodies against SARS-CoV-2. While a fast and reliable IgG response has been reported for samples from hospitalized COVID-19 patients, less is known about ambulatory patients. We evaluated the SARS-CoV-2-IgG response by the Anti-SARS-CoV-2-ELISA IgG (Euroimmun) in a defined cohort of SARS-CoV-2-PCR-confirmed outpatients and asymptomatic contact persons including 137 serum samples from PCR-confirmed outpatients (n = 111) and asymptomatic but PCR-positive contact persons (n = 26) sent to our laboratory as part of routine diagnostics for determination of SARS-CoV-2-IgG. Overall positivity rate for SARS-CoV-2-IgG was 81.1 % in outpatients (irrespective of sampling before or after day 21 after onset of symptoms) but significantly lower in asymptomatic contact persons (15.4 %, p < 0.0001). In contact persons without symptoms the ct values of the PCR assays were significantly higher (5-7 threshold cycles) than in outpatients, and ct values were significantly negative correlated to the SARS-CoV-2-IgG ratio, suggesting a lower viral load as a possible explanation for lower rate of seropositivity. In summary, our study shows that serological response to SARS-CoV-2 in outpatients including asymptomatic persons is less pronounced than in hospitalized patients. Further controlled studies are urgently needed to determine serological response in outpatients and asymptomatic persons since this is the main target population for seroepidemiological investigations.

Keywords: COVID-19; Contact persons; Outpatients; SARS-CoV-2-IgG; ct values.

Fig. 1

Relation of Ct values of the RT-PCR runs and Anti-SARS-CoV-2-ELISA IgG ratio in symptomatic outpatients (A) and asymptomatic contact persons (B). Figure legend: Ct values of 94 outpatients and 23 asymptomatic contact persons were plotted against SARS-CoV-2-IgG ratios determined by SARS-CoV-2-ELISA IgG (Euroimmun). Data included ct values for the E gene (n = 82 patients and n = 19 contact persons), orf gene (n = 50 patients and n = 8 contact persons), and N gene (n = 20 patients and N = 2 contact persons).