Application of SARS-CoV-2 Serology to Address Public Health Priorities

Amy C. Sherman, Teresa Smith, Yerun Zhu, Kaitlin Taibl, Jessica Howard-Anderson, Taylor Landay, Nora Pisanic, Jennifer Kleinhenz, Trevor W. Simon, Daniel Espinoza, Neena Edupuganti, Skyler Hammond, Nadine Rouphael, Huifeng Shen, Jessica K. Fairley, Srilatha Edupuganti, Jaime A. Cardona-Ospina, Alfonso J. Rodriguez-Morales, Lakshmanane Premkumar, Jens WrammertRick Tarleton, Scott Fridkin, Christopher D. Heaney, Erin M. Scherer, Matthew H. Collins

Research output: Contribution to journalArticlepeer-review


Background: Antibodies against SARS-CoV-2 can be detected by various testing platforms, but a detailed understanding of assay performance is critical. Methods: We developed and validated a simple enzyme-linked immunosorbent assay (ELISA) to detect IgG binding to the receptor-binding domain (RBD) of SARS-CoV-2, which was then applied for surveillance. ELISA results were compared to a set of complimentary serologic assays using a large panel of clinical research samples. Results: The RBD ELISA exhibited robust performance in ROC curve analysis (AUC> 0.99; Se = 89%, Sp = 99.3%). Antibodies were detected in 23/353 (6.5%) healthcare workers, 6/9 RT-PCR-confirmed mild COVID-19 cases, and 0/30 non-COVID-19 cases from an ambulatory site. RBD ELISA showed a positive correlation with neutralizing activity (p = <0.0001, R2 = 0.26). Conclusions: We applied a validated SARS-CoV-2-specific IgG ELISA in multiple contexts and performed orthogonal testing on samples. This study demonstrates the utility of a simple serologic assay for detecting prior SARS-CoV-2 infection, particularly as a tool for efficiently testing large numbers of samples as in population surveillance. Our work also highlights that precise understanding of SARS-CoV-2 infection and immunity at the individual level, particularly with wide availability of vaccination, may be improved by orthogonal testing and/or more complex assays such as multiplex bead assays.

Original languageEnglish (US)
Article number744535
JournalFrontiers in Public Health
StatePublished - Nov 23 2021


  • SARS-CoV-2
  • antibody response
  • public health
  • serology

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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