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Five Antigen Tests for SARS-CoV-2: Virus Viability Matters.

Miroslav Homza1,2, Hana Zelena3,4, Jaroslav Janosek5

  • 1Hospital Karvina-Raj, Vydmuchov 399, 734 01 Karvina, Czech Republic.

Viruses
|April 30, 2021
PubMed
Summary

Antigen tests for SARS-CoV-2 (AGT) can identify infectious patients, even when RT-PCR tests are negative. Considering virus viability improves AGT accuracy, making them valuable for high-prevalence screening.

Keywords:
COVID-19RT-PCRSARS-CoV-2antigen testinginfectiousnessviability

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Area of Science:

  • Virology
  • Infectious Diseases
  • Diagnostic Testing

Background:

  • Antigen testing for SARS-CoV-2 (AGT) is less sensitive than RT-PCR.
  • Infectiousness of RT-PCR positive, AGT negative cases is poorly understood.
  • High prevalence screening settings present unique diagnostic challenges.

Purpose of the Study:

  • To evaluate the performance of five AGTs against RT-PCR in a high-prevalence screening setting.
  • To assess the impact of virus viability on AGT accuracy.
  • To determine the utility of AGTs in identifying infectious individuals.

Main Methods:

  • 1141 mildly symptomatic or asymptomatic patients were tested with AGT and RT-PCR.
  • Virus viability was assessed using cell culture for discordant results.
  • Five different AGTs were compared to RT-PCR.

Main Results:

  • AGT sensitivities ranged from 42% to 76% compared to RT-PCR.
  • The best AGT showed 76% sensitivity and 97% specificity.
  • Adjusting for virus viability, sensitivities increased to 81-97%, with high specificities (>96%).
  • Nearly 90% of "false negative" AGT results showed no viable virus.

Conclusions:

  • Virus viability is crucial for accurate AGT performance assessment.
  • Well-performing AGTs can effectively identify infectious patients in high-prevalence settings.
  • Further investigation into RT-PCR positive, non-viable virus samples may prevent unnecessary isolation.