At the individual level, there is some debate about the utility of serology assays for diagnosing acute COVID-19 infection 11 however, the assays provide a tool for diagnosing post-acute or chronic COVID-19 symptoms in individuals who may have had asymptomatic or undiagnosed acute infections 12. Serology has also been used in population studies to evaluate approaches to vaccine prioritization 7 and dosing 8 and to assess the durability of antibody production as a correlate of immunity after vaccination 9 or natural infection 10. Serosurveillance can be invaluable for determining the case fatality rate, tracking incidence and prevalence, and investigating medical sequelae following recovery 5, 6. At the population level, serology can be used for disease surveillance and the evaluation of public health countermeasures to decrease transmission rates, and is a critical component of clinical studies to qualify new vaccines 1, 2, 3, 4. Serology assays measuring the development of host antibodies against SARS-CoV-2 antigens are important tools in the public health response to COVID-19. The easy-to-use saliva collection kit, coupled with thresholds for positivity and methods of flagging samples for retest, provides a framework for large-scale serosurveillance of SARS-CoV-2. Moreover, serologic testing for endemic coronaviruses performed in multiplex with SARS-CoV-2 antigens has the potential to identify samples that may require retesting due to effects of pre-analytical factors. Reactivity to N antigen also was detected with 92.6% sensitivity and 90.7% specificity at 4–8 weeks after diagnostic testing. At our pre-established threshold (0.963 AU/mL), salivary IgG reactivity to full-length spike protein achieved 95.8% sensitivity and 92.4% specificity at 2–4 weeks after diagnostic testing, which is comparable to the typical sensitivity and specificity achieved for serum testing. Diverse users self-collected saliva and returned specimens via mail in compliance with shipping regulations. Longitudinal specimens were analyzed in order to monitor seroconversion in the weeks after a diagnostic PCR test for SARS-CoV-2. In this prospective study, non-vaccinated patients were recruited after PCR testing to self-collect saliva and return their specimens via mail. Automated serologic testing of saliva, especially specimens that are self-collected at home and sent to a laboratory via the mail without refrigeration, could be a highly-scalable strategy for population-wide testing. Serology provides tools for epidemiologic studies, and may have a role in vaccine prioritization and selection.
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