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

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Hospital Karvina-Raj, Vydmuchov 399, 734 01 Karvina, Czech Republic
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Department of Internal Medicine, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
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Institute of Public Health Ostrava, Partyzánské Náměstí 7, 702 00 Ostrava, Czech Republic
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Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
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Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
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Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
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Department of Clinical Biochemistry, Institute of Laboratory Medicine, University Hospital Ostrava, 17. Listopadu 1790/5, 708 00 Ostrava, Czech Republic
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Faculty of Medicine Hradec Kralove, Charles University Prague, Simkova 870, 500 03 Hradec Kralove, Czech Republic
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Author to whom correspondence should be addressed.
Academic Editor: Tomas Ruml
Viruses 2021, 13(4), 684; https://doi.org/10.3390/v13040684
Received: 13 March 2021 / Revised: 8 April 2021 / Accepted: 13 April 2021 / Published: 15 April 2021
Antigen testing for SARS-CoV-2 (AGT) is generally considered inferior to RT-PCR testing in terms of sensitivity. However, little is known about the infectiousness of RT-PCR positive patients who pass undetected by AGT. In a screening setting for mildly symptomatic or asymptomatic patients with high COVID-19 prevalence (30–40%), 1141 patients were tested using one of five AGTs and RT-PCR. Where the results differed, virus viability in the samples was tested on cell culture (CV-1 cells). The test battery included AGTs by JOYSBIO, Assure Tech, SD Biosensor, VivaChek Biotech and NDFOS. Sensitivities of the ATGs compared to RT-PCR ranged from 42% to 76%. The best test yielded a 76% sensitivity, 97% specificity, 92% positive, and 89% negative predictive values, respectively. However, in the best performing ATG tests, almost 90% of samples with “false negative” AGT results contained no viable virus. Corrected on the virus viability, sensitivities grew to 81–97% and, with one exception, the tests yielded high specificities >96%. Performance characteristics of the best test after adjustment were 96% sensitivity, 97% specificity, 92% positive, and 99% negative predictive values (high prevalence population). We, therefore, believe that virus viability should be considered when assessing the AGT performance. Also, our results indicate that a well-performing antigen test could in a high-prevalence setting serve as an excellent tool for identifying patients shedding viable virus. We also propose that the high proportion of RT-PCR-positive samples containing no viable virus in the group of “false negatives” of the antigen test should be further investigated with the aim of possibly preventing needless isolation of such patients. View Full-Text
Keywords: SARS-CoV-2; COVID-19; RT-PCR; antigen testing; infectiousness; viability SARS-CoV-2; COVID-19; RT-PCR; antigen testing; infectiousness; viability
MDPI and ACS Style

Homza, M.; Zelena, H.; Janosek, J.; Tomaskova, H.; Jezo, E.; Kloudova, A.; Mrazek, J.; Svagera, Z.; Prymula, R. Five Antigen Tests for SARS-CoV-2: Virus Viability Matters. Viruses 2021, 13, 684. https://doi.org/10.3390/v13040684

AMA Style

Homza M, Zelena H, Janosek J, Tomaskova H, Jezo E, Kloudova A, Mrazek J, Svagera Z, Prymula R. Five Antigen Tests for SARS-CoV-2: Virus Viability Matters. Viruses. 2021; 13(4):684. https://doi.org/10.3390/v13040684

Chicago/Turabian Style

Homza, Miroslav; Zelena, Hana; Janosek, Jaroslav; Tomaskova, Hana; Jezo, Eduard; Kloudova, Alena; Mrazek, Jakub; Svagera, Zdenek; Prymula, Roman. 2021. "Five Antigen Tests for SARS-CoV-2: Virus Viability Matters" Viruses 13, no. 4: 684. https://doi.org/10.3390/v13040684

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