Suggested new breakpoints of anti-MERS-CoV antibody ELISA titers: performance analysis of serologic tests.
Identifieur interne : 000C29 ( PubMed/Corpus ); précédent : 000C28; suivant : 000C30Suggested new breakpoints of anti-MERS-CoV antibody ELISA titers: performance analysis of serologic tests.
Auteurs : J-H Ko ; M A Müller ; H. Seok ; G E Park ; J Y Lee ; S Y Cho ; Y E Ha ; J Y Baek ; S H Kim ; J-M Kang ; Y-J Kim ; I J Jo ; C R Chung ; M-J Hahn ; C. Drosten ; C-I Kang ; D R Chung ; J-H Song ; E-S Kang ; K R PeckSource :
- European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology [ 1435-4373 ] ; 2017.
English descriptors
- KwdEn :
- Antibodies, Viral (blood), Coronavirus Infections (blood), Coronavirus Infections (diagnosis), Coronavirus Infections (immunology), Coronavirus Infections (virology), Enzyme-Linked Immunosorbent Assay (methods), Humans, Immunoglobulin A (blood), Immunoglobulin G (blood), Immunoglobulin M (blood), Middle East Respiratory Syndrome Coronavirus (immunology), Sensitivity and Specificity, Serologic Tests (methods).
- MESH :
- chemical , blood : Antibodies, Viral, Immunoglobulin A, Immunoglobulin G, Immunoglobulin M.
- blood : Coronavirus Infections.
- diagnosis : Coronavirus Infections.
- immunology : Coronavirus Infections, Middle East Respiratory Syndrome Coronavirus.
- methods : Enzyme-Linked Immunosorbent Assay, Serologic Tests.
- virology : Coronavirus Infections.
- Humans, Sensitivity and Specificity.
Abstract
To provide optimal cut-off values of anti-Middle East respiratory syndrome coronavirus (MERS-CoV) serologic tests, we evaluated performance of ELISA IgG, ELISA IgA, IFA IgM, and IFA IgG using 138 serum samples of 49 MERS-CoV-infected patients and 219 serum samples of 219 rRT-PCR-negative MERS-CoV-exposed healthcare personnel and patients. The performance analysis was conducted for two different purposes: (1) prediction of neutralization activity in MERS-CoV-infected patients, and (2) epidemiologic surveillance of MERS-CoV infections among MERS-CoV-exposed individuals. To evaluate performance according to serum collection time, we used 'days post onset of illness (dpoi)' and 'days post exposure (dpex)' assessing neutralization activity and infection diagnosis, respectively. Performance of serologic tests improved with delayed sampling time, being maximized after a seroconversion period. In predicting neutralization activity, ELISA IgG tests showed optimal performance using sera collected after 21 dpoi at cut-off values of OD ratio 0.4 (sensitivity 100% and specificity 100%), and ELISA IgA showed optimal performance using sera collected after 14 dpoi at cut-off value of OD ratio 0.2 (sensitivity 85.2% and specificity 100%). In diagnosis of MERS-CoV infection, ELISA IgG exhibited optimal performance using sera collected after 28 dpex, at a cut-off value of OD ratio 0.2 (sensitivity 97.3% and specificity 92.9%). These new breakpoints are markedly lower than previously suggested values (ELISA IgG OD ratio 1.1, sensitivity 34.8% and specificity 100% in the present data set), and the performance data help serologic tests to be practically used in the field of MERS management.
DOI: 10.1007/s10096-017-3043-3
PubMed: 28695355
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Suggested new breakpoints of anti-MERS-CoV antibody ELISA titers: performance analysis of serologic tests.</title><author><name sortKey="Ko, J H" sort="Ko, J H" uniqKey="Ko J" first="J-H" last="Ko">J-H Ko</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Muller, M A" sort="Muller, M A" uniqKey="Muller M" first="M A" last="Müller">M A Müller</name><affiliation><nlm:affiliation>Institute of Virology, Charité - Universitätsmedizin Berlin, Helmut-Ruska-Haus Charitéplatz 1, 10117, Berlin, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Seok, H" sort="Seok, H" uniqKey="Seok H" first="H" last="Seok">H. Seok</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Park, G E" sort="Park, G E" uniqKey="Park G" first="G E" last="Park">G E Park</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Lee, J Y" sort="Lee, J Y" uniqKey="Lee J" first="J Y" last="Lee">J Y Lee</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Cho, S Y" sort="Cho, S Y" uniqKey="Cho S" first="S Y" last="Cho">S Y Cho</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Ha, Y E" sort="Ha, Y E" uniqKey="Ha Y" first="Y E" last="Ha">Y E Ha</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Baek, J Y" sort="Baek, J Y" uniqKey="Baek J" first="J Y" last="Baek">J Y Baek</name><affiliation><nlm:affiliation>Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Kim, S H" sort="Kim, S H" uniqKey="Kim S" first="S H" last="Kim">S H Kim</name><affiliation><nlm:affiliation>Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Kang, J M" sort="Kang, J M" uniqKey="Kang J" first="J-M" last="Kang">J-M Kang</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Kim, Y J" sort="Kim, Y J" uniqKey="Kim Y" first="Y-J" last="Kim">Y-J Kim</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Jo, I J" sort="Jo, I J" uniqKey="Jo I" first="I J" last="Jo">I J Jo</name><affiliation><nlm:affiliation>Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Chung, C R" sort="Chung, C R" uniqKey="Chung C" first="C R" last="Chung">C R Chung</name><affiliation><nlm:affiliation>Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Hahn, M J" sort="Hahn, M J" uniqKey="Hahn M" first="M-J" last="Hahn">M-J Hahn</name><affiliation><nlm:affiliation>Department of Molecular Cell Biology, Center for Molecular Medicine, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, 440-746, South Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Drosten, C" sort="Drosten, C" uniqKey="Drosten C" first="C" last="Drosten">C. Drosten</name><affiliation><nlm:affiliation>Institute of Virology, Charité - Universitätsmedizin Berlin, Helmut-Ruska-Haus Charitéplatz 1, 10117, Berlin, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Kang, C I" sort="Kang, C I" uniqKey="Kang C" first="C-I" last="Kang">C-I Kang</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Chung, D R" sort="Chung, D R" uniqKey="Chung D" first="D R" last="Chung">D R Chung</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Song, J H" sort="Song, J H" uniqKey="Song J" first="J-H" last="Song">J-H Song</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Kang, E S" sort="Kang, E S" uniqKey="Kang E" first="E-S" last="Kang">E-S Kang</name><affiliation><nlm:affiliation>Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. eskang@skku.edu.</nlm:affiliation></affiliation></author><author><name sortKey="Peck, K R" sort="Peck, K R" uniqKey="Peck K" first="K R" last="Peck">K R Peck</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea. krpeck@skku.edu.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2017">2017</date><idno type="RBID">pubmed:28695355</idno><idno type="pmid">28695355</idno><idno type="doi">10.1007/s10096-017-3043-3</idno><idno type="wicri:Area/PubMed/Corpus">000C29</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000C29</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Suggested new breakpoints of anti-MERS-CoV antibody ELISA titers: performance analysis of serologic tests.</title><author><name sortKey="Ko, J H" sort="Ko, J H" uniqKey="Ko J" first="J-H" last="Ko">J-H Ko</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Muller, M A" sort="Muller, M A" uniqKey="Muller M" first="M A" last="Müller">M A Müller</name><affiliation><nlm:affiliation>Institute of Virology, Charité - Universitätsmedizin Berlin, Helmut-Ruska-Haus Charitéplatz 1, 10117, Berlin, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Seok, H" sort="Seok, H" uniqKey="Seok H" first="H" last="Seok">H. Seok</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Park, G E" sort="Park, G E" uniqKey="Park G" first="G E" last="Park">G E Park</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Lee, J Y" sort="Lee, J Y" uniqKey="Lee J" first="J Y" last="Lee">J Y Lee</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Cho, S Y" sort="Cho, S Y" uniqKey="Cho S" first="S Y" last="Cho">S Y Cho</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Ha, Y E" sort="Ha, Y E" uniqKey="Ha Y" first="Y E" last="Ha">Y E Ha</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Baek, J Y" sort="Baek, J Y" uniqKey="Baek J" first="J Y" last="Baek">J Y Baek</name><affiliation><nlm:affiliation>Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Kim, S H" sort="Kim, S H" uniqKey="Kim S" first="S H" last="Kim">S H Kim</name><affiliation><nlm:affiliation>Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Kang, J M" sort="Kang, J M" uniqKey="Kang J" first="J-M" last="Kang">J-M Kang</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Kim, Y J" sort="Kim, Y J" uniqKey="Kim Y" first="Y-J" last="Kim">Y-J Kim</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Jo, I J" sort="Jo, I J" uniqKey="Jo I" first="I J" last="Jo">I J Jo</name><affiliation><nlm:affiliation>Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Chung, C R" sort="Chung, C R" uniqKey="Chung C" first="C R" last="Chung">C R Chung</name><affiliation><nlm:affiliation>Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Hahn, M J" sort="Hahn, M J" uniqKey="Hahn M" first="M-J" last="Hahn">M-J Hahn</name><affiliation><nlm:affiliation>Department of Molecular Cell Biology, Center for Molecular Medicine, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, 440-746, South Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Drosten, C" sort="Drosten, C" uniqKey="Drosten C" first="C" last="Drosten">C. Drosten</name><affiliation><nlm:affiliation>Institute of Virology, Charité - Universitätsmedizin Berlin, Helmut-Ruska-Haus Charitéplatz 1, 10117, Berlin, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Kang, C I" sort="Kang, C I" uniqKey="Kang C" first="C-I" last="Kang">C-I Kang</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Chung, D R" sort="Chung, D R" uniqKey="Chung D" first="D R" last="Chung">D R Chung</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Song, J H" sort="Song, J H" uniqKey="Song J" first="J-H" last="Song">J-H Song</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Kang, E S" sort="Kang, E S" uniqKey="Kang E" first="E-S" last="Kang">E-S Kang</name><affiliation><nlm:affiliation>Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. eskang@skku.edu.</nlm:affiliation></affiliation></author><author><name sortKey="Peck, K R" sort="Peck, K R" uniqKey="Peck K" first="K R" last="Peck">K R Peck</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea. krpeck@skku.edu.</nlm:affiliation></affiliation></author></analytic><series><title level="j">European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology</title><idno type="eISSN">1435-4373</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antibodies, Viral (blood)</term><term>Coronavirus Infections (blood)</term><term>Coronavirus Infections (diagnosis)</term><term>Coronavirus Infections (immunology)</term><term>Coronavirus Infections (virology)</term><term>Enzyme-Linked Immunosorbent Assay (methods)</term><term>Humans</term><term>Immunoglobulin A (blood)</term><term>Immunoglobulin G (blood)</term><term>Immunoglobulin M (blood)</term><term>Middle East Respiratory Syndrome Coronavirus (immunology)</term><term>Sensitivity and Specificity</term><term>Serologic Tests (methods)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Antibodies, Viral</term><term>Immunoglobulin A</term><term>Immunoglobulin G</term><term>Immunoglobulin M</term></keywords><keywords scheme="MESH" qualifier="blood" xml:lang="en"><term>Coronavirus Infections</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Coronavirus Infections</term></keywords><keywords scheme="MESH" qualifier="immunology" xml:lang="en"><term>Coronavirus Infections</term><term>Middle East Respiratory Syndrome Coronavirus</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Enzyme-Linked Immunosorbent Assay</term><term>Serologic Tests</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>Coronavirus Infections</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Humans</term><term>Sensitivity and Specificity</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">To provide optimal cut-off values of anti-Middle East respiratory syndrome coronavirus (MERS-CoV) serologic tests, we evaluated performance of ELISA IgG, ELISA IgA, IFA IgM, and IFA IgG using 138 serum samples of 49 MERS-CoV-infected patients and 219 serum samples of 219 rRT-PCR-negative MERS-CoV-exposed healthcare personnel and patients. The performance analysis was conducted for two different purposes: (1) prediction of neutralization activity in MERS-CoV-infected patients, and (2) epidemiologic surveillance of MERS-CoV infections among MERS-CoV-exposed individuals. To evaluate performance according to serum collection time, we used 'days post onset of illness (dpoi)' and 'days post exposure (dpex)' assessing neutralization activity and infection diagnosis, respectively. Performance of serologic tests improved with delayed sampling time, being maximized after a seroconversion period. In predicting neutralization activity, ELISA IgG tests showed optimal performance using sera collected after 21 dpoi at cut-off values of OD ratio 0.4 (sensitivity 100% and specificity 100%), and ELISA IgA showed optimal performance using sera collected after 14 dpoi at cut-off value of OD ratio 0.2 (sensitivity 85.2% and specificity 100%). In diagnosis of MERS-CoV infection, ELISA IgG exhibited optimal performance using sera collected after 28 dpex, at a cut-off value of OD ratio 0.2 (sensitivity 97.3% and specificity 92.9%). These new breakpoints are markedly lower than previously suggested values (ELISA IgG OD ratio 1.1, sensitivity 34.8% and specificity 100% in the present data set), and the performance data help serologic tests to be practically used in the field of MERS management.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">28695355</PMID><DateCompleted><Year>2018</Year><Month>06</Month><Day>12</Day></DateCompleted><DateRevised><Year>2020</Year><Month>03</Month><Day>24</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1435-4373</ISSN><JournalIssue CitedMedium="Internet"><Volume>36</Volume><Issue>11</Issue><PubDate><Year>2017</Year><Month>Nov</Month></PubDate></JournalIssue><Title>European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology</Title><ISOAbbreviation>Eur. J. Clin. Microbiol. Infect. Dis.</ISOAbbreviation></Journal><ArticleTitle>Suggested new breakpoints of anti-MERS-CoV antibody ELISA titers: performance analysis of serologic tests.</ArticleTitle><Pagination><MedlinePgn>2179-2186</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1007/s10096-017-3043-3</ELocationID><Abstract><AbstractText>To provide optimal cut-off values of anti-Middle East respiratory syndrome coronavirus (MERS-CoV) serologic tests, we evaluated performance of ELISA IgG, ELISA IgA, IFA IgM, and IFA IgG using 138 serum samples of 49 MERS-CoV-infected patients and 219 serum samples of 219 rRT-PCR-negative MERS-CoV-exposed healthcare personnel and patients. The performance analysis was conducted for two different purposes: (1) prediction of neutralization activity in MERS-CoV-infected patients, and (2) epidemiologic surveillance of MERS-CoV infections among MERS-CoV-exposed individuals. To evaluate performance according to serum collection time, we used 'days post onset of illness (dpoi)' and 'days post exposure (dpex)' assessing neutralization activity and infection diagnosis, respectively. Performance of serologic tests improved with delayed sampling time, being maximized after a seroconversion period. In predicting neutralization activity, ELISA IgG tests showed optimal performance using sera collected after 21 dpoi at cut-off values of OD ratio 0.4 (sensitivity 100% and specificity 100%), and ELISA IgA showed optimal performance using sera collected after 14 dpoi at cut-off value of OD ratio 0.2 (sensitivity 85.2% and specificity 100%). In diagnosis of MERS-CoV infection, ELISA IgG exhibited optimal performance using sera collected after 28 dpex, at a cut-off value of OD ratio 0.2 (sensitivity 97.3% and specificity 92.9%). These new breakpoints are markedly lower than previously suggested values (ELISA IgG OD ratio 1.1, sensitivity 34.8% and specificity 100% in the present data set), and the performance data help serologic tests to be practically used in the field of MERS management.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Ko</LastName><ForeName>J-H</ForeName><Initials>JH</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, South Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Müller</LastName><ForeName>M A</ForeName><Initials>MA</Initials><AffiliationInfo><Affiliation>Institute of Virology, Charité - Universitätsmedizin Berlin, Helmut-Ruska-Haus Charitéplatz 1, 10117, Berlin, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>German Centre for Infection Research, Braunschweig, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Seok</LastName><ForeName>H</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Park</LastName><ForeName>G E</ForeName><Initials>GE</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lee</LastName><ForeName>J Y</ForeName><Initials>JY</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cho</LastName><ForeName>S Y</ForeName><Initials>SY</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ha</LastName><ForeName>Y E</ForeName><Initials>YE</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Baek</LastName><ForeName>J Y</ForeName><Initials>JY</Initials><AffiliationInfo><Affiliation>Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Republic of Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kim</LastName><ForeName>S H</ForeName><Initials>SH</Initials><AffiliationInfo><Affiliation>Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Republic of Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kang</LastName><ForeName>J-M</ForeName><Initials>JM</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kim</LastName><ForeName>Y-J</ForeName><Initials>YJ</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jo</LastName><ForeName>I J</ForeName><Initials>IJ</Initials><AffiliationInfo><Affiliation>Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chung</LastName><ForeName>C R</ForeName><Initials>CR</Initials><AffiliationInfo><Affiliation>Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hahn</LastName><ForeName>M-J</ForeName><Initials>MJ</Initials><AffiliationInfo><Affiliation>Department of Molecular Cell Biology, Center for Molecular Medicine, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, 440-746, South Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Drosten</LastName><ForeName>C</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Institute of Virology, Charité - Universitätsmedizin Berlin, Helmut-Ruska-Haus Charitéplatz 1, 10117, Berlin, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>German Centre for Infection Research, Braunschweig, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kang</LastName><ForeName>C-I</ForeName><Initials>CI</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chung</LastName><ForeName>D R</ForeName><Initials>DR</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Republic of Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Song</LastName><ForeName>J-H</ForeName><Initials>JH</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Republic of Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kang</LastName><ForeName>E-S</ForeName><Initials>ES</Initials><AffiliationInfo><Affiliation>Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. eskang@skku.edu.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Peck</LastName><ForeName>K R</ForeName><Initials>KR</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea. krpeck@skku.edu.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2017</Year><Month>07</Month><Day>11</Day></ArticleDate></Article><MedlineJournalInfo><Country>Germany</Country><MedlineTA>Eur J Clin Microbiol Infect Dis</MedlineTA><NlmUniqueID>8804297</NlmUniqueID><ISSNLinking>0934-9723</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance 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