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IgA is most abundant in mucosal surfaces but can also be found in serum, and arises within the first week of symptom onset. Immunoglobulin (Ig) M quickly appears but has a short half-life ( Fig. 1 The humoral immunity is characterized by the production of antibodies by B cells as a response to antigens. This review summarizes the basic principles of serological and immunological tests for COVID-19 and provides recommendations for its application. Cellular immunity also plays a potential role in the protection against COVID-19. However, humoral immunity is just one part of our immune system.
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Moreover, serological tests are important to assess seroprevalence and evaluate the effectiveness of applied containment strategies at the community level. In those cases, serological tests may explain a particular clinical presentation, although it does not assess infectiousness. However, in some cases with negative molecular or antigen tests for COVID-19 but remaining high suspicion, it can be relevant to determine whether a patient has previously been infected with COVID-19. Both aim to detect COVID-19 during the early phase of infection. T-cell responses against SARS-CoV-2 have also been detected in recovered COVID-19 patients with no detectable antibodies.ĭiagnostics for coronavirus disease 2019 (COVID-19) are mostly performed in cases of a suspected acute respiratory infection or for screening of asymptomatic cases as part of outbreak management. The presence of cross-reactive SARS-CoV-2-specific T cells in never exposed patients suggests the possibility of cellular immunity induced by other circulating coronaviruses. Enzyme-linked immunospot (ELISpot) assays can be used to measure T-cell responses against SARS-CoV-2. Besides humoral immunity, cellular immunity is also essential for successful host defences against viruses. Enzyme-linked immunosorbent assay (ELISA) and chemiluminescence immunoassays (CLIAs) have higher sensitivities. Lateral flow immunoassay (LFIA) antibody tests have the advantages of being easy and fast to perform, but many have a low sensitivity in acute settings. The presence of antibodies against SARS-CoV-2 may indicate a recent or past COVID-19 infection. For certain indications, including delayed disease presentations, serological tests can have added value. Serological tests are highly specific but heterogeneous in their sensitivity for the diagnosis of COVID-19.