Virological and Serological Assessment of US Army Trainees Isolated for Coronavirus Disease 2019

Shilpa Hakre; Ines Lakhal-Naouar; David B King; Jennifer L Burns; Kenya N Jackson; Stephen W Krauss; Prabha Chandrasekaran; Melanie D McCauley; Brittany L Ober Shepherd; Samantha McHenry; Elizabeth J Bianchi; Jason Ouellette; Janice M Darden; Aaron D Sanborn; Sharon P Daye; Paul O Kwon; Jeremiah Stubbs; Crystal L Brigantti; Tara L Hall; Milford H Beagle; Jason A Pieri; Timothy R Frambes; Robert J O'Connell; Kayvon Modjarrad; Clinton K Murray; Linda L Jagodzinski; Paul T Scott; Sheila A Peel

doi:10.1093/infdis/jiac198

Virological and Serological Assessment of US Army Trainees Isolated for Coronavirus Disease 2019

J Infect Dis. 2022 Nov 11;226(10):1743-1752. doi: 10.1093/infdis/jiac198.

Authors

Shilpa Hakre^{1

2}, Ines Lakhal-Naouar^{2

3}, David B King², Jennifer L Burns⁴, Kenya N Jackson⁵, Stephen W Krauss⁶, Prabha Chandrasekaran^{2

3}, Melanie D McCauley^{1

2}, Brittany L Ober Shepherd^{1

2}, Samantha McHenry², Elizabeth J Bianchi^{1

2}, Jason Ouellette^{2

3}, Janice M Darden^{2

3}, Aaron D Sanborn⁷, Sharon P Daye⁸, Paul O Kwon⁹, Jeremiah Stubbs¹⁰, Crystal L Brigantti¹¹, Tara L Hall¹², Milford H Beagle¹³, Jason A Pieri¹⁴, Timothy R Frambes¹⁴, Robert J O'Connell¹⁵, Kayvon Modjarrad¹, Clinton K Murray¹⁶, Linda L Jagodzinski³, Paul T Scott¹, Sheila A Peel³

Affiliations

¹ Walter Reed Army Institute of Research, Emerging Infectious Diseases Branch, Silver Spring, Maryland, USA.
² Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MarylandUSA.
³ Walter Reed Army Institute of Research, Diagnostics and Countermeasures Branch, Silver Spring, Maryland, USA.
⁴ Walter Reed Army Institute of Research, Pilot Bioproduction Facility, Silver Spring, Maryland, USA.
⁵ Walter Reed Army Institute of Research, Experimental Therapeutics, Silver Spring, Maryland, USA.
⁶ Walter Reed Army Institute of Research, Center for Military Psychiatry and Neuroscience, Silver Spring, Maryland, USA.
⁷ Walter Reed Army Institute of Research, Clinical Trials Center, Silver Spring, Maryland, USA.
⁸ Walter Reed Army Institute of Research, One Health Branch, Silver Spring, Maryland, USA.
⁹ Program Executive Office for Simulation, Training and Instrumentation, Orlando, Florida, USA.
¹⁰ Fort Belvoir, Occupational Medicine, Virginia, USA.
¹¹ DiLorenzo Pentagon Health Clinic, Optometry, Washington, District of Columbia, USA.
¹² Moncrief Army Health Clinic, Fort Jackson, South Carolina, USA.
¹³ 10th Mountain Division, Fort Drum, New York, USA.
¹⁴ United States Army Training Center, Fort Jackson, South Carolina, USA.
¹⁵ Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
¹⁶ Brooke Army Medical Center, Fort Sam Houston, Texas, USA.

Abstract

Background: Laboratory screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a key mitigation measure to avoid the spread of infection among recruits starting basic combat training in a congregate setting. Because viral nucleic acid can be detected persistently after recovery, we evaluated other laboratory markers to distinguish recruits who could proceed with training from those who were infected.

Methods: Recruits isolated for coronavirus disease 2019 (COVID-19) were serially tested for SARS-CoV-2 subgenomic ribonucleic acid (sgRNA), and viral load (VL) by reverse-transcriptase polymerase chain reaction (RT-PCR), and for anti- SARS-CoV-2. Cluster and quadratic discriminant analyses of results were performed.

Results: Among 229 recruits isolated for COVID-19, those with a RT-PCR cycle threshold >30.49 (sensitivity 95%, specificity 96%) or having sgRNA log10 RNA copies/mL <3.09 (sensitivity and specificity 96%) at entry into isolation were likely SARS-CoV-2 uninfected. Viral load >4.58 log10 RNA copies/mL or anti-SARS-CoV-2 signal-to-cutoff ratio <1.38 (VL: sensitivity and specificity 93%; anti-SARS-CoV-2: sensitivity 83%, specificity 79%) had comparatively lower sensitivity and specificity when used alone for discrimination of infected from uninfected.

Conclusions: Orthogonal laboratory assays used in combination with RT-PCR may have utility in determining SARS-CoV-2 infection status for decisions regarding isolation.

Keywords: Army recruit; SARS-CoV-2; cycle threshold value; isolation; sgRNA.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19 Testing
COVID-19* / diagnosis
Humans
RNA
RNA, Viral / genetics
Reverse Transcriptase Polymerase Chain Reaction
SARS-CoV-2
Sensitivity and Specificity

Substances

RNA
RNA, Viral