{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T03:44:12Z","timestamp":1772163852063,"version":"3.50.1"},"reference-count":33,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2022,8,30]],"date-time":"2022-08-30T00:00:00Z","timestamp":1661817600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/bmj.com\/coronavirus\/usage"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Clin Pathol"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Serological tests are widely used in various medical disciplines for diagnostic and monitoring purposes. Unfortunately, the sensitivity and specificity of test systems are often poor, leaving room for false-positive and false-negative results. However, conventional methods were used to increase specificity and decrease sensitivity and vice versa. Using SARS-CoV-2 serology as an example, we propose here a novel testing strategy: the \u2018sensitivity improved two-test\u2019 or \u2018SIT\u00b2\u2019 algorithm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>SIT\u00b2 involves confirmatory retesting of samples with results falling in a predefined retesting zone of an initial screening test, with adjusted cut-offs to increase sensitivity. We verified and compared the performance of SIT\u00b2 to single tests and orthogonal testing (OTA) in an Austrian cohort (1117 negative, 64 post-COVID-positive samples) and validated the algorithm in an independent British cohort (976 negatives and 536 positives).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The specificity of SIT\u00b2 was superior to single tests and non-inferior to OTA. The sensitivity was maintained or even improved using SIT\u00b2 when compared with single tests or OTA. SIT\u00b2 allowed correct identification of infected individuals even when a live virus neutralisation assay could not detect antibodies. Compared with single testing or OTA, SIT\u00b2 significantly reduced total test errors to 0.46% (0.24\u20130.65) or 1.60% (0.94\u20132.38) at both 5% or 20% seroprevalence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>For SARS-CoV-2 serology, SIT\u00b2 proved to be the best diagnostic choice at both 5% and 20% seroprevalence in all tested scenarios. It is an easy to apply algorithm and can potentially be helpful for the serology of other infectious diseases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jcp-2022-208171","type":"journal-article","created":{"date-parts":[[2022,8,30]],"date-time":"2022-08-30T13:20:10Z","timestamp":1661865610000},"page":"770-777","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Increasing test specificity without impairing sensitivity: lessons learned from SARS-CoV-2 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Reduced sensitivity of commercial Spike-specific antibody assays after primary infection with the SARS-CoV-2 omicron variant. 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