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Letter to the Editor Re Assessing the Detection of Middle East Respiratory Syndrome Coronavirus IgG in Suspected and Proven Cases of Middle East Respiratory Syndrome Coronavirus Infection by Alhetheel et al Viral Immunol 2017 Epub ahead of print DOI 10 1089 vim 2017 0091 Sora Yasri 1 and Viroj Wiwanitkit 2 3 To the Editor W e read the article on Detection of Middle East Respiratory Syndrome Coronavirus MERS CoV IgG with great interest 1 Alhetheel et al concluded that MERS CoV IgG testing may not be suitable for diagnosing acute infection or estimating its prevalence during an outbreak 1 We agree that the serological investigation for MERS CoV might have some problems in diagnosis Nevertheless it is still used in some countries due to the less expensive cost comparing with molecular assay The good example is the use for sur veillance in Korea 2 Focusing on the false negative result in the report by Alhetheel et al the possible cause might be due to several reasons First in very early infection the main immu nological response should be IgM not IgG Hence the use of MERS CoV IgG test might result in false negative Second in case that there is an excessive immunological response to the infection the prozone effect is possible and this can result in false negative To manage possible prozone effect by dilution preparation or EDTA treatment 3 might help improve the diagnostic property of MERS CoV IgG test References 1 Alhetheel A Altalhi H Albarrag A et al Assessing the detection of Middle East respiratory syndrome coronavirus IgG in suspected and proven cases of Middle East re spiratory syndrome coronavirus infection Viral Immu nol 2017 Epub ahead of print DOI 10 1089 vim 2017 0091 2 Kim CJ Choi WS Jung Y et al Surveillance of the Middle East respiratory syndrome MERS coronavirus CoV infection in healthcare workers after contact with confirmed MERS patients incidence and risk factors of MERS CoV seropositivity Clin Microbiol Infect 2016 22 880 886 3 Wang J Meade JR Brown NK et al EDTA is superior to DTT treatment for overcoming the prozone effect in HLA antibody testing HLA 2017 89 82 89 Address correspondence to Dr Sora Yasri KMT Primary Care Center 15 Rama 2 Road Bangkok 10150 Thailand E mail sorayasri outlook co th 1 KMT Primary Care Center Bangkok Thailand 2 Department of Tropical Medicine Hainan Medical University Haikou China 3 Department of Community Medicine Dr DY Patil University Navi Mumbai India VIRAL IMMUNOLOGY Volume 30 Number 10 2017 Mary Ann Liebert Inc P 1 DOI 10 1089 vim 2017 0161 1 Downloaded by Tufts University package NERL from at 10 28 17 For personal use only