A systematic review of antibody mediated immunity to coronaviruses: kinetics, correlates of protection, and association with severity
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Abstract
Many public health responses and modeled scenarios for COVID-19 outbreaks caused by SARS-CoV-2 assume that infection results in an immune response that protects individuals from future infections or illness for some amount of time. The presence or absence of protective immunity due to infection or vaccination (when available) will affect future transmission and illness severity. Here, we review the scientific literature on antibody immunity to coronaviruses, including SARS-CoV-2 as well as the related SARS-CoV, MERS-CoV and endemic human coronaviruses (HCoVs). We reviewed 2,452 abstracts and identified 491 manuscripts relevant to 5 areas of focus: 1) antibody kinetics, 2) correlates of protection, 3) immunopathogenesis, 4) antigenic diversity and cross-reactivity, and 5) population seroprevalence. While further studies of SARS-CoV-2 are necessary to determine immune responses, evidence from other coronaviruses can provide clues and guide future research.
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Seroprevalence did not vary significantly by sex, consistent with other studies.
“Consistent with other studies, seroprevalence did not vary significantly by sex (9, 10, 16); however, it peaked in 35- to 44-year-olds and was lowest for those ≥45 years, which is also consistent with existing reports in which seroprevalence was found to be lower in older adults (9, 10).”
From Seroprevalence of anti–SARS-CoV-2 IgG antibodies in Kenyan blood donors (2021) · cites this paper as [16]
Most people have pre-existing immune responses to other endemic human coronaviruses.
“Finally, most individuals have pre-existing immune responses to other endemic human coronaviruses109.”
From Immunological mechanisms of vaccine-induced protection against COVID-19 in humans (2021) · cites this paper as [109]
High levels of neutralising antibodies against the SARS-CoV-2 spike protein provide substantial protection against reinfection, as supported by data from common human coronaviruses, non-human primate models, and vaccine studies.
“High concentrations of neutralising antibodies targeting the SARS-CoV-2 spike protein offer considerable protection against SARS-CoV-2 reinfection, supported by data from common human coronaviruses and non-human primate models and vaccine studies.”
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“Second, in some individuals, SARS-CoV-2 antibodies wane over time to undetectable levels leading to false negatives, especially in those who had asymptomatic COVID-19 [27, 28].”
BackgroundAnti-SARS-CoV-2 Antibodies Persist for up to 13 Months and Reduce Risk of Reinfection
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- Authors
- Huang, A. T., Garcia-Carreras, B., Hitchings, M. D. T., Yang, B., Katzelnick, L. C., Rattigan, S. M., Borgert, B. A., Moreno, C. A., Solomon, B. D., Trimmer-Smith, L., Etienne, V., Rodriguez-Barraquer, I., Lessler, J., Salje, H., Burke, D. S., Wesolowski, A., & Cummings, D. A. T.
- Affiliations
- University of Florida (US)
- National Institutes of Health (US)
- Johns Hopkins University (US)
- Institut Pasteur (FR)
- University of Pittsburgh (US)
- Corresponding author
- Cummings, Derek A. T.
- ORCID
- Venue
- Nature Communications
- Published
- 2020-09-17
- Volume
- 11
- Issue
- 1
- Pages
- 4704-4704
- ISSN
- 2041-1723 (ISSN-L)
- PMC
- PMC7499300
- OpenAlex
- W3087128437
- Cited by
- 1,026
- References
- 149
- Citations by year
- 2026: 10 · 2025: 28 · 2024: 57 · 2023: 92 · 2022: 227 · 2021: 412 · 2020: 199 · 2018: 1
- FWCI
- 11.02
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Nature Communications (publishedVersion, cc-by)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion, cc-by)
- PubMed Central (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion, cc-by-nc-nd)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- Apollo (cc-by)
- Apollo
- Funders
- John A Watson Faculty Scholar fellowship
- U.S. Department of Health & Human Services | National Institutes of Health (DP2LM013102)
- Burroughs Wellcome Fund (Career Award at the Scientific Interface)
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Life Sciences › Agricultural and Biological Sciences › Animal Science and Zoology › Animal Virus Infections Studies
- Life Sciences › Immunology and Microbiology › Immunology › Immune responses and vaccinations
- Keywords
- humoral immunity, SARS-CoV-2, COVID-19 pandemic, SARS-CoV, MERS-CoV, antibody kinetics, correlates of protection, immunopathogenesis, antigenic diversity, cross-reactivity, seroprevalence, disease severity, protective immunity
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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