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Longitudinal observation and decline of neutralizing antibody responses in the three months following SARS-CoV-2 infection in humans
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Abstract
Antibody responses to SARS-CoV-2 can be detected in most infected individuals 10-15 d after the onset of COVID-19 symptoms. However, due to the recent emergence of SARS-CoV-2 in the human population, it is not known how long antibody responses will be maintained or whether they will provide protection from reinfection. Using sequential serum samples collected up to 94 d post onset of symptoms (POS) from 65 individuals with real-time quantitative PCR-confirmed SARS-CoV-2 infection, we show seroconversion (immunoglobulin (Ig)M, IgA, IgG) in >95% of cases and neutralizing antibody responses when sampled beyond 8 d POS. We show that the kinetics of the neutralizing antibody response is typical of an acute viral infection, with declining neutralizing antibody titres observed after an initial peak, and that the magnitude of this peak is dependent on disease severity. Although some individuals with high peak infective dose (ID 50 > 10,000) maintained neutralizing antibody titres >1,000 at >60 d POS, some with lower peak ID 50 had neutralizing antibody titres approaching baseline within the follow-up period. A similar decline in neutralizing antibody titres was observed in a cohort of 31 seropositive healthcare workers. The present study has important implications when considering widespread serological testing and antibody protection against reinfection with SARS-CoV-2, and may suggest that vaccine boosters are required to provide long-lasting protection.
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“SARS-CoV-2 infection rapidly elicits nAbs (16, 21–24) that decline, but remain detectable, over several months (25–29).”
From mRNA vaccination boosts cross-variant neutralizing antibodies elicited by SARS-CoV-2 infection (2021) · cites this paper as [28]
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COVID-19 Antibody Tests and Their Limitations
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Large-Scale Study of Antibody Titer Decay following BNT162b2 mRNA Vaccine or SARS-CoV-2 Infection
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The effect of spike mutations on SARS-CoV-2 neutralization
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“Cells were transfected using 60 mg of PEI-Max (Polysciences) with amix of three plasmids: 9.1 mgHIV-1 luciferase reporter vector (Seow et al., 2020), 9.1 mg HIV p8.”
InfluentialSelf-citationHe, Z., Ren, L., Yang, J., Guo, L., Feng, S., Ma, C., Wang, X., Leng, Z., Tong, X., Zhou, W., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00238-5 · Cited by 226
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“Recent reports that COVID-19 patients become seronegative early during convalescence (Long et al., 2020; Seow et al., 2020; Ward et al., 2020) raise the question of whether recovery from COVID-19 confers immunity to reinfection, as was shown in a rhesus macaque model (Chandrashekar et al.”
BackgroundDiscordant neutralizing antibody and T cell responses in asymptomatic and mild SARS-CoV-2 infection
Reynolds, C. J., Swadling, L., Gibbons, J. M., Pade, C., Jensen, M. P., Diniz, M. O., Schmidt, N. M., Butler, D. K., Amin, O. E., Bailey, S. N. L., et al. (2020) · Science Immunology · doi:10.1126/sciimmunol.abf3698 · Cited by 196
Self-citationA simple protein-based surrogate neutralization assay for SARS-CoV-2
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Viral persistence, reactivation, and mechanisms of long COVID
Chen, B. K., Jülg, B. D., Mohandas, S., Bradfute, S. B., & RECOVER Mechanistic Pathways Task Force (2023) · eLife · doi:10.7554/elife.86015 · Cited by 211
The humoral response and antibodies against SARS-CoV-2 infection
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Decline of Humoral Responses against SARS-CoV-2 Spike in Convalescent Individuals
Beaudoin-Bussières, G., Laumaea, A., Anand, S. P., Prévost, J., Gasser, R., Goyette, G., Medjahed, H., Perreault, J., Tremblay, T., Lewin, A., et al. (2020) · mBio · doi:10.1128/mbio.02590-20 · Cited by 189
The durability of immunity against reinfection by SARS-CoV-2: a comparative evolutionary study
Townsend, J. P., Hassler, H. B., Wang, Z., Miura, S., Singh, J., Kumar, S., Ruddle, N. H., Galvani, A. P., & Dornburg, A. (2021) · The Lancet Microbe · doi:10.1016/s2666-5247(21)00219-6 · Cited by 186
Quick COVID-19 Healers Sustain Anti-SARS-CoV-2 Antibody Production
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Inefficiency of SIR models in forecasting COVID-19 epidemic: a case study of Isfahan
Moein, S., Nickaeen, N., Roointan, A., Borhani, N., Heidary, Z., Javanmard, S. H., Ghaisari, J., & Gheisari, Y. (2021) · Scientific Reports · doi:10.1038/s41598-021-84055-6 · Cited by 184
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“The intensity of the epidemic with a high risk of re-exposure to the infection, as well as the availability of a centralized data-capture system of all laboratory-confirmed infections, provided an opportunity to epidemiologically assess the presence and incidence of reinfections; a poorly-understood feature of SARS-Co…”
Kinetics and correlates of the neutralizing antibody response to SARS-CoV-2 infection in humans
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“S-specific IgM, IgA, and IgG antibodies are detected early after infection (Long et al., 2020; Seow et al., 2020) and IgG antibody levels and IgG memory B cells can persist post-infection (Dan et al.”
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“58 SARS- CoV-2 seroprevalence is high and heterogenous in Africa, suggesting greater population exposure to SARS- CoV-2 and potential protection against COVID-19 severe disease than has been previously indicated by confirmed case data and vaccine coverage.”
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“Longitudinal data from a larger sample size with varying clinical symptoms ranging from asymptomatic to critical cases as well as individuals below 20 years and over 65 years of age would be required for a more precise understanding of the overall immune durability against COVID-19.”
Repeated cross-sectional sero-monitoring of SARS-CoV-2 in New York City
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Hyperinflammatory Immune Response and COVID-19: A Double Edged Sword
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“seropositivity Significant decline in neutralising antibodies titres & seropositivity (63, 66)”
BackgroundSARS-CoV-2 vaccination induces mucosal antibody responses in previously infected individuals
Sano, K., Bhavsar, D., Singh, G., Floda, D. L., Srivastava, K., Gleason, C., PARIS Study Group, Amoako, A. A., Andre, D., Beach, K. F., et al. (2022) · Nature Communications · doi:10.1038/s41467-022-32389-8 · Cited by 167
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Self-citationGarcía‐Abellán, J., Padilla, S., Fernández‐González, M., García, J. A., Agulló, V., Galera, M. A., Ruiz, S., Galiana, A., Gutiérrez, F., & Masiá, M. (2021) · Journal of Clinical Immunology · doi:10.1007/s10875-021-01083-7 · Cited by 157
“Severity of disease has actually been associated with the magnitude and duration of the antibody response [13].”
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Antibody titers against SARS-CoV-2 decline, but do not disappear for several months
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SARS-CoV-2 can recruit a heme metabolite to evade antibody immunity
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Self-citationLaboratory diagnosis of COVID-19
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“Themajority of SARS-CoV-2 infected individuals have been shown to generate an antibody response 5– 15 days post onset of symptoms (POS) that peaks after 3– 4 weeks and then starts to decline (Crawford et al., 2020; Muecksch et al., 2020; Prévost et al., 2020; Seow et al., 2020).”
InfluentialSelf-citationAntibody-mediated neutralization of SARS-CoV-2
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Prospect of SARS-CoV-2 spike protein: Potential role in vaccine and therapeutic development
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Metadata
- Authors
- Seow, J., Graham, C., Merrick, B., Acors, S., Pickering, S., Steel, K. J. A., Hemmings, O., O’Byrne, A., Kouphou, N., Galao, R. P., Betancor, G., Wilson, H. D., Signell, A. W., Winstone, H., Kerridge, C., Huettner, I., Jimenez-Guardeño, J. M., Lista, M. J., Temperton, N., Snell, L. B., Bisnauthsing, K., Moore, A., Green, A., Martinez, L., Stokes, B., Honey, J., Izquierdo-Barras, A., Arbane, G., Patel, A., Tan, M. K. I., O’Connell, L., O’Hara, G., MacMahon, E., Douthwaite, S., Nebbia, G., Batra, R., Martinez-Nunez, R., Shankar-Hari, M., Edgeworth, J. D., Neil, S. J. D., Malim, M. H., & Doores, K. J.
- Affiliations
- King's College London (GB)
- Guy's Hospital (GB)
- Medway School of Pharmacy (GB)
- Guy's and St Thomas' NHS Foundation Trust (GB)
- Corresponding author
- Doores, Katie J.
- ORCID
- Seow, Jeffrey
- Merrick, Blair
- Acors, Sam
- Pickering, Suzanne
- Steel, Kathryn J. A.
- Hemmings, Oliver
- O’Byrne, Aoife
- Kouphou, Neophytos
- Galao, Rui Pedro
- Betancor, Gilberto
- Wilson, Harry D.
- Signell, Adrian W.
- Winstone, Helena
- Jimenez-Guardeño, Jose M.
- Temperton, Nigel
- Snell, Luke B.
- Bisnauthsing, Karen
- Martinez, Lauren
- Stokes, Brielle
- Izquierdo-Barras, Alba
- Patel, Amita
- Tan, Mark Kia Ik
- O’Connell, Lorcan
- O’Hara, Geraldine
- Douthwaite, Sam
- Nebbia, Gaia
- Batra, Rahul
- Shankar-Hari, Manu
- Edgeworth, Jonathan D.
- Neil, Stuart J. D.
- Malim, Michael H.
- Doores, Katie J.
- Venue
- Nature Microbiology
- Published
- 2020-10-26
- Volume
- 5
- Issue
- 12
- Pages
- 1598-1607
- ISSN
- 2058-5276 (ISSN-L)
- PMC
- PMC7610833
- OpenAlex
- W3093667122
- Cited by
- 1,419
- References
- 62
- Citations by year
- 2026: 18 · 2025: 44 · 2024: 75 · 2023: 147 · 2022: 311 · 2021: 615 · 2020: 207
- FWCI
- 41.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Nature Microbiology (publishedVersion)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Kent Academic Repository (University of Kent) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Repositorio Institucional de la Universidad de Málaga (University of Málaga) (submittedVersion, cc-by-nc-nd)
- Funders
- RCUK | Medical Research Council (MC/PC/15068, MR/N013700/1, MR/R015643/1, MC/PC/15068, MR/R015643/1, MR/S023747/1)
- Huo Family Foundation
- Wellcome Trust (WT098049AIA, MR/S023747/1, 106223/Z/14/Z)
- Huo Family Foundation King’s Together Rapid COVID-19 Call award
- DH | National Institute for Health Research (CS-2016-16-011)
- King’s Together Rapid COVID-19 Call award Huo Family Foundation
- Fondation Dormeur, Vaduz King’s Together Rapid COVID-19 Call award Huo Family Foundation
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 detection and testing
- Keywords
- SARS-CoV-2, COVID-19 pandemic, neutralizing antibodies, antibody waning, seroconversion, antibody kinetics, disease severity, infectious dose, reinfection protection, healthcare workers, booster vaccination, serological testing
- MeSH terms
- Seroconversion, COVID-19, SARS-CoV-2, Adult, Aged, Aged, 80 and over, Antibodies, Viral, Female, Humans, Kinetics, Longitudinal Studies, Male, Middle Aged, Severity of Illness Index, Young Adult, Antibodies, Neutralizing
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