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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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“There is also evidence of declining levels of neutralizing antibodies in COVID-19 patients within two to three months after recovery (Long et al., 2020; Seow et al., 2020).”
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Self-citationDecline of antibody titres 3 months after two doses of BNT162b2 in non-immunocompromised adults
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SARS-CoV-2 501Y.V2 (B.1.351) elicits cross-reactive neutralizing antibodiesPreprint
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Is Herd Immunity Against SARS-CoV-2 a Silver Lining?
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“It is important to mention, though, that reaching herd immunity through vaccination for COVID-19 can be a hard task, probably requiring revaccination, since the immune response to SARS-CoV-2 may be lost rapidly (42) and people might thereafter be susceptible to reinfection with the virus.”
BackgroundHamelin, D. J., Fournelle, D., Grenier, J., Schockaert, J., Kovalchik, K. A., Kubiniok, P., Mostefai, F., Duquette, J. D., Saab, F., Sirois, I., et al. (2021) · Cell Systems · doi:10.1016/j.cels.2021.09.013 · Cited by 35
da Cunha, L. E. R., Stolet, A. A., Strauch, M. A., Pereira, V. A. R., Dumard, C. H., Gomes, A. M. O., Monteiro, F. L. L., Higa, L. M., Souza, P. N. C., Fonseca, J. G. D. S., et al. (2021) · iScience · doi:10.1016/j.isci.2021.103315 · Cited by 37
SARS‐CoV‐2 during pregnancy and associated outcomes: Results from an ongoing prospective cohort
Molenaar, N. M., Rommel, A., de Witte, L. D., Dolan, S. M., Lieb, W., Ibroçi, E., Ohrn, S., Lynch, J., Capuano, C., Stadlbauer, D., et al. (2021) · Paediatric and Perinatal Epidemiology · doi:10.1111/ppe.12812 · Cited by 36
Yadav, S., Sadique, M. A., Ranjan, P., & Khan, R. (2023) · Analytica Chimica Acta · doi:10.1016/j.aca.2023.341326 · Cited by 35
Enhanced SARS-CoV-2 Neutralization by Secretory IgA in vitroPreprint
Wang, Z., Lorenzi, J. C. C., Muecksch, F., Finkin, S., Viant, C., Gaebler, C., Cipolla, M., Hoffmann, H.-H., Oliveira, T. Y., Oren, D. A., et al. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.09.09.288555 · Cited by 35
Harrington, P., Doores, K. J., Saha, C., Saunders, J. G., Child, F. J., Dillon, R. J., Saglam, S., Raj, K. K., McLornan, D. P., Avenoso, D., et al. (2021) · Cancer Cell · doi:10.1016/j.ccell.2021.10.002 · Cited by 34
Self-citationDifferential Antibody Response to Inactivated COVID-19 Vaccines in Healthy Subjects
Zhang, J., Xing, S., Liang, D., Hu, W. G., Ke, C., He, J., Yuan, R., Huang, Y., Li, Y., Liu, D., et al. (2021) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2021.791660 · Cited by 34
Mechanisms of Dysregulated Humoral and Cellular Immunity by SARS-CoV-2
Taefehshokr, N., Taefehshokr, S., & Heit, B. (2020) · Pathogens · doi:10.3390/pathogens9121027 · Cited by 35
“Preliminary studies have suggested that SARS-CoV-2-specific antibodies in some patients may only be maintained at protective levels for 2 months, indicating that humoral immunity to SARS-CoV-2 may be short-lived [65].”
BackgroundHow should we conduct pandemic vaccination?
Williams, J. H., Degeling, C., McVernon, J., & Dawson, A. (2021) · Vaccine · doi:10.1016/j.vaccine.2020.12.059 · Cited by 34
Bessalah, S., Jebahi, S., Mejri, N., Salhi, I., Khorchani, T., & Hammadi, M. (2021) · 3 Biotech · doi:10.1007/s13205-021-02647-5 · Cited by 34
Betton, M., Livrozet, M., Planas, D., Fayol, A., Monel, B., Vedie, B., Bruel, T., Tartour, É., Robillard, N., Manuguerra, J., et al. (2021) · Clinical Infectious Diseases · doi:10.1093/cid/ciab308 · Cited by 36
“This correlation between sero-neutralization and clinical severity has been previously described[7,10,13,14], and our results now indicate that this trend might persist over time.”
ResultCorrelates of Neutralization against SARS-CoV-2 Variants of Concern by Early Pandemic Sera
Vidal, S. J., Collier, A.-R. Y., Yu, J., McMahan, K., Tostanoski, L. H., Ventura, J. D., Aïd, M., Peter, L. E., Jacob-Dolan, C., Anioke, T., et al. (2021) · Journal of Virology · doi:10.1128/jvi.00404-21 · Cited by 34
Serum IgG levels in children 6 months after SARS-CoV-2 infection and comparison with adults
Bloise, S., Marcellino, A., Testa, A., Dilillo, A., Mallardo, S., Isoldi, S., Martucci, V., Sanseviero, M. T., Giudice, E. D., Iorfida, D., et al. (2021) · European Journal of Pediatrics · doi:10.1007/s00431-021-04124-w · Cited by 34
Dergaa, I., Abdelrahman, H., Varma, A., Yousfi, N., Souissi, A., Ghram, A., Hammad, A. S., Musa, E. R., Taheri, M., Irandoust, K., et al. (2021) · Annals of Applied Sport Science · doi:10.52547/aassjournal.1032 · Cited by 34
Khairullin, B. M., Zakarya, K. D., Orynbayev, M. B., Abduraimov, Y. O., Kassenov, M., Sarsenbayeva, G., Sultankulova, K. T., Chervyakova, O. V., Myrzakhmetova, B. S., Куралбаевич, Н. А., et al. (2022) · EClinicalMedicine · doi:10.1016/j.eclinm.2022.101526 · Cited by 36
Nationwide seroprevalence of antibodies against SARS-CoV-2 in Israel
Reicher, S., Ratzon, R., Ben-Sahar, S., Alon, S. H., Mossinson, D., Shenhar, Y., Friger, M. D., Lustig, Y., Alroy‐Preis, S., Anis, E., et al. (2021) · European Journal of Epidemiology · doi:10.1007/s10654-021-00749-1 · Cited by 31
Blain, H., Tuaillon, É., Gamon, L., Pisoni, A., Miot, S., Rolland, Y., Picot, M., & Bousquet, J. J. (2021) · Allergy · doi:10.1111/all.15007 · Cited by 31
Rodrigues, E. P. S., Abreu, I. N., Lima, C. N. C., Fonseca, D. L. M., Pereira, S. F. G., dos Reis, L. C., Vallinoto, I. M. V. C., Guerreiro, J. F., & Vallinoto, A. C. R. (2021) · International Journal for Equity in Health · doi:10.1186/s12939-021-01392-8 · Cited by 33
The evolving direct and indirect platforms for the detection of SARS-CoV-2
Fathi‐karkan, S., Maleki-baladi, R., Shahgolzari, M., Gholizadeh, M., Shayegh, F., & Arashkia, A. (2021) · Journal of Virological Methods · doi:10.1016/j.jviromet.2021.114381 · Cited by 33
Fernández‐González, M., Agulló, V., Padilla, S., García, J. A., García‐Abellán, J., Botella, Á., Mascarell, P., Ruiz‐García, M., Masiá, M., & Gutiérrez, F. (2021) · Clinical Infectious Diseases · doi:10.1093/cid/ciab1021 · Cited by 34
Children and Adults With Mild COVID-19: Dynamics of the Memory T Cell Response up to 10 Months
Kaaijk, P., Pimentel, V. O., Emmelot, M. E., Poelen, M. C. M., Çevirgel, A., Schepp, R. M., den Hartog, G., Reukers, D. F. M., Beckers, L., van Beek, J., et al. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.817876 · Cited by 32
Long-Term Persistence of Anti-SARS-COV-2 IgG Antibodies
Yousefi, Z., Taheri, N., Dargahi, M., Chaman, R., Binesh, E., Emamian, M. H., & Jafari, R. (2022) · Current Microbiology · doi:10.1007/s00284-022-02800-0 · Cited by 31
“The findings showed that the levels of antiSARS-CoV-2 IgG antibody were at their highest level for 3 months (1st, 2nd, and 3rd samples) and then decreased in 15 months (the 5th sample) POS.”
BackgroundInfluentialLechmere, T., Snell, L. B., Graham, C., Seow, J., Shalim, Z. A., Charalampous, T., Alcolea-Medina, A., Batra, R., Nebbia, G., Edgeworth, J. D., et al. (2022) · mBio · doi:10.1128/mbio.03798-21 · Cited by 30
Self-citationPorcine Respiratory Coronavirus as a Model for Acute Respiratory Coronavirus Disease
Keep, S., Carr, B. V., Lean, F. Z. X., Fones, A., Newman, J., Dowgier, G., Freimanis, G., Vatzia, E., Polo, N., Everest, H., et al. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.867707 · Cited by 33
Evidence of previous SARS-CoV-2 infection in seronegative patients with long COVID
Krishna, B. A., Lim, E. Y., Mactavous, L., Lyons, P., Döffinger, R., Bradley, J. R., Smith, K. G. C., Sinclair, J. H., Matheson, N. J., Lehner, P. J., et al. (2022) · EBioMedicine · doi:10.1016/j.ebiom.2022.104129 · Cited by 32
Rosati, M., Terpos, E., Ntanasis‐Stathopoulos, I., Agarwal, M., Bear, J., Burns, R. T., Hu, X., Korompoki, E., Donohue, D. E., Venzon, D. J., et al. (2021) · Frontiers in Immunology · doi:10.3389/fimmu.2021.793953 · Cited by 34
Tomov, L., Chervenkov, L., Miteva, D., Batselova, H., & Velikova, T. V. (2023) · World Journal of Clinical Cases · doi:10.12998/wjcc.v11.i29.6974 · Cited by 47
COVID-19 illness and autoimmune diseases: recent insights
Li, J., Liu, H., Yin, X., Li, C., & Wang, J. (2021) · Inflammation Research · doi:10.1007/s00011-021-01446-1 · Cited by 33
Zhou, X., Ma, F., Xie, J., Yuan, M., Li, Y., Shaabani, N., Zhao, F., Huang, D., Wu, N. C., Lee, C.-C. D., et al. (2021) · Cell Reports · doi:10.1016/j.celrep.2021.109109 · Cited by 31
“0204 log10) (Figures 1C and 1D), suggesting rapid decay of neutralizing antibodies in convalescent patients (Prévost et al., 2020; Seow et al., 2020).”
InfluentialSpecific COVID-19 Symptoms Correlate with High Antibody Levels against SARS-CoV-2
Amjadi, M. F., O’Connell, S. E., Armbrust, T., Mergaert, A. M., Narpala, S., Halfmann, P., Bashar, S. J., Glover, C. R., Heffron, A. S., Taylor, A., et al. (2021) · ImmunoHorizons · doi:10.4049/immunohorizons.2100022 · Cited by 34
The impact of digital contact tracing on the SARS-CoV-2 pandemic—a comprehensive modelling study
Pollmann, T. R., Pollmann, J., Wiesinger, C., Haack, C., Shtembari, L., Turcati, A., Neumair, B., Meighen-Berger, S. A., Zattera, G., Neumair, B., et al. (2021) · EPJ Data Science · doi:10.1140/epjds/s13688-021-00290-x · Cited by 33
A rapid simple point-of-care assay for the detection of SARS-CoV-2 neutralizing antibodies
Kongsuphol, P., Jia, H., Cheng, H. L., Gu, Y., Shunmuganathan, B. D. O., Chen, M. W., Lim, S. M., Ng, S. Y., Tambyah, P. A., Nasir, H., et al. (2021) · Communications Medicine · doi:10.1038/s43856-021-00045-9 · Cited by 33
Liu, B., Su, X., Yu, G., Yang, S.-L., Wang, F., Huang, T., Zhou, L., Hui, Z., Liao, Y., Qiu, Y., et al. (2021) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2021.12.316 · Cited by 32
Reyes, R. A., Clarke, K., Gonzales, S. J., Cantwell, A. M., Garza, R., Catano, G., Tragus, R. E., Patterson, T. F., Bol, S. M., & Bunnik, E. M. (2021) · PLoS ONE · doi:10.1371/journal.pone.0261656 · Cited by 33
“COVID-19 patients rapidly generate potent neutralizing IgG antibodies against the spike protein [15, 16].”
BackgroundBenet, S., Blanch-Lombarte, O., Ainsua‐Enrich, E., Pedreño-López, N., Muñoz‐Basagoiti, J., Regué, D. R., Perez‐Zsolt, D., Peña, R., Jímenez, E., de la Concepción, M. L. R., et al. (2022) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiac406 · Cited by 33
Aiello, A., Coppola, A., Vanini, V., Petrone, L., Cuzzi, G., Salmi, A., Altera, A. M. G., Tortorella, C., Gualano, G., Gasperini, C., et al. (2022) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2022.07.049 · Cited by 32
Localized and Systemic Immune Responses against SARS-CoV-2 Following Mucosal Immunization
Chandrasekar, S., Phanse, Y., Hildebrand, R. E., Hanafy, M., Wu, C., Hansen, C. H., Osorio, J. E., Suresh, M., & Talaat, A. M. (2021) · Vaccines · doi:10.3390/vaccines9020132 · Cited by 31
Repeated SARS-CoV-2 Positivity: Analysis of 123 Cases
Váncsa, S., Dembrovszky, F., Farkas, N., Szakó, L., Teutsch, B., Bunduc, Ș., Nagy, R., Párniczky, A., Erőss, B. M., Péterfi, Z., et al. (2021) · Viruses · doi:10.3390/v13030512 · Cited by 33
Varona, J. F., Madurga, R., Peñalver, F. J., Abarca, E., Almirall, C., Cruz, M., Ramos, E., & Castellano-Vazquez, J. M. (2021) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2021.05.028 · Cited by 31
“Previous reports have described that levels of antibodies against SARS-CoV-2 in the acute phase correlate to clinical disease severity and then decline after 3 months since onset of illness [17-19].”
Amodio, E., Capra, G., Casuccio, A., Grazia, S. D., Genovese, D., Pizzo, S., Calamusa, G., Ferraro, D., Giammanco, A., Vitale, F. M., et al. (2021) · Vaccines · doi:10.3390/vaccines9070714 · Cited by 30
Macioła, A. K., Raja, M. L., Pacenti, M., Salata, C., Silvestro, G. D., Rosato, A., & Pasqual, G. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.830710 · Cited by 31
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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