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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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“Importantly, the kinetics of nAb responses seen here are concordant with that of other longitudinal SARS-CoV-2 and human coronavirus studies [11-15,17-19], which may have been limited by either participant”
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“This proportion of samples exhibiting relevant virus neutralizing capacity is in line with results of a previous study in a similar cohort of convalescent COVID-19 patients [21].”
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Rybkina, K., Davis‐Porada, J., & Färber, D. L. (2022) · Immunological Reviews · doi:10.1111/imr.13112 · Cited by 19
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Emmerich, P., von Possel, R., Hemmer, C. J., Fritzsche, C., Geerdes-Fenge, H. F., Menge, B., Messing, C., Borchardt‐Lohölter, V., Deschermeier, C., & Steinhagen, K. (2021) · Journal of Medical Virology · doi:10.1002/jmv.27113 · Cited by 19
“Usually, specific immunoglobulin M (IgM) and immunoglobulin A (IgA) antibodies are detectable earlier than specific immunoglobulin G (IgG) antibodies.(5,7,8) In individual cases, anti‐ SARS‐CoV‐2 antibodies are either only detectable more than four weeks after onset of symptoms or not at all due to generally absent an…”
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Persistence of immunity to SARS-CoV-2 over time in the ski resort Ischgl
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“Our study extends the previous research in three important ways: First, we con fi rm that immunity as de fi ned by T cell and/or neutralizing antibody response lasts for up to several months and that T cell and antibody responses can be discordant [8 (cid:1) 14,26].”
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“3 days POS with a wide range (range 3–59 days) [14], and these factors are likely reflected in our results.”
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Antibody Dynamics and Durability in Coronavirus Disease-19
Zuiani, A., & Wesemann, D. R. (2021) · Clinics in Laboratory Medicine · doi:10.1016/j.cll.2021.10.004 · Cited by 19
Peluso, M. J., Donatelli, J. L., & Henrich, T. J. (2021) · Translational research · doi:10.1016/j.trsl.2021.11.006 · Cited by 18
Persistence of SARS-CoV-2-Specific Antibodies for 13 Months after Infection
Kučinskaitė-Kodzė, I., Simanavičius, M., Šimaitis, A., & Žvirblienė, A. (2021) · Viruses · doi:10.3390/v13112313 · Cited by 19
Liu, K., Gong, Y., Huang, C., Huang, P.-N., Yu, K.-Y., Lee, H.-C., Lee, S.-C., Chiang, H.-J., Kung, Y.-A., Lin, Y., et al. (2022) · mSphere · doi:10.1128/msphere.00883-21 · Cited by 19
“The actual decrease was also dependent on the severity of the disease in the patients (26).”
BackgroundMaking COVID-19 mRNA vaccines accessible: challenges resolved
Niazi, S. K. (2022) · Expert Review of Vaccines · doi:10.1080/14760584.2022.2089121 · Cited by 19
“For example, anti-SARS-CoV-2 T cells may be necessary since neutralizing antibodies wane over time [11,12].”
BackgroundFouad, M. M., Zawilla, N. H., & Maged, L. A. (2022) · Infection · doi:10.1007/s15010-022-01942-4 · Cited by 19
Humoral immunity and B-cell memory in response to SARS-CoV-2 infection and vaccination
Fryer, H. A., Hartley, G. E., Edwards, E. S. J., O’Hehir, R. E., & van Zelm, M. C. (2022) · Biochemical Society Transactions · doi:10.1042/bst20220415 · Cited by 16
He, X., Zhang, X., Wu, B., Deng, J., Zhang, Y., Zhu, A., Yuan, Y., Lin, Y., Chen, A., Feng, J., et al. (2024) · Nature Immunology · doi:10.1038/s41590-024-01776-2 · Cited by 20
“However, the unprecedented spread of the virus still poses a serious threat to public health 7,8 .”
Single-Dilution COVID-19 Antibody Test with Qualitative and Quantitative Readouts
Bortz, R. H., Florez, C., Laudermilch, E., Wirchnianski, A. S., Lasso, G., Malonis, R. J., Georgiev, G. I., Vergnolle, O., Herrera, N. G., Morano, N. C., et al. (2021) · mSphere · doi:10.1128/msphere.00224-21 · Cited by 20
Antibody (Serology) Tests for COVID-19: a Case Study
West, R. M., Kobokovich, A. L., Connell, N. D., & Grönvall, G. K. (2021) · mSphere · doi:10.1128/msphere.00201-21 · Cited by 19
“which form 7 to 10 or more days after initial infection (3, 4).”
BackgroundBauer, G. (2022) · Exploration of Immunology · doi:10.37349/ei.2022.00040 · Cited by 19
“What might then be the overall benefit derived from the generation of immune cells that allow generating high avidity IgG directed towards critical viral surface structures? As the IgG responses towards SARS-CoV-2 are waning after natural infection, as well as after vaccination [103, 104], reinfection might be facilit…”
BackgroundChang, M., Ke, H., Coherd, C. D., Wang, Y., Mashima, K., Kastrunes, G. M., Huang, C., & Marasco, W. A. (2022) · EBioMedicine · doi:10.1016/j.ebiom.2022.104025 · Cited by 20
da Cunha, L. E. R., Stolet, A. A., Strauch, M. A., Pereira, V. A. R., Dumard, C. H., Gomes, A. M. O., Souza, P. N. C., Fonseca, J. G. D. S., de Pontes, F. E., Meirelles, L. G. R., et al. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.08.17.254375 · Cited by 21
Immunogenicity of novel mRNA COVID-19 vaccine MRT5500 in mice and non-human primates
Kalnin, K. V., Plitnik, T., Kishko, M., Zhang, J., Zhang, D., Beauvais, A., Anosova, N. G., Tibbitts, T., DiNapoli, J. M., Huang, P.-W. D., et al. (2020) · doi:10.1101/2020.10.14.337535 · Cited by 18
Laboratory diagnosis of severe acute respiratory syndrome coronavirus 2
Gulholm, T., Basile, K., Kok, J., Chen, S. C.-A., & Rawlinson, W. D. (2020) · Pathology · doi:10.1016/j.pathol.2020.09.011 · Cited by 18
Jónsdóttir, H. R., Bielecki, M., Siegrist, D., Buehrer, T. W., Züst, R., & Deuel, J. (2021) · Viruses · doi:10.3390/v13020284 · Cited by 17
“Thus, antibody titers seem to be determined by disease severity and not duration, with varied numbers of asymptomatic cases having been reported to produce nAbs [24].”
BackgroundSARS-CoV-2 Antibody Binding and Neutralization in Dried Blood Spot Eluates and Paired Plasma
Itell, H. L., Weight, H., Fish, C. S., Logue, J. K., Franko, N., Wolf, C. R., McCulloch, D. J., Galloway, J., Matsen, F. A., IV, Chu, H. Y., et al. (2021) · Microbiology Spectrum · doi:10.1128/spectrum.01298-21 · Cited by 18
“(3) Cohort-level agreement between sample types was evaluated by”
BackgroundWang, B., Goh, Y. S., Prince, T., Ngoh, E. Z. X., Salleh, S. N. M., Hor, P. X., Loh, C. Y., Fong, S., Hartley, C. S., Tan, S. Y., et al. (2021) · npj Vaccines · doi:10.1038/s41541-021-00389-2 · Cited by 19
SARS-CoV-2 Spike Expression at the Surface of Infected Primary Human Airway Epithelial Cells
Ding, S., Adam, D., Beaudoin-Bussières, G., Tauzin, A., Gong, S. Y., Gasser, R., Laumaea, A., Anand, S. P., Privé, A., Bourassa, C., et al. (2021) · Viruses · doi:10.3390/v14010005 · Cited by 18
Stewart, A., Sinclair, E. L., Ng, J. C.-F., O’Hare, J. S., Page, A., Serangeli, I., Margreitter, C., Orsenigo, F., Longman, K., Frampas, C., et al. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.807104 · Cited by 18
Serological antibody testing in the COVID-19 pandemic: their molecular basis and applications
Jiang, J.-C., & Zhang, Y. (2020) · Biochemical Society Transactions · doi:10.1042/bst20200744 · Cited by 19
IgM and IgG Profiles Reveal Peculiar Features of Humoral Immunity Response to SARS-CoV-2 Infection
Donno, A. D., Lobreglio, G., Panìco, A., Grassi, T., Bagordo, F., Bozzetti, M. P., Massari, S., Siculella, L., Damiano, F., Guerra, F., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18031318 · Cited by 21
Garritsen, A., Scholzen, A., van den Nieuwenhof, D. W. A., Smits, A. P. F., Datema, E. S., van Galen, L. S., & Kouwijzer, M. (2021) · Scandinavian Journal of Infectious Diseases · doi:10.1080/23744235.2021.1893378 · Cited by 15
“Overall, IgM and IgA antibody responses against SARS-CoV-2 RBD, S1 and NCP appear to contract rapidly, while circulating antiSARS-CoV-2 IgG directed against these antigens remain much more stable [23,25,29].”
BackgroundMulchandani, R., Taylor-Philips, S., Jones, H. E., Ades, A. E., Borrow, R., Linley, E., Kirwan, P., Stewart, R., Moore, P., Boyes, J., et al. (2021) · Journal of Infection · doi:10.1016/j.jinf.2021.03.019 · Cited by 18
Sustained Neutralizing Antibodies 6 Months Following Infection in 376 Japanese COVID-19 Survivors
Goto, A., Go, H., Miyakawa, K., Yamaoka, Y., Ohtake, N., Kubo, S., Jeremiah, S. S., Mihara, T., Senuki, K., Miyazaki, T., et al. (2021) · Frontiers in Microbiology · doi:10.3389/fmicb.2021.661187 · Cited by 18
“This decline in neutralizing antibodies at a relatively early phase of infection has been consistently reported in many studies with varieties of populations (Crawford et al., 2020; Gaebler et al., 2020; Ibarrondo et al., 2020; Kutsuna et al., 2020; Long et al., 2020; Patel et al., 2020; Ripperger et al., 2020; Seow e…”
BackgroundMethodResultInfluentialGauttier, V., Morello, A., Girault, I., Mary, C., Belarif, L., Desselle, A., Wilhelm, E., Bourquard, T., Pengam, S., Teppaz, G., et al. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.08.14.240093 · Cited by 18
COVID-19 transmission in a university setting: a rapid review of modelling studiesPreprint
Christensen, H., Turner, K., Trickey, A., Booton, R. D., Hemani, G., Nixon, E. J., Relton, C. L., Danon, L., Hickman, M., & Brooks‐Pollock, E. (2020) · medRxiv · doi:10.1101/2020.09.07.20189688 · Cited by 18
Decay of Fc-dependent antibody functions after mild to moderate COVID-19
Lee, W. S., Selva, K. J., Davis, S. K., Wines, B. D., Reynaldi, A., Esterbauer, R., Kelly, H. G., Haycroft, E. R., Tan, H.-X., Juno, J. A., et al. (2020) · doi:10.1101/2020.12.13.20248143 · Cited by 80
Mustapha, J. O., Abdullahi, I. N., Ajagbe, O., Emeribe, A. U., Fasogbon, S. A., Onoja, S. O., Ugwu, C. E., Umeozuru, C. M., Ajayi, F. O., Tanko, W. N., et al. (2021) · Heliyon · doi:10.1016/j.heliyon.2021.e05951 · Cited by 17
RetractedSARS-CoV-2 virus: Vaccines in development
Huang, Q., & Yan, J. (2021) · Fundamental Research · doi:10.1016/j.fmre.2021.01.009 · Cited by 18
A review of COVID-19 convalescent plasma use in COVID-19 with focus on proof of efficacy
Devarasetti, P. K., Rajasekhar, L., Baisya, R., Sreejitha, K. S., & Vardhan, Y. K. (2021) · Immunologic Research · doi:10.1007/s12026-020-09169-x · Cited by 17
Antibody kinetics and clinical course of COVID-19 a prospective observational study
Bläckberg, A., Fernström, N., Sarbrant, E., Rasmussen, M., & Sunnerhagen, T. (2021) · PLoS ONE · doi:10.1371/journal.pone.0248918 · Cited by 18
“Seow et al reported an average higher titer of neutralizing antibodies in patients with severe COVID-19, however no correlation of antibody kinetics was established [11].”
BackgroundSwadźba, J., Anyszek, T., Panek, A., & Martin, E. (2021) · Vaccines · doi:10.3390/vaccines9111367 · Cited by 17
Aiello, A., Grossi, A., Meschi, S., Meledandri, M., Vanini, V., Petrone, L., Casetti, R., Cuzzi, G., Salmi, A., Altera, A. M. G., et al. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.920227 · Cited by 18
“Age median (IQR) 48 (29-55) 58 (52-71) 42 (38-54) <0.”
BackgroundHigh SARS-CoV-2 seroprevalence in Karaganda, Kazakhstan before the launch of COVID-19 vaccination
Kadyrova, I., Yegorov, S., Negmetzhanov, B., Kolesnikova, Y. A., Kolesnichenko, S. I., Korshukov, I., Akhmaltdinova, L., Vazenmiller, D., Stupina, Y., Амирбековна, К. Н., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0272008 · Cited by 17
Can live-attenuated SARS-CoV-2 vaccine contribute to stopping the pandemic?
Tang, P. C. H., Ng, W. H., King, N. J. C., & Mahalingam, S. (2022) · PLoS Pathogens · doi:10.1371/journal.ppat.1010821 · Cited by 18
“In general, disease severity enhanced these responses [12], as has previously been observed [13,14].”
ResultRuiz, M. J., Siracusano, G., Cottignies-Calamarte, A., Tudor, D., Real, F., Zhu, A., Pastori, C., Capron, C., Rosenberg, A. R., Temperton, N. J., et al. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.842468 · Cited by 21
“Outcome Survivor Non-survivor 7 (64) 4 (36) 14 (61) 9 (39) 21 (100) 0 (0) 42 (76) 13 (24)”
BackgroundSelf-citationGraham, C., Lechmere, T., Rehman, A., Seow, J., Kurshan, A., Huettner, I., Maguire, T. J. A., Tam, J. C. H., Cox, D., Ward, C. C., et al. (2022) · PLoS Pathogens · doi:10.1371/journal.ppat.1010882 · Cited by 14
“14 Recombinant Spike and nucleoprotein for ELISA were expressed and purified as 337 previously described [17, 53].”
BackgroundMethodSelf-citationPortable Surface Plasmon Resonance Detector for COVID-19 Infection
Trzaskowski, M., Mazurkiewicz-Pisarek, A., Trzciński, J., Drozd, M., Podgórski, R., ZABOST, A. T., & AUGUSTYNOWICZ-KOPEĆ, E. M. (2023) · Sensors · doi:10.3390/s23083946 · Cited by 17
Joshi, D., Nyhoff, L. E., Zarnitsyna, V. I., Moreno, A., Manning, K. E., Linderman, S. L., Burrell, A. R., Stephens, K., Norwood, C., Mantus, G. E., et al. (2023) · iScience · doi:10.1016/j.isci.2023.107967 · Cited by 17
“23 It is well established that the loss of binding titers results in a coordinated loss of neutralization titer (Figure 5A), 16,24–26 most likely due to the strong correlation between spike and RBD-binding titers and neutralization (Figure 5B), 11,27 indicating that fraction of anti-spike/RBD IgG…”
Vallinoto, A. C. R., Torres, M. K. D. S., Vallinoto, M. C., & Vallinoto, I. M. V. C. (2020) · International Journal for Equity in Health · doi:10.1186/s12939-020-01256-7 · Cited by 17
Covid-19 transmission modelling of students returning home from university
Harper, P., Moore, J. W., & Woolley, T. E. (2021) · Health Systems · doi:10.1080/20476965.2020.1857214 · Cited by 17
“However, questions regarding how long the immunity will last (Ripperger et al. 2020, Tan et al. 2020, Callow et al. 1990, Seow et al. 2020) coupled with suffering through the actual disease and the stress of missing coursework (Husky et al. 2020) leads this to be an unsympathetic plan of action.”
Background
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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