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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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BackgroundPersistence of humoral response upon SARS‐CoV‐2 infection
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“They can persist for an extended period [12,13] or decline subsequently [14,15], leading to decreased protection and an increased risk of reinfection by SARS-CoV-2.”
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Escalera, A., Rojo-Fernandez, A., Rombauts, A., Abelenda-Alonso, G., Carratalà, J., García‐Sastre, A., & Aydillo, T. (2024) · iScience · doi:10.1016/j.isci.2024.109210 · Cited by 17
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“The relative durability of the Ab responses to SARS-CoV-2 infection has been controversial, with initial studies reporting a dramatic early decline in titers that may leave patients susceptible to reinfection (18).”
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MethodResultInfluentialSerial SARS-CoV-2 Receptor-Binding Domain Antibody Responses in Patients Receiving Dialysis
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“These studies, and others (2, 3), have been confined to healthy populations or have not separately examined response among subgroups known to have blunted or shortened adaptive immune responses.”
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“While a decline in neutralizing antibody is seen [90], it can persist in individuals for at least 8 months, and possibly longer, after infection [29].”
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BackgroundDeciphering Fc-effector functions against SARS-CoV-2
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“Neutralizing antibody kinetics were consistent with other acute viral infections (13), with an initial peak at 3–4 weeks (magnitude of peak dependent on disease severity) followed by declining neutralizing antibody titres.”
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“Antibody titres may correlate with severity of illness, with lower titres observed in patients who remain asymptomatic throughout their infection.(7,8) The longevity of the antibody response to SARS-CoV-2 is unknown, although based on studies of the related seasonal beta-coronaviruses as well as SARS-CoV-1 and MERS-Co…”
BackgroundResultImmunology of SARS-CoV-2 infections and vaccines
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“response induced by vaccination or initial infection weakening over time [5,6], whether nonneutralizing or subneutralizing antibodies would lead to enhanced”
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“Previous studies have shown a decline in N- and S1-specific antibodies after SARSCoV-2 infection (16, 17).”
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Violán, C., Carrasco-Ribelles, L. A., Collatuzzo, G., Ditano, G., Abedini, M., Janke, C., Reinkemeyer, C., Thi, T. G. L., Liviero, F., Scapellato, M. L., et al. (2023) · Vaccines · doi:10.3390/vaccines11081340 · Cited by 14
Annen, K., Morrison, T. E., DomBourian, M. G., McCarthy, M. K., Huey, L., Merkel, P. A., Andersen, G., Schwartz, E., & Knight, V. (2021) · Transfusion · doi:10.1111/trf.16261 · Cited by 13
“Antibody strength and longevity seem to correlate with the severity of illness,(35) and while some studies indicate that antibody titers remain stable over time,(36) others suggest that antibody titers may quickly wane, and concerns for reinfection, particularly with mild or no symptoms, are not unwarranted.(32-34,37)…”
BackgroundPersistence of SARS-CoV-2 N-Antibody Response in Healthcare Workers, London, UK
Shrotri, M., Harris, R., Rodger, A. J., Planche, T., Sanderson, F., Mahungu, T. W., McGregor, A. C., Heath, P. T., The LondonCOVID Group, Brown, C. S., et al. (2021) · Emerging infectious diseases · doi:10.3201/eid2704.204554 · Cited by 13
“In contrast, the few studies conducting serial testing for >3 months by using N-antibody assays, particularly the Elecsys assay, report that titers remained steady (9) or increased (11; F.”
ResultSARS-CoV2 IgG antibody: Seroprevalence among health care workers
Prakash, O., Solanki, B., Sheth, J. K., Makwana, G., Kadam, M., Vyas, S., Shukla, A. A., Pethani, J., & Tiwari, H. (2021) · Clinical Epidemiology and Global Health · doi:10.1016/j.cegh.2021.100766 · Cited by 14
Bubonja‐Šonje, M., Batičić, L., Abram, M., & Grbeša, Đ. C. (2021) · Journal of Virological Methods · doi:10.1016/j.jviromet.2021.114173 · Cited by 14
Hedges, J. F., Thompson, M. A., Snyder, D. T., Robison, A., Taylor, M. P., & Jutila, M. A. (2021) · Vaccines · doi:10.3390/vaccines9060587 · Cited by 14
Ringlander, J., Olausson, J., Nyström, K., Härnqvist, T., Jakobsson, H. E., & Lindh, M. (2021) · Scandinavian Journal of Infectious Diseases · doi:10.1080/23744235.2021.1957143 · Cited by 14
“The reinfected patient had a lower viral load and milder symptoms during the second infection episode which suggests that she had developed an immune response sufficient to prevent serious disease [20,22].”
BackgroundDurable T-cellular and humoral responses in SARS-CoV-2 hospitalized and community patients
Mohn, K. G.-I., Bredholt, G., Zhou, F., Madsen, A., Onyango, T. B., Fjelltveit, E. B., Lartey, S. L., Brokstad, K. A., Cantoni, D. M., Neto, M. M., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0261979 · Cited by 16
“Age is the most important risk factor for severe disease and mortality from SARS-CoV-2 infection and may explain our findings of significantly higher antibody titers in patients with severe disease and with increasing age, in agreement with other studies [39, 40].”
ResultSelf-citationLambarey, H., Blumenthal, M. J., Chetram, A., Joyimbana, W., Jennings, L., Tincho, M. B., Burgers, W. A., Orrell, C., & Schäfer, G. (2022) · Viruses · doi:10.3390/v14061222 · Cited by 14
“Although IgM and IgA immune responses to RBD and S1 were specific to SARS-CoV-2 when compared to a pre-pandemic cohort (Figure S1A), IgG responses are known to persist longer and stay at relatively high levels post-illness onset, compared to IgA and IgM responses, which wane soon after they peak [24,25], making IgG th…”
BackgroundMartin‐Vicente, M., Carrasco, I., Muñoz‐Gómez, M. J., Hernanz‐Lobo, A., Más, V., Vigil‐Vázquez, S., Vázquez, M., Manzanares, Á., Cano, O., Alonso, R., et al. (2022) · Birth · doi:10.1111/birt.12667 · Cited by 13
Carreño, J. M., Mendu, D. R., Simon, V. R., Shariff, M. A., Singh, G., Menon, V. P., & Krammer, F. (2021) · iScience · doi:10.1016/j.isci.2021.102937 · Cited by 12
Longitudinal analysis of the humoral response to SARS-CoV-2 spike RBD in convalescent plasma donorsPreprint
Perreault, J., Tremblay, T., Fournier, M., Drouin, M., Beaudoin-Bussières, G., Prévost, J., Lewin, A., Bégin, P., Finzi, A., & Bazin, R. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.07.16.206847 · Cited by 12
COVID-19: The Pseudo-Environment and the Need for a Paradigm Change
Stein, R. A., Ometa, O., & Broker, T. R. (2021) · GERMS · doi:10.18683/germs.2021.1283 · Cited by 16
Flinck, H., Rauhio, A., Luukinen, B. V., Lehtimäki, T. J., Haapala, A., Seiskari, T., & Aittoniemi, J. (2020) · Diagnostic Microbiology and Infectious Disease · doi:10.1016/j.diagmicrobio.2020.115197 · Cited by 13
Antibody and T Cell Immune Responses to SARS-CoV-2 Peptides in COVID-19 Convalescent Patients
Garanina, E. E., Hamza, S., Stott-Marshall, R. J., Martynova, E. V., Markelova, M., Davidyuk, Y. N., Shakirova, V. G., Kaushal, N., Baranwal, M., Хаертынова, И. М., et al. (2022) · Frontiers in Microbiology · doi:10.3389/fmicb.2022.842232 · Cited by 13
“Interestingly, convalescent serum reactivity with N protein was demonstrated in several studies (Brochot et al., 2020; Kang et al., 2021; Shah et al., 2021).”
ResultBeisenova, A., Adi, W., Bashar, S. J., Velmurugan, M., Germanson, K. B., Shelef, M. A., & Yesilköy, F. (2023) · Sensors & Diagnostics · doi:10.1039/d3sd00081h · Cited by 14
Seow, J., Shalim, Z. A., Graham, C., Kimuda, S., Pillai, A., Lechmere, T., Kurshan, A., Khimji, A. M., Snell, L. B., Nebbia, G., et al. (2023) · mBio · doi:10.1128/mbio.01206-23 · Cited by 10
“1D) with the remaining mAbs specific for NTD. Neutralization activity of concentrated supernatant was determined using HIV-1 viral particles, pseudotyped with SARS-CoV-2 Wuhan-1 (WT) Spike (34).”
MethodSelf-citationWangari, I. M., Olaniyi, S., Lebelo, R. S., & Okosun, K. O. (2023) · Frontiers in Applied Mathematics and Statistics · doi:10.3389/fams.2023.1292443 · Cited by 14
Prognostic value of anti-SARS-CoV-2 antibodies: a systematic review
Mink, S., Reimann, P., & Fraunberger, P. (2024) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm-2023-1487 · Cited by 14
Mele, D., Ottolini, S., Lombardi, A., Conteianni, D., Bandera, A., Oliviero, B., Mantovani, S., Cassaniti, I., Baldanti, F., Gori, A., et al. (2024) · Journal of Medical Virology · doi:10.1002/jmv.29585 · Cited by 13
Hu, Z., López-Muñoz, A. D., Košík, I., Li, T., Callahan, V., Brooks, K., Yee, D. S., Hollý, J., Santos, J. J. D. S., Brant, A. C., et al. (2024) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2310421121 · Cited by 11
“For SARS - CoV - 2, it has been reported that antiviral IgA antibodies are produced prior to IgG antibodies and persist in sera and saliva of COVID - 19 patients for 40 d post onset of symptoms (30–33).”
BackgroundOlvera, À., Noguera-Julián, M., Kilpeläinen, A., Romero-Martín, L., Prado, J. G., & Brander, C. (2020) · Vaccines · doi:10.3390/vaccines8030444 · Cited by 14
Salvamani, S., Tan, H., Thang, W., Ter, H., Wan, M., Gunasekaran, B., & Rhodes, A. (2020) · British Journal of Biomedical Science · doi:10.1080/09674845.2020.1826136 · Cited by 14
Antibody tests: They are more important than we thought
Guimarães, L. (2021) · Journal of Mathematical Economics · doi:10.1016/j.jmateco.2021.102485 · Cited by 13
Moeller, M. E., Fock, J., Pah, P., Veras, A. D. L. C., Bade, M., Donolato, M., Israelsen, S. B., Eugen‐Olsen, J., Benfield, T., & Engsig, F. N. (2021) · Journal of Medical Virology · doi:10.1002/jmv.26854 · Cited by 13
“The median time for detection of antibodies for COVID‐ 19 is generally 11 days (IQR = 7.0 – 14.0) but several studies have shown that some individuals take longer to develop antibodies against COVID‐19.12,40,41 In general, the immune response decrease with age which may be the reason why POS 1, who was in his seventie…”
BackgroundInfluentialSARS-CoV-2 vaccines — the biggest medical research project of the 21st century
Kurup, D., & Schnell, M. J. (2021) · Current Opinion in Virology · doi:10.1016/j.coviro.2021.04.008 · Cited by 13
“The same study also indicated that antibodies against SARS-CoV-2 S, RBD, and neutralizing antibodies declined moderately over eight months, raising concerns for long-term protection and herd immunity post-infection [11 ,12,13].”
Egorov, A. I., Griffin, S. M., Fuzawa, M., Kobylanski, J., Grindstaff, R. D., Padgett, W. T., Simmons, S. O., Hallinger, D. R., Styles, J. N., Wickersham, L. C., et al. (2021) · Microbiology Spectrum · doi:10.1128/spectrum.00693-21 · Cited by 13
“This time interval was selected to maximize the proportion of IgG-seropositive individuals, based on previous research (12, 32, 33).”
MethodLing, R. R., Sim, J. J. L., Tan, F. L., Tai, B. C., Syn, N. L. X., Sadasiv, M. S., Fan, B. E., Mitra, S., & Ramanathan, K. R. (2021) · Transfusion Medicine Reviews · doi:10.1016/j.tmrv.2021.09.001 · Cited by 13
“Beyond 8 days after symptom onset, nearly all patients with COVID-19 had neutralizing antibody responses [43] .”
Science, M. E., Bolotin, S., Silverman, M. E., Nadarajah, J., Maguire, B. R., Parekh, R. S., McGeer, A., Schwartz, K. L., Alexander, L. E. C., Allen, U., et al. (2021) · CMAJ Open · doi:10.9778/cmajo.20210044 · Cited by 13
Tyner, H. L., Burgess, J. L., Grant, L., Gaglani, M., Kuntz, J. L., Naleway, A. L., Thornburg, N. J., Caban-Martinez, A. J., Yoon, S. K., Herring, M. K., et al. (2021) · Clinical Infectious Diseases · doi:10.1093/cid/ciab1038 · Cited by 13
“Ac ce pte d M an us cri pt Unlike other studies which have observed a correlation between more severe SARSCoV-2 infection and higher antibody response [30-37], an association was not observed between febrile symptoms during infection, weeks of virus detection, or nasal viral RNA load and the development of nAb.”
ResultKurano, M., Ohmiya, H., Kishi, Y., Okada, J., Nakano, Y., Yokoyama, R., Qian, C., Xia, F., He, F., Zheng, L., et al. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.811952 · Cited by 13
“…made in a rather acute phase of the disease, that is, within 2 weeks from the onset of symptoms, in some studies (8 – 20), in others, they were made in the later phases of the disease (8 – 10, 13, 16 – 19, 21 – 32), at the time of admission to the hospital (33, 34), or at arbitrary times (35 – 37).”
BackgroundProduction and Quality Assurance of Human Polyclonal Hyperimmune Immunoglobulins Against SARS-CoV-2
Burnouf, T., Gathof, B. S., Bloch, E. M., Bazin, R., Angelis, V. D., Patidar, G. K., Rastvorceva, R. M. G., Oreh, A. C., Goel, R., Rahimi‐Levene, N., et al. (2022) · Transfusion Medicine Reviews · doi:10.1016/j.tmrv.2022.06.001 · Cited by 13
The Four Ws of the Fourth Dose COVID-19 Vaccines: Why, Who, When and What
Khong, K.-W., Zhang, R., & Hung, I. F. (2022) · Vaccines · doi:10.3390/vaccines10111924 · Cited by 14
López-Cortés, L. F., Saborido-Alconchel, A., Trujillo‐Rodríguez, M., Serna‐Gallego, A., Llaves-Flores, S., Muñoz‐Muela, E., Pérez-Santos, M. J., Lozano, C., Mejías-Trueba, M., Roca, C., et al. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1129753 · Cited by 12
Antibody Responses to SARS-CoV-2 Antigens in Humans and Animals
Kim, H., Seiler, P., Jones, J. C., Ridout, G., Camp, K. P., Fabrizio, T. P., Jeevan, T., Miller, L. A., Throm, R. E., Ferrara, F., et al. (2020) · Vaccines · doi:10.3390/vaccines8040684 · Cited by 13
“This phenomenon has received much attention in the context of COVID-19, and some have suggested a short duration of responding antibodies [6,24,25].”
BackgroundPlebani, M., Parčina, M., Bechri, I., Zehender, G., Terkeš, V., Hafith, B. A., Antinori, S., Pillet, S., Gonzalo, S., Hoerauf, A. M., et al. (2020) · Journal of Clinical Microbiology · doi:10.1128/jcm.02240-20 · Cited by 13
Bayat, M., Asemani, Y., & Najafi, S. (2021) · International Immunopharmacology · doi:10.1016/j.intimp.2021.107679 · Cited by 15
Possas, C. D. A., Marques, E. T. A., Risi, J. B., & Homma, A. (2021) · Circular Economy and Sustainability · doi:10.1007/s43615-021-00060-x · Cited by 13
Testing for antibodies to SARS-CoV-2
Gill, D., & Ponsford, M. (2020) · BMJ · doi:10.1136/bmj.m4288 · Cited by 13
COVID-19 viral and serology testing in New York city health care workers
Racine-Brzostek, S. E., Yang, H. S., Chadburn, A., Orlander, D., An, A., Campion, T. R., Yee, J., Chen, Z., Loda, M., Zhao, Z., et al. (2020) · American Journal of Clinical Pathology · doi:10.1093/ajcp/aqaa142 · Cited by 12
Ionov, S., & Lee, J. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.832533 · Cited by 12
Humoral response to SARS-CoV-2 infection among liver transplant recipients
Becchetti, C., Broekhoven, A. G. C., Dahlqvist, G., Fraga, M., Zambelli, M. F., Ciccarelli, O., Saouli, A.-C., Trizzino, A., Banz, V. M., Dufour, J., et al. (2022) · Gut · doi:10.1136/gutjnl-2021-326609 · Cited by 12
Chisanga, M., Stuible, M., Gervais, C., L’Abbé, D., Cass, B., Bisson, L., Pelletier, A., Lord‐Dufour, S., Durocher, Y., Boudreau, D., et al. (2022) · Sensors & Diagnostics · doi:10.1039/d2sd00073c · Cited by 16
Kim, Y., Bae, J., Kwon, K. T., Chang, H., Lee, W. K., Park, H., Kim, J., Choi, I., Park, M., & Kim, S. (2022) · Scientific Reports · doi:10.1038/s41598-022-17605-1 · Cited by 12
Kasbergen, L. M. R., de Bruin, E., Chandler, F. D., Sigfrid, L., Chan, X. H. S., Hookham, L., Wei, J., Chen, S., GeurtsvanKessel, C. H., Scherbeijn, S. M. J., et al. (2025) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(24)00654-6 · Cited by 12
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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