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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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“The stability of the IgG reactivity for three months has been previously demonstrated (36, 37).”
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Bansal, A., Trieu, M.-C., Mohn, K. G.-I., Madsen, A., Olofsson, J. S., Sandnes, H. H., Sævik, M., Søyland, H., Hansen, L., Onyango, T. B., et al. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1164326 · Cited by 13
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“It is documented that antibody levels in response to SARSCoV-2 infection decline over time (15, 16).”
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“However, the immune responses to a viral disease are much more extensive and complex, and depend on a number of factors (25, 26).”
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“correlation between longevity of the antibody responses with disease severity (82, 83).”
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“Gender has been shown not to play a role in infection rates (32), but our findings could suggest gender equitable solutions are required for management of COVID-19 prevention.”
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BackgroundCharacterization of humoral and SARS-CoV-2 specific T cell responses in people living with HIVPreprint
Alrubayyi, A., Gea‐Mallorquí, E., Touizer, E., Hameiri‐Bowen, D., Kopycinski, J. T., Charlton, B. G., Fisher-Pearson, N., Muir, L., Rosa, A., Roustan, C., et al. (2021) · Research Square · doi:10.21203/rs.3.rs-309746/v1 · Cited by 12
Panorama of Breakthrough Infection Caused by SARS-CoV-2: A Review
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“Consistent with the observation of the rapid waning of neutralizing antibodies in both COVID-19 convalescents and vaccinees [51, 52], we found that only approximately 10% of spike-speci fi c antibody lineages that presented at early times persisted for at least 12 months.”
ResultZhou, H., Leng, P., Wang, Y., Yang, K., Li, C., Ojcius, D. M., Wang, P., & Jiang, S. (2024) · 中国科学通报:英文版 · doi:10.1016/j.scib.2024.02.041 · Cited by 10
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“Although COVID-19 vaccines can induce high titers of neutralizing IgG and IgA class antibodies against the SARS-CoV-2 spike protein, they only offer temporary protection against the SARS-CoV-2 infection [1,111–113].”
A first probable case of SARS-CoV-2 reinfection in Colombia
Novoa, W., Miller, H., Mattar, S., V, Faccini‐Martínez, Á. A., Rivero, R., & Coll, H. A. S. (2021) · Annals of Clinical Microbiology and Antimicrobials · doi:10.1186/s12941-020-00413-8 · Cited by 10
Weber, M. S., Nicholas, J. A., & Yeaman, M. R. (2021) · Neurology Neuroimmunology & Neuroinflammation · doi:10.1212/nxi.0000000000001067 · Cited by 12
“Third, patients with the most severe cases of COVID-19 often have the highest titers of specific antibodies.(33,34) Collectively, these findings suggest that B-cell function and antibody generation may have secondary roles compared with T cells and IFNs in protective immunity against COVID-19.”
BackgroundDecarreaux, D., Pouquet, M., Souty, C., Vilcu, A., Prévot-Monsacre, P., Fourié, T., Villarroel, P. M. S., Priet, S., Blanché, H., Sébaoun, J.-M., et al. (2022) · Viruses · doi:10.3390/v14050957 · Cited by 10
A chimeric MERS-CoV virus-like particle vaccine protects mice against MERS-CoV challenge
Park, J.-E., Kim, J.-H., Park, J.-Y., Jun, S., & Shin, H. (2022) · Virology Journal · doi:10.1186/s12985-022-01844-9 · Cited by 10
Increasing test specificity without impairing sensitivity: lessons learned from SARS-CoV-2 serology
Perkmann, T., Köller, T., Perkmann‐Nagele, N., Ozsvár-Kozma, M., Eyre, D. W., Matthews, P. C., Bown, A., Stoesser, N. E., Breyer, M., Breyer‐Kohansal, R., et al. (2022) · Journal of Clinical Pathology · doi:10.1136/jcp-2022-208171 · Cited by 10
Denaro, M. F., Ferro, E., Barrano, G., Meli, S., Busacca, M., Corallo, D., Capici, A., Zisa, A., Cucuzza, L., Gradante, S., et al. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24054742 · Cited by 10
“Further knowledge on the magnitude, timing, and longevity of nAb responses following SARS-CoV-2 infection is vital for understanding the role that nAbs might play in disease clearance and protection from reinfection (also called renewed or second wave infections) or disease [10].”
BackgroundInfluentialParker, E. L., Thomas, J., Roper, K. J., Ijaz, S., Edwards, T., Marchesin, F., Katsanovskaja, K., Lett, L., Jones, C., Hardwick, H., et al. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1146702 · Cited by 10
Guan, X., Huang, Q., Dong, M., Li, M., Xie, H., Wei, X., Kang, L., Wang, X., Li, A., Wang, Q., et al. (2023) · Journal of Infection · doi:10.1016/j.jinf.2023.08.010 · Cited by 10
SARS-CoV-2 NSP5 antagonizes MHC II expression by subverting histone deacetylase 2
Taefehshokr, N., Lac, A., Vrieze, A. M., Dickson, B. H., Guo, P. N., Jung, C., Blythe, E. N., Fink, C., Aktar, A., Dikeakos, J. D., et al. (2024) · Journal of Cell Science · doi:10.1242/jcs.262172 · Cited by 16
Detection of SARS‐CoV‐2‐specific memory B cells to delineate long‐term COVID‐19 immunity
Thieme, C. J., Abou‐El‐Enein, M., Fritsche, E., Anft, M., Paniskaki, K., Skrzypczyk, S., Doevelaar, A., Elsallab, M., Brindle, N. R., Blazquez‐Navarro, A., et al. (2021) · Allergy · doi:10.1111/all.14827 · Cited by 10
Lytton, S. D., Yeasmin, M., Ghosh, A. K., Bulbul, M. R. H., Molla, M. M. A., Herr, M., Duchmann, H., Sharif, M., Nafisa, T., Amin, M. R., et al. (2021) · Pathogens · doi:10.3390/pathogens10060637 · Cited by 10
Anti-SARS-CoV-2 IgA Identifies Asymptomatic Infection in First Responders
Montague, B. T., Wipperman, M. F., Hooper, A. T., Hamon, S., Crow, R., Elemo, F., Hersh, L., Langdon, S., Hamilton, J. D., O’Brien, M. P., et al. (2021) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiab524 · Cited by 10
“4 infection.[14-18] Persons with asymptomatic or mild infection in prior studies may have lower levels of IgG and may show a more rapid decay in antibody titers.”
BackgroundMenon, V. P., Shariff, M. A., Perez-Gutierrez, V. A., Carreño, J. M., Yu, B., Jawed, M., Gossai, M., Valdez, E., Pillai, A., Venugopal, U., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-051045 · Cited by 9
Theel, E. S. (2021) · Clinics in Laboratory Medicine · doi:10.1016/j.cll.2021.10.006 · Cited by 10
Sen, K., Datta, S., Ghosh, A., Jha, A., Ahad, A., Chatterjee, S., Suranjika, S., Sengupta, S., Bhattacharya, G., Shriwas, O., et al. (2021) · Frontiers in Immunology · doi:10.3389/fimmu.2021.733539 · Cited by 10
“T-cell-mediated response is also critical in mediating longterm protection against SARS-CoV-2 (20), while B-cell-mediated antibody response tends to decline in convalescent patients (21).”
BackgroundZhou, Y., Yuan, S., To, K. K., Xu, X., Li, H., Cai, J., Luo, C., Hung, I. F., Chan, K., Yuen, K., et al. (2022) · Chemical Science · doi:10.1039/d1sc05852e · Cited by 10
Humoral response to viral vector COVID-19 vaccine in hemodialysis patients
Raja, N., Rajagopalan, A., Arunachalam, J., Prasath, A., Durai, R., & Rajendran, M. (2022) · Kidney Research and Clinical Practice · doi:10.23876/j.krcp.21.184 · Cited by 10
“In some studies, SARS-CoV-2 IgG titers decline substantially in dialysis patients within 3 months after diagnosis [25].”
BackgroundSulbarán, G., Maisonnasse, P., Amen, A., Effantin, G., Guilligay, D., Dereuddre‐Bosquet, N., Burger, J. A., Poniman, M., Grobben, M., Buisson, M., et al. (2022) · Cell Reports Medicine · doi:10.1016/j.xcrm.2022.100528 · Cited by 11
COVID-19 Vaccination Strategies and Their Adaptation to the Emergence of SARS-CoV-2 Variants
Stefanelli, P., & Rezza, G. (2022) · Vaccines · doi:10.3390/vaccines10060905 · Cited by 10
Danchin, A., Pagani-Azizi, O., Turinici, G., & Yahiaoui, G. (2022) · Acta Biotheoretica · doi:10.1007/s10441-022-09447-1 · Cited by 8
Panahi, Y., Einollahi, B., Beiraghdar, F., Darvishi, M., Fathi, S., Javanbakht, M., Shafiee, S., & Akhavan‐Sigari, R. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.947602 · Cited by 10
Translational Research in the Time of COVID-19—Dissolving Boundaries
Edgeworth, J. D., Batra, R., Nebbia, G., Bisnauthsing, K. N., MacMahon, E. M. E., Sudhanva, M., Douthwaite, S. T., Goldenberg, S. D., O’Hara, G. A., Shankar‐Hari, M., et al. (2020) · PLoS Pathogens · doi:10.1371/journal.ppat.1008898 · Cited by 10
Self-citationDomènech-Montoliu, S., Puig‐Barberà, J., Pac-Sa, M. R., Vidal-Utrillas, P., Latorre-Poveda, M., Rio-González, A. D., Ferrando-Rubert, S., Ferrer-Abad, G., Sanchéz-Urbano, M., Aparisi-Esteve, L., et al. (2021) · COVID · doi:10.3390/covid1010006 · Cited by 8
Learning from success: how has Hungary responded to the COVID pandemic?
McKee, M. (2020) · GeroScience · doi:10.1007/s11357-020-00240-x · Cited by 10
Tighe, P. J., Urbanowicz, R. A., Fairclough, L. C., McClure, C. P., Thomson, B. J., Gomez, N., Chappell, J. G., Tsoleridis, T., Loose, M., Carlile, M., et al. (2020) · medRxiv · doi:10.1101/2020.08.22.20176834 · Cited by 10
Self-citationLaing, E. D., Sterling, S. L., Richard, S. A., Phogat, S., Samuels, E. C., Epsi, N. J., Yan, L., Moreno, N., Coles, C., Mehalko, J. L., et al. (2020) · medRxiv · doi:10.1101/2020.10.14.20207050 · Cited by 10
Fanne, R. A., Lidawi, G., Maraga, E., Moed, M., Roguin, A., & Meisel, S.-R. (2022) · Vaccines · doi:10.3390/vaccines10122116 · Cited by 9
Andreev, A. I., Andreev, I. V., Nechay, K. O., Esaulova, D. R., Baklakova, O. S., Vecherko, V. I., Shilovskiy, I. P., Кофиади, И. А., Гудима, Г. О., Martynov, A. I., et al. (2022) · Immunologiya · doi:10.33029/0206-4952-2022-43-5-583-592 · Cited by 18
Nakai, M., Yokoyama, D., Sato, T., Sato, R., Kojima, C., & Shimosawa, T. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e16547 · Cited by 10
“64 SARS-CoV-2 elicits an immune response in the host with simultaneous production 65 of IgG, IgA, and IgM antibodies [5-7].”
BackgroundMartel, F., Cuervo-Rojas, J., Ángel, J., Ariza, B., González, J. M., Ramírez-Santana, C., Acosta‐Ampudia, Y., Murcia-Soriano, L. F., Montoya, N., Cardozo-Romero, C. C., et al. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1241038 · Cited by 9
Xu, J., Chen, J., Wen, F., Liu, K., & Chen, Y. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e24580 · Cited by 9
RetractedNouanesengsy, A., Semesi, A., Quách, K. Ư., Ivanochko, D., Byrne, W., Hwang, M. K., Neve, M.-R. L., Leon‐Ponte, M., Litosh, A., Wisener, N., et al. (2025) · Microbiology Spectrum · doi:10.1128/spectrum.01333-24 · Cited by 9
“Many studies have suggested that the humoral response differs in patients with distinct clinical disease progression and infection kinetics (18, 22– 28).”
Tam, J. C. H., Sibayan, A. C., Seow, J., Graham, C., Kurshan, A., Merrick, B., Stanton, R. J., & Doores, K. J. (2025) · Cell Reports · doi:10.1016/j.celrep.2025.116000 · Cited by 12
Self-citationSevere Acute Respiratory Syndrome Coronavirus 2 Reinfection Cases Corroborated by Sequencing
Massachi, J., Donohue, K. C., & Kelly, J. D. (2021) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.21-0365 · Cited by 8
“Several hypotheses that are of particular interest are that escape mutations enabling evasion of established immune responses would result in a greater probability of reinfection, individuals who experienced a less severe clinical syndrome during initial infection (especially asymptomatic individuals) may be at greate…”
BackgroundDuarte, G. G., Coutinho, C. M., Rolnik, D. L., Quintana, S. M., Silva, A. C. R. E., Poon, L. C., & Costa, F. D. S. (2021) · AJOG Global Reports · doi:10.1016/j.xagr.2021.100020 · Cited by 9
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“Sequential follow up of 39 patients from Japan [4] and 65 patients from UK [14] yielded similar findings.”
Shim, H. W., Shin, J. H., Shin, S. C., Lee, H. J., So, K. S., Lee, S. Y., Jun, J. W., Seo, J. K., Lee, H. S., Lee, S. Y., et al. (2022) · Diagnostics · doi:10.3390/diagnostics12081924 · Cited by 10
Vega, M.-A. D. L., Polychronopoulou, E., Ara, X. I. I. I., Ding, Z., Chen, T., Liu, Q., Lan, J., Nepveu-Traversy, M.-É., Fausther‐Bovendo, H., Zaidan, M., et al. (2023) · Emerging Microbes & Infections · doi:10.1080/22221751.2023.2169198 · Cited by 10
“Likewise, neutralizing antibody (NAb) levels in individuals recovering from a low peak-infective dose of SARS-CoV-2 were found to decline to titres approaching baseline levels within three months [3].”
BackgroundPrevalence of Coronavirus Antibody Among First Responders in Lubbock, Texas
IWUJI, K. C., Islam, E. A., Berdine, G. G., NUGENT, K. M., Test, V. J., & Tijerina, A. J. (2020) · Journal of Primary Care & Community Health · doi:10.1177/2150132720971390 · Cited by 9
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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