Antibody Status and Incidence of SARS-CoV-2 Infection in Health Care Workers
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Abstract
BACKGROUND: The relationship between the presence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the risk of subsequent reinfection remains unclear. METHODS: We investigated the incidence of SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) in seropositive and seronegative health care workers attending testing of asymptomatic and symptomatic staff at Oxford University Hospitals in the United Kingdom. Baseline antibody status was determined by anti-spike (primary analysis) and anti-nucleocapsid IgG assays, and staff members were followed for up to 31 weeks. We estimated the relative incidence of PCR-positive test results and new symptomatic infection according to antibody status, adjusting for age, participant-reported gender, and changes in incidence over time. RESULTS: A total of 12,541 health care workers participated and had anti-spike IgG measured; 11,364 were followed up after negative antibody results and 1265 after positive results, including 88 in whom seroconversion occurred during follow-up. A total of 223 anti-spike-seronegative health care workers had a positive PCR test (1.09 per 10,000 days at risk), 100 during screening while they were asymptomatic and 123 while symptomatic, whereas 2 anti-spike-seropositive health care workers had a positive PCR test (0.13 per 10,000 days at risk), and both workers were asymptomatic when tested (adjusted incidence rate ratio, 0.11; 95% confidence interval, 0.03 to 0.44; P = 0.002). There were no symptomatic infections in workers with anti-spike antibodies. Rate ratios were similar when the anti-nucleocapsid IgG assay was used alone or in combination with the anti-spike IgG assay to determine baseline status. CONCLUSIONS: The presence of anti-spike or anti-nucleocapsid IgG antibodies was associated with a substantially reduced risk of SARS-CoV-2 reinfection in the ensuing 6 months. (Funded by the U.K. Government Department of Health and Social Care and others.).
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In health-care workers, seropositivity at enrolment reduced incidence of detected reinfection by almost 89% over a median follow-up of 139 days.
“This study estimated that seropositivity at enrolment reduced the incidence of detected reinfection by almost 89% over a median follow-up of 139 days.”
From Prospects for durable immune control of SARS-CoV-2 and prevention of reinfection (2021) · cites this paper as [53]
Natural SARS-CoV-2 infection has been estimated to give 89-95% protection, a level statistically indistinguishable from that of licensed vaccines in the short term.
“a level of protection that is not significantly different to the 89–95% protection that has been estimated following natural infection53,54.”
From Prospects for durable immune control of SARS-CoV-2 and prevention of reinfection (2021) · cites this paper as [53]
Preexisting immunity to SARS-CoV-2 is associated with protection against reinfection in humans and in nonhuman primates.
“Preexisting immunity to SARS-CoV-2 is associated with protection against reinfection in humans (9–11) and in nonhuman primates (12, 13).”
From mRNA vaccination boosts cross-variant neutralizing antibodies elicited by SARS-CoV-2 infection (2021) · cites this paper as [11]
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“Introduction Neutralizing antibodies against the SARS-CoV-2 spike are associated with protection against infection in both humans (Addetia et al., 2020; Lumley et al., 2020) and animal models (Alsoussi et al.”
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- Authors
- Lumley, S. F., O’Donnell, D., Stoesser, N. E., Matthews, P. C., Howarth, A., Hatch, S. B., Marsden, B. D., Cox, S., James, T., Warren, F., Peck, L. J., Ritter, T. G., de Toledo, Z., Warren, L., Axten, D., Cornall, R. J., Jones, E. Y., Stuart, D. I., Screaton, G., Ebner, D., Hoosdally, S., Chand, M., Crook, D. W., O’Donnell, A.-M., Conlon, C. P., Pouwels, K. B., Walker, A. S., Peto, T. E. A., Hopkins, S., Walker, T. M., Jeffery, K., & Eyre, D. W.
- Affiliations
- Public Health England (GB)
- From Oxford University Hospitals NHS Foundation Trust (S.F.L., N.E.S., P.C.M., S.C., T.J., F.W., L.W., D.A., A.-M.O., K.J.), Nuffield Department of Medicine (S.F.L., D.O., N.E.S., P.C.M., A.H., S.B.H., B.D.M., R.J.C., E.Y.J., D.I.S., G.S., D.E., S. Hoosdally, D.W.C., C.P.C., A.S.W., T.E.A.P., T.M.W.), the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (N.E.S., P.C.M., S. Hoosdally, D.W.C., A.S.W., T.E.A.P., D.W.E.), the Kennedy Institute of Rheumatology Research (B.D...
- Corresponding author
- Eyre, David W.
- ORCID
- Lumley, Sheila F.
- Stoesser, Nicole E.
- Matthews, Philippa C.
- Hatch, Stephanie B.
- Marsden, Brian D.
- Peck, Liam J.
- Ritter, Thomas G.
- Cornall, Richard J.
- Stuart, David I.
- Screaton, Gavin
- Ebner, Daniel
- Hoosdally, Sarah
- Chand, Meera
- Crook, Derrick W.
- Conlon, Christopher P.
- Pouwels, Koen B.
- Walker, A. Sarah
- Peto, Tim E.A.
- Hopkins, Susan
- Jeffery, Katie
- Eyre, David W.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2021-02-11
- Volume
- 384
- Issue
- 6
- Pages
- 533-540
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC7781098
- OpenAlex
- W3117382778
- Cited by
- 940
- References
- 29
- Citations by year
- 2026: 7 · 2025: 26 · 2024: 53 · 2023: 103 · 2022: 299 · 2021: 434 · 2020: 16
- FWCI
- 28.01
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- Locations
- New England Journal of Medicine (publishedVersion)
- medRxiv (acceptedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- U.K. Government
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- SARS-CoV-2, COVID-19 reinfection, healthcare workers, anti-spike IgG, seropositivity, seroconversion, asymptomatic infection, symptomatic infection, infection incidence, antibody status
- MeSH terms
- Seroconversion, COVID-19, SARS-CoV-2, Coronavirus Nucleocapsid Proteins, COVID-19 Nucleic Acid Testing, COVID-19 Serological Testing, Adolescent, Adult, Aged, Aged, 80 and over, Antibodies, Viral, Female, United Kingdom, Health Personnel, Humans, Immunoglobulin G, Longitudinal Studies, Male, Middle Aged, Recurrence, Incidence, Polymerase Chain Reaction, Young Adult, Spike Glycoprotein, Coronavirus
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