Cited by 940SARS-CoV-2 and COVID-19 ResearchCOVID-19 epidemiological studiesCOVID-19 Clinical Research Studies

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Antibody Status and Incidence of SARS-CoV-2 Infection in Health Care Workers

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Lumley, Sheila F., O’Donnell, Denise, Stoesser, Nicole E., Matthews, Philippa C., Howarth, Alison, Hatch, Stephanie B., Marsden, Brian D., Cox, Stuart, James, Tim, Warren, Fiona, Peck, Liam J., Ritter, Thomas G., de Toledo, Zoe, Warren, Laura, Axten, David, Cornall, Richard J., Jones, E. Yvonne, Stuart, David I., Screaton, Gavin, Ebner, Daniel, Hoosdally, Sarah, Chand, Meera, Crook, Derrick W., O’Donnell, Anne-Marie, Conlon, Christopher P., Pouwels, Koen B., Walker, A. Sarah, Peto, Tim E.A., Hopkins, Susan, Walker, Timothy M., Jeffery, Katie, Eyre, David W.·2021·New England Journal of Medicine

DOI 10.1056/nejmoa2034545PMC PMC7781098

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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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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
DOI: 10.1056/nejmoa2034545
PMC: PMC7781098
OpenAlex: W3117382778
Cited by: 940
References: 29
Citations by year: 2026: 7 · 2025: 26 · 2024: 53 · 2023: 103 · 2022: 299 · 2021: 434
FWCI: 28.01
Type: journal article
Language: en
Open access: green
doi.org
Licence: cc-by
www.nejmgroup.org/legal/terms-of-use.htm (vor)
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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Antibody Status and Incidence of SARS-CoV-2 Infection in Health Care Workers

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