Antibody Response After SARS-CoV-2 Infection and Implications for Immunity

Arkhipova-Jenkins, Irina; Helfand, Mark; Armstrong, Charlotte; Gean, Emily; Anderson, Joanna; Paynter, Robin; Mackey, Katherine

doi:10.7326/m20-7547

Cited by 110 publications

(86 citation statements)

References 76 publications

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“…It is well known that antibody levels correlate with protection against many viruses including SARS-CoV-2, and recent data suggest that high neutralizing titers are particularly important for protection against the novel SARS-CoV-2 causing the COVID-19 pandemic. 12,13 In the current study we used the Euroimmune ELISA assay to quantify SARS-CoV-2 antibody level as it was reported to highly correlate with the neutralizing antibody assay. 14 Our findings demonstrated that untreated COVID-19-vaccinated MS patients developed protective SARS-CoV-2 humoral responses similarly to healthy vaccinees, and similarly to the findings recently reported in the literature for non-MS vaccinees.…”

Section: Discussionmentioning

confidence: 99%

Humoral immune response to COVID-19 mRNA vaccine in patients with multiple sclerosis treated with high-efficacy disease-modifying therapies

Achiron

Mandel

Dreyer-Alster

et al. 2021

Ther Adv Neurol Disord

312

326

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Background and Aims: The National Multiple Sclerosis Society and other expert organizations recommended that all patients with multiple sclerosis (MS) should be vaccinated against COVID-19. However, the effect of disease-modifying therapies (DMTs) on the efficacy to mount an appropriate immune response is unknown. We aimed to characterize humoral immunity in mRNA-COVID-19 MS vaccinees treated with high-efficacy DMTs. Methods: We measured SARS-CoV-2 IgG response using anti-spike protein-based serology (EUROIMMUN) in 125 MS patients vaccinated with BNT162b2-COVID-19 vaccine 1 month after the second dose. Patients were either untreated or under treatment with fingolimod, cladribine, or ocrelizumab. A group of healthy subjects similarly vaccinated served as control. The percent of subjects that developed protective antibodies, the titer, and the time from the last dosing were evaluated. Results: Protective humoral immunity of 97.9%, 100%, 100%, 22.7%, and 3.8%, was observed in COVID-19 vaccinated healthy subjects ( N = 47), untreated MS patients ( N = 32), and MS patients treated with cladribine ( N = 23), ocrelizumab ( N = 44), and fingolimod ( N = 26), respectively. SARS-CoV-2 IgG antibody titer was high in healthy subjects, untreated MS patients, and MS patients under cladribine treatment, within 29.5–55 days after the second vaccine dose. Only 22.7% of patients treated with ocrelizumab developed humoral IgG response irrespective to normal absolute lymphocyte count. Most fingolimod-treated MS patients had very low lymphocyte count and failed to develop SARS-COV-2 antibodies. Age, disease duration, and time from the last dosing did not affect humoral response to COVID-19 vaccination. Conclusions: Cladribine treatment does not impair humoral response to COVID-19 vaccination. We recommend postponing ocrelizumab treatment in MS patients willing to be vaccinated as a protective humoral response can be expected only in some. We do not recommend vaccinating MS patients treated with fingolimod as a protective humoral response is not expected.

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Section: Discussionmentioning

confidence: 99%

Humoral immune response to COVID-19 mRNA vaccine in patients with multiple sclerosis treated with high-efficacy disease-modifying therapies

Achiron

Mandel

Dreyer-Alster

et al. 2021

Ther Adv Neurol Disord

312

326

View full text Add to dashboard Cite

show abstract

“…Our evaluation of serological responses is one of few in the community to our knowledge and highlights that a significant minority (~20%) of RT-PCR-positive cases do not appear to seroconvert, particularly those with higher Ct values and not reporting symptoms. A recent systematic review estimated that 95% of adults with laboratory confirmed SARS-CoV-2 infection developed IgG antibodies ( Arkhipova-Jenkins et al, 2021 ), peaking around 25 days. However, only 23% of included studies were in outpatient settings and 14% included only participants with asymptomatic or mild disease.…”

Section: Discussionmentioning

confidence: 99%

Ct threshold values, a proxy for viral load in community SARS-CoV-2 cases, demonstrate wide variation across populations and over time

Walker

Pritchard

House

et al. 2021

eLife

108

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Background:Information on SARS-CoV-2 in representative community surveillance is limited, particularly cycle threshold (Ct) values (a proxy for viral load).Methods:We included all positive nose and throat swabs 26 April 2020 to 13 March 2021 from the UK’s national COVID-19 Infection Survey, tested by RT-PCR for the N, S, and ORF1ab genes. We investigated predictors of median Ct value using quantile regression.Results:Of 3,312,159 nose and throat swabs, 27,902 (0.83%) were RT-PCR-positive, 10,317 (37%), 11,012 (40%), and 6550 (23%) for 3, 2, or 1 of the N, S, and ORF1ab genes, respectively, with median Ct = 29.2 (~215 copies/ml; IQR Ct = 21.9–32.8, 14–56,400 copies/ml). Independent predictors of lower Cts (i.e. higher viral load) included self-reported symptoms and more genes detected, with at most small effects of sex, ethnicity, and age. Single-gene positives almost invariably had Ct > 30, but Cts varied widely in triple-gene positives, including without symptoms. Population-level Cts changed over time, with declining Ct preceding increasing SARS-CoV-2 positivity. Of 6189 participants with IgG S-antibody tests post-first RT-PCR-positive, 4808 (78%) were ever antibody-positive; Cts were significantly higher in those remaining antibody negative.Conclusions:Marked variation in community SARS-CoV-2 Ct values suggests that they could be a useful epidemiological early-warning indicator.Funding:Department of Health and Social Care, National Institutes of Health Research, Huo Family Foundation, Medical Research Council UK; Wellcome Trust.

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“…The first class to be activated through the entry of an infectious agent are immunoglobulins IgM, followed by IgA and IgG. 23 Dimeric IgA can be found on mucosal surfaces and in secretions, such as saliva, breast milk and nasal mucus. Hence, IgA also plays a crucial role for mucosal immunity.…”

Section: Persistence Of Humoral Responsementioning

confidence: 99%

“…In general, it should be noted that test procedures including test timing, assay types, targeted antibodies/antigens and positivity thresholds varied considerably across reviewed studies, as no standard procedures have yet been established. 23 Several immunoassays have not been approved by health and safety agencies such as the US Food and Drug Administration 2 , 23 and numerous studies reviewed here developed their own in‐house tests. More in depth details such as diagnostic test accuracy and approvals for the most common tests have been summarized by previous more rigorous reviews.…”

Section: Persistence Of Humoral Responsementioning

confidence: 99%

Persistence of humoral response upon SARS‐CoV‐2 infection

Knies

Braun

Kimpel

et al. 2021

Reviews in Medical Virology

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Summary SARS‐CoV‐2 continues to leave its toll on global health and the economy. Management of the pandemic will rely heavily on the degree of adaptive immunity persistence following natural SARS‐CoV‐2 infection. Along with the progression of the pandemic, more literature on the persistence of the SARS‐CoV‐2‐specific antibody response is becoming available. Here, we summarize findings on the persistence of the humoral, including neutralizing antibody, response at three to eight months post SARS‐CoV‐2 infection in non‐pregnant adults. While the comparability of the literature is limited, findings on the detectability of immunoglobulin G class of antibodies (IgG) were most consistent and were reported in most studies to last for six to eight months. Studies investigating the response of immunoglobins M and A (IgM, IgA) were limited and reported mixed results, in particular, for IgM. The majority of studies observed neutralizing antibodies at all time points tested, which in some studies lasted up to eight months. The presence of neutralizing antibodies has been linked to protection from re‐infection, suggesting long‐term immunity to SARS‐CoV‐2. These neutralizing capacities may be challenged by emerging virus variants, but mucosal antibodies as well as memory B and T cells may optimize future immune responses. Thus, further longitudinal investigation of PCR‐confirmed seropositive individuals using sensitive assays is warranted to elucidate the nature and duration of a more long‐term humoral response.

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Antibody Response After SARS-CoV-2 Infection and Implications for Immunity

Cited by 110 publications

References 76 publications

Humoral immune response to COVID-19 mRNA vaccine in patients with multiple sclerosis treated with high-efficacy disease-modifying therapies

Humoral immune response to COVID-19 mRNA vaccine in patients with multiple sclerosis treated with high-efficacy disease-modifying therapies

Ct threshold values, a proxy for viral load in community SARS-CoV-2 cases, demonstrate wide variation across populations and over time

Persistence of humoral response upon SARS‐CoV‐2 infection

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