Antibody response to SARS-CoV-2 infection in humans: a systematic review

Post, Nathan; Eddy, Danielle; Huntley, Catherine; Schalkwyk, May C I van; Shrotri, Madhumita; Leeman, David; Rigby, S.E.; Williams, Sarah; Bermingham, William; Kellam, Paul; Maher, John; Shields, Adrian; Amirthalingam, Gayatri; Peacock, Sharon J.; Ismail, Sharif

doi:10.1101/2020.08.25.20178806

Cited by 92 publications

(58 citation statements)

References 174 publications

(331 reference statements)

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“…The IgG antibody titre was high in only a few specimens, consistent with evidence that most infections during the first wave were mild or asymptomatic, cases that are associated with lower antibody levels than more severe disease 12 . Peak IgM and IgA levels are lower than for SARS‐CoV‐2‐specific IgG, and they decline more rapidly, in most cases to undetectable levels by six weeks 10,12,13 . It was therefore unsurprising that few IgG‐positive specimens in our survey were also positive for IgM or IgA, given the period during which they were collected.…”

Section: Discussionsupporting

confidence: 71%

“…The SARS‐CoV‐2 antibody profiles of seropositive people were consistent with what is known about antibody kinetics. The IgG antibody titre was high in only a few specimens, consistent with evidence that most infections during the first wave were mild or asymptomatic, cases that are associated with lower antibody levels than more severe disease 12 . Peak IgM and IgA levels are lower than for SARS‐CoV‐2‐specific IgG, and they decline more rapidly, in most cases to undetectable levels by six weeks 10,12,13 .…”

Section: Discussionsupporting

confidence: 64%

“…SARS‐CoV‐2‐neutralising antibody was detected in 24 of 38 of IgG‐positive specimens (63%), but the proportion differed by collection group. Most studies have found that more than 90% of SARS‐CoV‐2‐infected people developed neutralising antibodies, 14 but most were studies of hospitalised patients and may therefore reflect the higher antibody levels generated during more severe disease 12,13,15 . Alternatively, the IFA detection of IgG in some samples without detectable neutralising antibody may have been false positive results.…”

Section: Discussionmentioning

confidence: 99%

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Seroprevalence of SARS‐CoV‐2‐specific antibodies in Sydney after the first epidemic wave of 2020

Gidding

Machalek

Hendry

et al. 2021

Medical Journal of Australia

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Objectives To estimate SARS‐CoV‐2‐specific antibody seroprevalence after the first epidemic wave of coronavirus disease 2019 (COVID‐19) in Sydney. Setting, participants People of any age who had provided blood for testing at selected diagnostic pathology services (general pathology); pregnant women aged 20–39 years who had received routine antenatal screening; and Australian Red Cross Lifeblood plasmapheresis donors aged 20–69 years. Design Cross‐sectional study; testing of de‐identified residual blood specimens collected during 20 April – 2 June 2020. Main outcome measure Estimated proportions of people seropositive for anti‐SARS‐CoV‐2‐specific IgG, adjusted for test sensitivity and specificity. Results Thirty‐eight of 5339 specimens were IgG‐positive (general pathology, 19 of 3231; antenatal screening, 7 of 560; plasmapheresis donors, 12 of 1548); there were no clear patterns by age group, sex, or location of residence. Adjusted estimated seroprevalence among people who had had general pathology blood tests (all ages) was 0.15% (95% credible interval [CrI], 0.04–0.41%), and 0.29% (95% CrI, 0.04–0.75%) for plasmapheresis donors (20–69 years). Among 20–39‐year‐old people, the age group common to all three collection groups, adjusted estimated seroprevalence was 0.24% (95% CrI, 0.04–0.80%) for the general pathology group, 0.79% (95% CrI, 0.04–1.88%) for the antenatal screening group, and 0.69% (95% CrI, 0.04–1.59%) for plasmapheresis donors. Conclusions Estimated SARS‐CoV‐2 seroprevalence was below 1%, indicating that community transmission was low during the first COVID‐19 epidemic wave in Sydney. These findings suggest that early control of the spread of COVID‐19 was successful, but efforts to reduce further transmission remain important.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

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Seroprevalence of SARS‐CoV‐2‐specific antibodies in Sydney after the first epidemic wave of 2020

Gidding

Machalek

Hendry

et al. 2021

Medical Journal of Australia

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“…This paper focuses on summarising current understanding of the cellular response to SARS-CoV-2 infection, specifically exploring the role that T cell-mediated immunity might play in resistance to severe infection, clinical and virological recovery, and long-term protection–while recognising the dynamic interdependence of the two arms of the adaptive immune response. It is the second of two linked papers summarising results from a wide-ranging systematic review of peer-reviewed and pre-print literature on the human adaptive immune response to SARS-CoV-2 infection [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

T cell response to SARS-CoV-2 infection in humans: A systematic review

et al. 2021

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Background Understanding the T cell response to SARS-CoV-2 is critical to vaccine development, epidemiological surveillance and disease control strategies. This systematic review critically evaluates and synthesises the relevant peer-reviewed and pre-print literature published from 01/01/2020-26/06/2020. Methods For this systematic review, keyword-structured literature searches were carried out in MEDLINE, Embase and COVID-19 Primer. Papers were independently screened by two researchers, with arbitration of disagreements by a third researcher. Data were independently extracted into a pre-designed Excel template and studies critically appraised using a modified version of the MetaQAT tool, with resolution of disagreements by consensus. Findings were narratively synthesised. Results 61 articles were included. 55 (90%) studies used observational designs, 50 (82%) involved hospitalised patients with higher acuity illness, and the majority had important limitations. Symptomatic adult COVID-19 cases consistently show peripheral T cell lymphopenia, which positively correlates with increased disease severity, duration of RNA positivity, and non-survival; while asymptomatic and paediatric cases display preserved counts. People with severe or critical disease generally develop more robust, virus-specific T cell responses. T cell memory and effector function has been demonstrated against multiple viral epitopes, and, cross-reactive T cell responses have been demonstrated in unexposed and uninfected adults, but the significance for protection and susceptibility, respectively, remains unclear. Conclusion A complex pattern of T cell response to SARS-CoV-2 infection has been demonstrated, but inferences regarding population level immunity are hampered by significant methodological limitations and heterogeneity between studies, as well as a striking lack of research in asymptomatic or pauci-symptomatic individuals. In contrast to antibody responses, population-level surveillance of the T cell response is unlikely to be feasible in the near term. Focused evaluation in specific sub-groups, including vaccine recipients, should be prioritised.

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“…Two systematic reviews deal with the antibody response ( Post et al, 2020 ) and the cellular immune response ( Shrotri et al, 2020 ) to the virus. The former contains amplification of the kind of results we discussed above; the latter states that the response of T-cells to SARS-CoV-2 is currently unknown.…”

Section: Introductionmentioning

confidence: 99%