Prior COVID-19 protects against reinfection, even in the absence of detectable antibodies

Breathnach, Aodhán S.; Duncan, Christopher J A; Bouzidi, Kate El; Hanrath, Aidan T.; Payne, Brendan; Randell, Paul; Habibi, Maximillian S.; Riley, Peter; Planche, Timothy; Busby, John; Sudhanva, Malur; Pallett, Scott J C; Kelleher, William P.

doi:10.1016/j.jinf.2021.05.024

Cited by 31 publications

(22 citation statements)

References 13 publications

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“…In the months following vaccination, QFN SARS-CoV-2 could be used to detect T cell responses even when antibody levels are low or undetectable. As it appears likely that prior COVID-19 protects against reinfection, even in the absence of detectable antibodies [36], testing for T cell response to vaccination could provide clearer information on vaccine-generated immunity, as opposed to testing antibody response alone. Furthermore, over a year into the COVID-19 pandemic, emerging vaccine-resistant variants are a concern, and will likely require the adaptation of existing vaccines or the development of new vaccines [37,38].…”

Section: Discussionmentioning

confidence: 99%

Preliminary Evaluation of QuantiFERON SARS-CoV-2 and QIAreach Anti-SARS-CoV-2 Total Test in Recently Vaccinated Individuals

et al. 2021

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Introduction There is an increasing body of evidence surrounding the importance of a T cell-mediated response to SARS-CoV-2 infection and after COVID-19 vaccination. In this internal feasibility study, we evaluated both the total antibody (IgA, IgM, and IgG) and T cell responses in a cohort of COVID-19 convalescents and vaccinated individuals. Methods Whole blood specimens were collected weekly from 12 subjects at different time points within/after the COVID-19 mRNA vaccination regimen, and from 4 PCR-confirmed convalescent donors to measure durability of humoral and cell-mediated immune response. T cell and antibody responses were evaluated via the QuantiFERON SARS-CoV-2 research use only (QFN SARS-CoV-2) assay which is an interferon gamma release assay (IGRA) and QIAreach Anti-SARS-CoV-2 total (Anti-CoV-2) test, respectively. Results In a cohort of recently vaccinated individuals, subjects demonstrated robust total antibody and CD4+/CD8+ T cell response to SARS-CoV-2 mRNA vaccines when followed for 2 months post-2nd dose. In most individuals, T cell response declined between the 1st and 2nd doses suggesting a need for a booster or the completion of the 2-dose vaccine series. In a group of convalescent donors tested with QFN SARS-CoV-2 and Anti-CoV-2 tests, all patients had an antibody and T cell response up to 1 year after natural infection. Conclusion This small feasibility study demonstrates that the QFN-SARS-CoV-2 test is able to identify CD4+ and CD8+ T cell-mediated responses in SARS-CoV-2-vaccinated subjects and those recovered from COVID-19, alongside a qualitative antibody response detectable via the QIAreach Anti-CoV2 test.

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Section: Discussionmentioning

confidence: 99%

Preliminary Evaluation of QuantiFERON SARS-CoV-2 and QIAreach Anti-SARS-CoV-2 Total Test in Recently Vaccinated Individuals

et al. 2021

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“…Prior epidemiologic studies have found that individuals who are SARS-CoV-2 antibody-positive are protected against reinfection (Abu- Raddad et al, 2021;Harvey et al, 2021;Jeffery-Smith et al, 2021). Furthermore, investigators have reported that even those with prior SARS-CoV-2 infection who lacked detectable antibodies were at 80% lower risk of reinfection than people who were SARS-CoV-2 naı ¨ve (Breathnach et al, 2021). One retrospective study that analyzed test results among nearly 10,000 individuals with prior SARS-CoV-2 infection found that only 0.7% became reinfected with SARS-CoV-2 (Qureshi et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review of the Protective Effect of Prior SARS-CoV-2 Infection on Repeat Infection

2021

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We systematically reviewed studies to estimate the risk of SARS-CoV-2 reinfection among those previously infected with SARS-CoV-2. For this systematic review, we searched scientific publications on PubMed and MedRxiv, a pre-print server, through August 18, 2021. Eligible studies were retrieved on August 18, 2021. The following search term was used on PubMed: (((“Cohort Studies”[Majr]) AND (“COVID-19”[Mesh] OR “SARS-CoV-2”[Mesh])) OR “Reinfection”[Majr]) OR “Reinfection”[Mesh]. The following search term was used on MedRxiv: “Cohort Studies” AND “COVID-19” OR “SARS-CoV-2” AND “Reinfection”. The search terms were broad to encompass all applicable studies. There were no restrictions on the date of publication. Studies that did not describe cohorts with estimates of the risk of SARS-CoV-2 reinfection among those with previous infection were excluded. Studies that included vaccinated participants were either excluded or limited to sub-groups of non-vaccinated individuals. To identify relevant studies with appropriate control groups, we developed the following criteria for studies to be included in the systematic analysis: (1) baseline polymerase chain reaction (PCR) testing, (2) a uninfected comparison group, (3) longitudinal follow-up, (4) a cohort of human participants, i.e. not a case report or case series, and (5) outcome determined by PCR. The review was conducted following PRISMA guidelines. We assessed for selection, information, and analysis bias, per PRISMA guidelines. We identified 1,392 reports. Of those, 10 studies were eligible for our systematic review. The weighted average risk reduction against reinfection was 90.4% with a standard deviation of 7.7% ( p-value: <0.01). Protection against SARS-CoV-2 reinfection was observed for up to 10 months. Studies had potential information, selection, and analysis biases. The protective effect of prior SARS-CoV-2 infection on re-infection is high and similar to the protective effect of vaccination. More research is needed to characterize the duration of protection and the impact of different SARS-CoV-2 variants.

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“…However, specific T-cells most likely also contribute decisively to protection against SARS-CoV-2 [24]. Immunity mediated by specific T cells can be present even if there have never been signs of disease and antibodies are absent [25,26]. In consequence, measuring antibodies alone, such as in our study, underestimates protection against COVID-19 in a population.…”

Section: Discussionmentioning

confidence: 69%

Impact of baseline SARS-CoV-2 antibody status on syndromic surveillance and the risk of subsequent Covid-19 – a prospective multicentre cohort study

Köhler

Güsewell

Seneghini

et al. 2021

Preprint

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Objectives In a prospective healthcare worker (HCW) cohort, we assessed the risk of SARS-CoV-2 infection according to baseline serostatus. Methods Baseline serologies were performed among HCW from 23 Swiss healthcare institutions between June and September 2020, before the second COVID-19 wave. Participants answered weekly electronic questionnaires covering information about nasopharyngeal swabs (PCR/rapid antigen tests) and symptoms compatible with Coronavirus Disease 2019 (COVID-19). Screening of symptomatic staff by nasopharyngeal swabs was routinely performed in participating facilities. We compared numbers of positive nasopharyngeal tests and occurrence of COVID-19 symptoms between HCW with and without anti-nucleocapsid antibodies. Results A total of 4′818 HCW participated, whereof 144 (3%) were seropositive at baseline. We analysed 107′820 questionnaires with a median follow-up of 7.9 months. Median number of answered questionnaires was similar (24 vs. 23 per person, P=0.83) between those with and without positive baseline serology. Among 2′713 HCW with ≥1 SARS-CoV-2 test during follow-up, 3/67 (4.5%) seropositive individuals reported a positive result (one of whom asymptomatic), compared to 547/2646 (20.7%) seronegative participants, 12 of whom asymptomatic (risk ratio [RR] 0.22; 95% confidence interval [CI] 0.07 to 0.66). Seropositive HCWs less frequently reported impaired olfaction/taste (6/144, 4.2% vs. 588/4674, 12.6%, RR 0.33, 95%-CI: 0.15-0.73), chills (19/144, 13.2% vs. 1040/4674, 22.3%, RR 0.59, 95%-CI: 0.39-0.90), and limb/muscle pain (28/144, 19.4% vs. 1335/4674, 28.6%, RR 0.68 95%-CI: 0.49-0.95). Impaired olfaction/taste and limb/muscle pain also discriminated best between positive and negative SARS-CoV-2 results. Conclusions Having SARS-CoV-2 anti-nucleocapsid antibodies provides almost 80% protection against SARS-CoV-2 re-infection for a period of at least eight months.

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Prior COVID-19 protects against reinfection, even in the absence of detectable antibodies

Cited by 31 publications

References 13 publications

Preliminary Evaluation of QuantiFERON SARS-CoV-2 and QIAreach Anti-SARS-CoV-2 Total Test in Recently Vaccinated Individuals

Preliminary Evaluation of QuantiFERON SARS-CoV-2 and QIAreach Anti-SARS-CoV-2 Total Test in Recently Vaccinated Individuals

A Systematic Review of the Protective Effect of Prior SARS-CoV-2 Infection on Repeat Infection

Impact of baseline SARS-CoV-2 antibody status on syndromic surveillance and the risk of subsequent Covid-19 – a prospective multicentre cohort study

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