Antibody persistence and neutralising activity in primary school students and staff: Prospective active surveillance, June to December 2020, England

Georgina Ireland*, Anna Jeffery-Smith, Maria Zambon, Katja Hoschler, Ross Harris, John Poh, Frances Baawuah, Joanne Beckmann, Ifeanyichukwu O. Okike, Shazaad Ahmad, Joanna Garstang, Andrew J. Brent, Bernadette Brent, Felicity Aiano, Zahin Amin-Chowdhury, Louise Letley, Samuel E.I. Jones, Meaghan Kall, Monika Patel, Robin GopalRay Borrow, Ezra Linley, Gayatri Amirthalingam, Kevin E. Brown, Mary E. Ramsay, Shamez N. Ladhani

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Background: Prospective, longitudinal SARS-CoV-2 sero-surveillance in schools across England was initiated after the first national lockdown, allowing comparison of child and adult antibody responses over time. Methods: Prospective active serological surveillance in 46 primary schools in England tested for SARS-CoV-2 antibodies during June, July and December 2020. Samples were tested for nucleocapsid (N) and receptor binding domain (RBD) antibodies, to estimate antibody persistence at least 6 months after infection, and for the correlation of N, RBD and live virus neutralising activity. Findings: In June 2020, 1,344 staff and 835 students were tested. Overall, 11.5% (95%CI: 9.4–13.9) and 11.3% (95%CI: 9.2–13.6; p = 0.88) of students had nucleoprotein and RBD antibodies, compared to 15.6% (95%CI: 13.7–17.6) and 15.3% (95%CI: 13.4–17.3; p = 0.83) of staff. Live virus neutralising activity was detected in 79.8% (n = 71/89) of nucleocapsid and 85.5% (71/83) of RBD antibody positive children. RBD antibodies correlated more strongly with neutralising antibodies (rs=0.7527; p<0.0001) than nucleocapsid antibodies (rs=0.3698; p<0.0001). A median of 24.4 weeks later, 58.2% (107/184) participants had nucleocapsid antibody seroreversion, compared to 20.9% (33/158) for RBD (p<0.001). Similar seroreversion rates were observed between staff and students for nucleocapsid (p = 0.26) and RBD-antibodies (p = 0.43). Nucleocapsid and RBD antibody quantitative results were significantly lower in staff compared to students (p = 0.028 and <0.0001 respectively) at baseline, but not at 24 weeks (p = 0.16 and p = 0.37, respectively). Interpretation: The immune response in children following SARS-CoV-2 infection was robust and sustained (>6 months) but further work is required to understand the extent to which this protects against reinfection. Funding: Department for Health and Social Care.

Original languageEnglish
Article number101150
Publication statusPublished - Nov 2021

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  • Antibody
  • SARS-CoV-2
  • School


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