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

5 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

Bibliographical note

Funding Information:
Department for Health and Social Care. Applications for relevant anonymised data should be submitted to the Public Health England Office for Data Release: The authors would like to thank the schools, headteachers, staff, families and their very brave children who took part in the sKIDs surveillance. The authors would also like to thank members of the Department for Education, Department of Health and Social Care, London School of Hygiene and Tropical medicine (LSHTM), Office for National Statistics (ONS) and the UK Scientific Advisory Group for Emergencies (SAGE) for their input and support for the sKIDs surveillance.

Publisher Copyright:
© 2021


  • Antibody
  • SARS-CoV-2
  • School


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