Abstract
BACKGROUND The relationship between the presence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the risk of subsequent reinfection remains unclear. METHODS We investigated the incidence of SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) in seropositive and seronegative health care workers attending testing of asymptomatic and symptomatic staff at Oxford University Hospitals in the United Kingdom. Baseline antibody status was determined by anti-spike (primary analysis) and anti-nucleocapsid IgG assays, and staff members were followed for up to 31 weeks. We estimated the relative incidence of PCR-positive test results and new symptomatic infection according to antibody status, adjusting for age, participant-reported gender, and changes in incidence over time. RESULTS A total of 12,541 health care workers participated and had anti-spike IgG measured; 11,364 were followed up after negative antibody results and 1265 after positive results, including 88 in whom seroconversion occurred during follow-up. A total of 223 anti-spike–seronegative health care workers had a positive PCR test (1.09 per 10,000 days at risk), 100 during screening while they were asymptomatic and 123 while symptomatic, whereas 2 anti-spike–seropositive health care workers had a positive PCR test (0.13 per 10,000 days at risk), and both workers were asymptomatic when tested (adjusted incidence rate ratio, 0.11; 95% confidence interval, 0.03 to 0.44; P=0.002). There were no symptomatic infections in workers with anti-spike antibodies. Rate ratios were similar when the anti-nucleocapsid IgG assay was used alone or in combination with the anti-spike IgG assay to determine baseline status. CONCLUSIONS The presence of anti-spike or anti-nucleocapsid IgG antibodies was associated with a substantially reduced risk of SARS-CoV-2 reinfection in the ensuing 6 months. (Funded by the U.K. Government Department of Health and Social Care and others.)
| Original language | English |
|---|---|
| Pages (from-to) | 533-540 |
| Number of pages | 8 |
| Journal | New England Journal of Medicine |
| Volume | 384 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 11 Feb 2021 |
Bibliographical note
Funding Information:Supported by the U.K. Government Department of Health and Social Care; the National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford University, in partnership with Public Health England (NIHR200915); the NIHR Biomedical Research Centre (BRC), Oxford; and benefactions from the Huo Family Foundation and Andrew Spokes. This study is affiliated with Public Health England’s SARS-CoV-2 Immunity and Reinfection Evaluation (SIREN) study. Dr. Eyre is a Robertson Foundation Fellow and an NIHR Oxford BRC Senior Fellow; Dr. Lumley is a Wellcome Trust Clinical Research Fellow; Prof. Stuart’s work is supported by the Medical Research Council (MR/N00065X/1); Dr. Matthews holds a Wellcome Intermediate Fellowship (110110/Z/15/Z); Dr. Marsden’s work is supported by the Kennedy Trust for Rheumatology Research and by the SGC, a registered charity (no. 1097737) that receives funds from AbbVie, Bayer Pharma, Boehringer Ingelheim, Canada Foundation for Innovation, Eshelman Institute for Innovation, Genome Canada through Ontario Genomics Institute (OGI-055), Innovative Medicines Initiative (EU/EFPIA) (ULTRA-DD grant no. 115766), Janssen, Merck, Darmstadt, Germany, MSD, Novartis Pharma, Pfizer, São Paulo Research Foundation (FAPESP), Takeda, and Wellcome. Prof. Screaton is a Wellcome Trust Senior Investigator with funding from the Schmidt Foundation; Dr. Timothy Walker is a Wellcome Trust Clinical Career Development Fellow (214560/Z/18/Z); and Prof. A. Sarah Walker is an NIHR Senior Investigator.
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