TY - JOUR
T1 - Antibody response after SARS-CoV-2 infection and implications for immunity
T2 - A rapid living review
AU - Arkhipova-Jenkins, Irina
AU - Helfand, Mark
AU - Armstrong, Charlotte
AU - Gean, Emily
AU - Anderson, Joanna
AU - Paynter, Robin A.
AU - Mackey, Katherine
N1 - Publisher Copyright:
© 2021 American College of Physicians. All rights reserved.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Background: The clinical significance of the antibody response after SARS-CoV-2 infection remains unclear. Purpose: To synthesize evidence on the prevalence, levels, and durability of detectable antibodies after SARS-CoV-2 infection and whether antibodies to SARS-CoV-2 confer natural immunity. Data Sources: MEDLINE (Ovid), Embase, CINAHL, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, World Health Organization global literature database, and Covid19 reviews.org from 1 January through 15 December 2020, limited to peer-reviewed publications available in English. Study Selection: Primary studies characterizing the prevalence, levels, and duration of antibodies in adults with SARS-CoV-2 infection confirmed by reverse transcriptase polymerase chain reaction (RT-PCR); reinfection incidence; and unintended consequences of antibody testing. Data Extraction: Two investigators sequentially extracted study data and rated quality. Data Synthesis: Moderate-strength evidence suggests that most adults develop detectable levels of IgM and IgG antibodies after infection with SARS-CoV-2 and that IgG levels peak approximately 25 days after symptom onset and may remain detectable for at least 120 days. Moderate-strength evidence suggests that IgM levels peak at approximately 20 days and then decline. Low-strength evidence suggests that most adults generate neutralizing antibodies, which may persist for several months like IgG. Low-strength evidence also suggests that older age, greater disease severity, and presence of symptoms may be associated with higher antibody levels. Some adults do not develop antibodies after SARS-CoV-2 infection for reasons that are unclear. Limitations: Most studies were small and had methodological limitations; studies used immunoassays of variable accuracy. Conclusion: Most adults with SARS-CoV-2 infection confirmed by RT-PCR develop antibodies. Levels of IgM peak early in the disease course and then decline, whereas IgG peaks later and may remain detectable for at least 120 days.
AB - Background: The clinical significance of the antibody response after SARS-CoV-2 infection remains unclear. Purpose: To synthesize evidence on the prevalence, levels, and durability of detectable antibodies after SARS-CoV-2 infection and whether antibodies to SARS-CoV-2 confer natural immunity. Data Sources: MEDLINE (Ovid), Embase, CINAHL, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, World Health Organization global literature database, and Covid19 reviews.org from 1 January through 15 December 2020, limited to peer-reviewed publications available in English. Study Selection: Primary studies characterizing the prevalence, levels, and duration of antibodies in adults with SARS-CoV-2 infection confirmed by reverse transcriptase polymerase chain reaction (RT-PCR); reinfection incidence; and unintended consequences of antibody testing. Data Extraction: Two investigators sequentially extracted study data and rated quality. Data Synthesis: Moderate-strength evidence suggests that most adults develop detectable levels of IgM and IgG antibodies after infection with SARS-CoV-2 and that IgG levels peak approximately 25 days after symptom onset and may remain detectable for at least 120 days. Moderate-strength evidence suggests that IgM levels peak at approximately 20 days and then decline. Low-strength evidence suggests that most adults generate neutralizing antibodies, which may persist for several months like IgG. Low-strength evidence also suggests that older age, greater disease severity, and presence of symptoms may be associated with higher antibody levels. Some adults do not develop antibodies after SARS-CoV-2 infection for reasons that are unclear. Limitations: Most studies were small and had methodological limitations; studies used immunoassays of variable accuracy. Conclusion: Most adults with SARS-CoV-2 infection confirmed by RT-PCR develop antibodies. Levels of IgM peak early in the disease course and then decline, whereas IgG peaks later and may remain detectable for at least 120 days.
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U2 - 10.7326/M20-7547
DO - 10.7326/M20-7547
M3 - Review article
C2 - 33721517
AN - SCOPUS:85104399627
SN - 0003-4819
VL - 174
SP - 811
EP - 821
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 6
ER -