Article
Author: Charlett, Andre ; Islam, Jasmin ; Hall, Victoria ; Brooks, Tim ; Hettiarachchi, Nipunadi ; Otter, Ashley D ; Beale, Rupert ; Cole, Michelle J ; Heeney, Jonathan L ; Insalata, Ferdinando ; Temperton, Nigel ; Chan, Andrew ; Nadesalingam, Angalee ; Tranquillini, Caio ; Foulkes, Sarah ; Lyall, Jonathan ; Linley, Ezra ; da Costa, Kelly ; Semper, Amanda ; Brown, Colin S ; Chand, Meera A ; Castillo-Olivares, Javier ; Monk, Edward J M ; Milligan, Iain D ; Wu, Mary ; Harvey, Ruth ; Cantoni, Diego ; Taylor-Kerr, Andrew ; Atti, Ana ; Munro, Katie ; Zambon, Maria ; Hopkins, Susan ; Carr, Edward J ; Howell, Michael ; Hewson, Jacqueline
OBJECTIVES:To investigate serological differences between SARS-CoV-2 reinfection cases and contemporary controls, to identify antibody correlates of protection against reinfection.
METHODS:We performed a case-control study, comparing reinfection cases with singly infected individuals pre-vaccination, matched by gender, age, region and timing of first infection. Serum samples were tested for anti-SARS-CoV-2 spike (anti-S), anti-SARS-CoV-2 nucleocapsid (anti-N), live virus microneutralisation (LV-N) and pseudovirus microneutralisation (PV-N). Results were analysed using fixed effect linear regression and fitted into conditional logistic regression models.
RESULTS:We identified 23 cases and 92 controls. First infections occurred before November 2020; reinfections occurred before February 2021, pre-vaccination. Anti-S levels, LV-N and PV-N titres were significantly lower among cases; no difference was found for anti-N levels. Increasing anti-S levels were associated with reduced risk of reinfection (OR 0·63, CI 0·47-0·85), but no association for anti-N levels (OR 0·88, CI 0·73-1·05). Titres >40 were correlated with protection against reinfection for LV-N Wuhan (OR 0·02, CI 0·001-0·31) and LV-N Alpha (OR 0·07, CI 0·009-0·62). For PV-N, titres >100 were associated with protection against Wuhan (OR 0·14, CI 0·03-0·64) and Alpha (0·06, CI 0·008-0·40).
CONCLUSIONS:Before vaccination, protection against SARS-CoV-2 reinfection was directly correlated with anti-S levels, PV-N and LV-N titres, but not with anti-N levels. Detectable LV-N titres were sufficient for protection, whilst PV-N titres >100 were required for a protective effect.
TRIAL REGISTRATION NUMBER:ISRCTN11041050.