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Multicenter Study
. 2021 Mar:136:104765.
doi: 10.1016/j.jcv.2021.104765. Epub 2021 Feb 18.

Longitudinal follow-up of IgG anti-nucleocapsid antibodies in SARS-CoV-2 infected patients up to eight months after infection

Jan Van Elslande  1 , Matthijs Oyaert  2 , Scott Ailliet  1 , Marc Van Ranst  3 , Natalie Lorent  4 , Yannick Vande Weygaerde  5 , Emmanuel André  3 , Katrien Lagrou  3 , Stien Vandendriessche  2 , Pieter Vermeersch  6
Affiliations
Multicenter Study

Longitudinal follow-up of IgG anti-nucleocapsid antibodies in SARS-CoV-2 infected patients up to eight months after infection

Jan Van Elslande et al. J Clin Virol. 2021 Mar.

Abstract

Background: Most SARS-CoV-2 infected patients develop IgG antibodies within 2-3 weeks after symptom onset. Antibody levels have been shown to gradually decrease in the first months after infection, but few data are available at six months or later.

Methods: A retrospective multi-center study was performed using 652 samples of 236 PCR-confirmed SARS-CoV-2 infected patients from 2 Belgian University hospitals. Patients were included if at least two samples were available (range 2-7 samples); including at least one sample collected 30 days or later after first positive PCR (range 0-240 days). Of those 236 patients, 19.1 % were classified as mild/asymptomatic (mild) and 80.9 % as moderate to critical (severe). IgG anti-nucleocapsid antibodies (anti-N) were measured using the Abbott Architect immunoassay.

Results: 22.2 % of mild and 2.6 % of severe COVID-19 cases never seroconverted (p < 0.001). Of the mild patients who seroconverted 0-59 days after PCR; 18.8 %, 40.0 % and 61.1 % were seronegative in the windows 60-119 days, 120-179 days and 180-240 days after PCR, respectively. In severe patients, these numbers were 1.9 %, 10.8 % and 29.4 % respectively (p < 0.05 each). Antibody levels were significantly higher in severe patients compared to mild patients in each 60 day window (p < 0.001 each).

Conclusions: SARS-CoV-2 anti-N IgG antibody levels steadily decreased after 2 months up to 8 months post PCR. Of severe COVID-19 patients, 70.6 % remained positive up to eight months after infection. Antibody levels were significantly lower in mild SARS-CoV-2 infected patients and 61.1 % became seronegative within 6 months after the first positive PCR.

Keywords: Antibodies; COVID-19; Coronavirus; Immunoglobulin G; Longitudinal studies; SARS-CoV-2.

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Conflict of interest statement

The authors report no declarations of interest.

Figures

Fig. 1
Fig. 1
Beeswarm plot of the IgG anti-N results in 191 severe (A) and 45 mild (B) COVID-19 patients. If more than one sample was tested for a patient in the 0-29 or 30-59 day window, only the result from the sample with the highest antibody level was included. If more than one sample was tested for a patient in the other time windows, only the result from the sample that was collected last was included (n = number of patients).
Fig. 2
Fig. 2
Median IgG (P25 and P75 as confidence intervals) anti-N antibody levels after first positive PCR in 191 severe and 45 mild COVID-19 patients. If more than one sample was tested for a patient in the 0-59 day window, only the result from the sample with the highest antibody level was included. If more than one sample was tested for a patient in the other time windows, only the result from the sample that was collected last was included (n = number of patients). * p-value <0.001 vs. mild COVID-19 patients.
See this image and copyright information in PMC

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