Longitudinal serological analysis and neutralizing antibody levels in Coronavirus disease 2019 convalescent patients

Frauke Muecksch, Helen Wise, Becky Batchelor, Maria Squires, Elizabeth Semple, Claire Richardson, Jacqueline McGuire, Sarah Clearly, Elizabeth Furrie, Neil Greig, Gordon Hay, Kate Templeton, Julio C. C. Lorenzi, Theodora Hatziioannou, Sara Jenks, Paul D. Bieniasz (Lead / Corresponding author)

Research output: Contribution to journalArticlepeer-review

167 Citations (Scopus)
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BACKGROUND: Understanding the longitudinal trajectory of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies is crucial for diagnosis of prior infection and predicting future immunity. METHODS: We conducted a longitudinal analysis of coronavirus disease 2019 convalescent patients, with neutralizing antibody assays and SARS-CoV-2 serological assay platforms using SARS-CoV-2 spike (S) or nucleocapsid (N) antigens. RESULTS: Sensitivities of serological assays in diagnosing prior SARS-CoV-2 infection changed with time. One widely used commercial platform that had an initial sensitivity of >95% declined to 71% at 81-100 days after diagnosis. The trajectories of median binding antibody titers measured over approximately 3-4 months were not dependent on the use of SARS-CoV-2 N or S proteins as antigen. The median neutralization titer decreased by approximately 45% per month. Each serological assay gave quantitative antibody titers that were correlated with SARS-CoV-2 neutralization titers, but S-based serological assay measurements better predicted neutralization potency. Correlation between S-binding and neutralization titers deteriorated with time, and decreases in neutralization titers were not predicted by changes in S-binding antibody titers. CONCLUSIONS: Different SARS-CoV-2 serological assays are more or less well suited for surveillance versus prediction of serum neutralization potency. Extended follow-up should facilitate the establishment of appropriate serological correlates of protection against SARS-CoV-2 reinfection.

Original languageEnglish
Pages (from-to)389-398
Number of pages10
JournalJournal of Infectious Diseases
Issue number3
Early online date3 Nov 2020
Publication statusPublished - 1 Feb 2021


  • COVID-19
  • Neutralizing antibodies
  • SARS-CoV-2
  • Serology

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases


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