Antibody levels following vaccination against SARS-CoV-2: associations with post-vaccination infection and risk factors in two UK longitudinal studies

• Published in: eLife 2023, Vol.12
• Main Authors: Cheetham, Nathan J, Kibble, Milla, Wong, Andrew, Silverwood, Richard J, Knuppel, Anika, Williams, Dylan M, Hamilton, Olivia KL, Lee, Paul H, Bridger Staatz, Charis, Di Gessa, Giorgio, Zhu, Jingmin, Katikireddi, Srinivasa Vittal, Ploubidis, George B, Thompson, Ellen J, Bowyer, Ruth CE, Zhang, Xinyuan, Abbasian, Golboo, Garcia, Maria Paz, Hart, Deborah, Seow, Jeffrey, Graham, Carl, Kouphou, Neophytos, Acors, Sam, Malim, Michael H, Mitchell, Ruth E, Northstone, Kate, Major-Smith, Daniel, Matthews, Sarah, Breeze, Thomas, Crawford, Michael, Molloy, Lynn, Kwong, Alex SF, Doores, Katie, Chaturvedi, Nishi, Duncan, Emma L, Timpson, Nicholas J, Steves, Claire J
• Format: Report
• Language: English
• Subjects: Complications and side effects; Coronaviruses; Immune response; Medical research; Medicine, Experimental; Pharmaceutical industry; Risk factors; Severe acute respiratory syndrome; Vaccination
• ISSN: 2050-084X; 2050-084X
• DOI: 10.7554/eLife.80428

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody levels can be used to assess humoral immune responses following SARS-CoV-2 infection or vaccination, and may predict risk of future infection. Higher levels of SARS-CoV-2 anti-Spike antibodies are known to be associated with increased protection against future SARS-CoV-2 infection. However, variation in antibody levels and risk factors for lower antibody levels following each round of SARS-CoV-2 vaccination have not been explored across a wide range of socio-demographic, SARS-CoV-2 infection and vaccination, and health factors within population-based cohorts. Within TwinsUK, single-vaccinated individuals with the lowest 20% of anti-Spike antibody levels at initial testing had threefold greater odds of SARS-CoV-2 infection over the next 6--9 months (OR = 2.9, 95% CI: 1.4, 6.0), compared to the top 20%. In TwinsUK and ALSPAC, individuals identified as at increased risk of COVID-19 complication through the UK 'Shielded Patient List' had consistently greater odds (two- to fourfold) of having antibody levels in the lowest 10%. Third vaccination increased absolute antibody levels for almost all individuals, and reduced relative disparities compared with earlier vaccinations. These findings quantify the association between antibody level and risk of subsequent infection, and support a policy of triple vaccination for the generation of protective antibodies.