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Antibody Response Following SARS-CoV-2 Infection and Implications for Immunity: A Living Rapid Review

Rapid Evidence Product

Version 1 (March 15, 2021): This report is available in PDF only (Living Rapid Review, 1.73 MB). For additional assistance, please contact us.

Purpose

The healthcare field is struggling with urgent questions about how to respond to the current COVID-19 pandemic. Health systems, clinicians, policymakers, and the general public want evidence to inform critical decisions. In the face of a rapidly changing field and an ongoing pandemic in which people need to make healthcare decisions quickly, the Evidence-based Practice Center (EPC) Program has commissioned "living reviews" with regularly updated literature searches, to keep the medical community and the public up to date as more studies are published and these living reviews put new studies in the context of what is known.

This rapid review was commissioned to inform practice points developed by the American College of Physicians.

The review examined four questions:

  1. What is the prevalence, level, and durability of detectable anti-SARS-CoV-2 antibodies among adults infected with or recovered from reverse transcription polymerase chain reaction (RT-PCR) -diagnosed SARS-CoV-2 infection?
    1. Do the levels and durability of detectable antibodies vary by patient characteristics (e.g., age, sex, race/ethnicity, and comorbidities), COVID-19 severity, presence of symptoms, time from symptom onset, or as measured by different types of immunoassays (e.g., immunoassays sensitivity/specificity)? 
  2. Do anti-SARS-CoV-2 antibodies confer natural immunity against reinfection? 
    1. Does conferred immunity vary by factors such as initial antibody levels, patient characteristics, presence of symptoms, or severity of disease?
    2. Is there a threshold level of detectable anti-SARS-CoV-2 antibodies necessary to confer natural immunity, and if so, does this threshold vary by patient characteristics (e.g., age, sex, race/ethnicity, and comorbidities)?
  3. If anti-SARS-CoV-2 antibodies confer natural immunity against reinfection, how long does this immunity last? 
    1. Does immunity vary by factors such as initial antibody levels, patient characteristics, presence of symptoms, or severity of disease?
  4. What are the unintended consequences of antibody testing after SARS-CoV-2 infection?

Related Link

Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, et al. What is the antibody response and role in conferring natural immunity after SARS-CoV-2 infection? Rapid, living practice points from the American College of Physicians (version 1). Ann Intern Med. 16 March 2021. [Epub ahead of print]. doi:10.7326/M20-7569.

Journal Citation

Arkhipova-Jenkins I, Helfand M, Armstrong C, et al. Antibody Response After SARS-CoV-2 Infection and Implications for Immunity: A Rapid Living Review. Annals of Internal Medicine. 16 March 2021. [Epub ahead of print.] DOI: 10.7326/M20-7547.

Rapid Review Citation

Mackey K, Arkhipova-Jenkins I, Armstrong C, Gean E, Anderson J, Paynter R, Helfand M. Antibody Response Following SARS-CoV-2 Infection and Implications for Immunity: A Rapid Living Review. (Prepared by the Portland VA Research Foundation under Contract No. 290-2017-00003-C). AHRQ Publication No. 21-EHC016. Rockville, MD: Agency for Healthcare Research and Quality. March 2021. Posted final reports are located on the Effective Health Care Program search page. DOI: 10.23970/AHRQEPCCOVIDIMMUITY.