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

Rapid Evidence Product Jan 25, 2022
Antibody Response Following SARS-CoV-2 Infection and Implications for Immunity: A Living Rapid Review

Version 2 (January 25, 2022): This report is available in PDF only (Living Rapid Review, 2.2 MB). 

Version 1 (March 15, 2021): This report is available in PDF only (Living Rapid Review, 1.73 MB). 

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. What is the risk of reinfection from SARS-CoV-2 among adults with prior SARS-CoV-2 infection?
    1. Does the risk of reinfection 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 immunity acquired by infection, and if so, does this threshold vary by patient characteristics (e.g., age, sex, race/ethnicity, and comorbidities)?
  3. What is the duration of protection against reinfection among adults with prior SARS-CoV-2 infection? 
    1. Does duration of protection vary by patient characteristics (e.g., age, sex, race/ethnicity, and comorbidities), severity of the initial infection, initial antibody levels, SARS-CoV-2 variants, or case identification method (e.g., surveillance, symptomatic testing only)?
  4. What are the unintended consequences of antibody testing after SARS-CoV-2 infection?

Related Links

Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, et al. Scientific Medical Policy Committee of the American College of Physicians. 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 2). Ann Intern Med. 25 January 2022. [Epub ahead of print]. doi:10.7326/M21-3272.

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 Citations

Helfand M, Fiordalisi C, Wiedrick J, et al. Risk of reinfection after SARS CoV-2. Living rapid review for ACP practice points on the role of the antibody response in conferring immunity following SARS-COV-2 infection. Ann Intern Med. 25 January 2022. [Epub ahead of print]. doi:10.7326/M21-4245.

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 Citations

Version 2: Helfand M, Fiordalisi C, Wiedrick J, Ramsey KL, Armstrong C, Gean E, Winchell K, Arkhipova-Jenkins I. Risk of Reinfection From SARS-CoV-2 – An Update of an Antibody Response Following SARS-CoV-2 Infection and Implications for Immunity: A Living Rapid Review. (Prepared by the Scientific Resource Center under Contract No. 290-2017-0003). AHRQ Publication No. 21-EHC034. Rockville, MD: Agency for Healthcare Research and Quality. January 2022. Posted final reports are located on the Effective Health Care Program search page. DOI: https://doi.org/10.23970/AHRQEPCCOVIDIMMUNITY2.

Version 1: 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/AHRQEPCCOVIDIMMUNITY.

Project Timeline

Immunity After COVID-19

Sep 2, 2020
Topic Initiated
Sep 10, 2020
Jan 25, 2022
Rapid Evidence Product
Page last reviewed January 2022
Page originally created February 2021

Internet Citation: Rapid Evidence Product: Antibody Response Following SARS-CoV-2 Infection and Implications for Immunity: A Living Rapid Review. Content last reviewed January 2022. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.
https://effectivehealthcare.ahrq.gov/products/immunity-after-covid/rapid-review

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