• Irina Arkhipova-Jenkins, Mark Helfand, Charlotte Armstrong, Emily Gean, Joanna Anderson, Robin A Paynter, and Katherine Mackey.
• Scientific Resource Center for the AHRQ Evidence-based Practice Center Program, Portland VA Research Foundation, and VA Portland Health Care System, Portland, Oregon (I.A.J., C.A., E.G., R.A.P.).
• Ann. Intern. Med. 2021 Jun 1; 174 (6): 811-821.

BackgroundThe clinical significance of the antibody response after SARS-CoV-2 infection remains unclear.PurposeTo synthesize evidence on the prevalence, levels, and durability of detectable antibodies after SARS-CoV-2 infection and whether antibodies to SARS-CoV-2 confer natural immunity.Data SourcesMEDLINE (Ovid), Embase, CINAHL, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, World Health Organization global literature database, and Covid19reviews.org from 1 January through 15 December 2020, limited to peer-reviewed publications available in English.Study SelectionPrimary studies characterizing the prevalence, levels, and duration of antibodies in adults with SARS-CoV-2 infection confirmed by reverse transcriptase polymerase chain reaction (RT-PCR); reinfection incidence; and unintended consequences of antibody testing.Data ExtractionTwo investigators sequentially extracted study data and rated quality.Data SynthesisModerate-strength evidence suggests that most adults develop detectable levels of IgM and IgG antibodies after infection with SARS-CoV-2 and that IgG levels peak approximately 25 days after symptom onset and may remain detectable for at least 120 days. Moderate-strength evidence suggests that IgM levels peak at approximately 20 days and then decline. Low-strength evidence suggests that most adults generate neutralizing antibodies, which may persist for several months like IgG. Low-strength evidence also suggests that older age, greater disease severity, and presence of symptoms may be associated with higher antibody levels. Some adults do not develop antibodies after SARS-CoV-2 infection for reasons that are unclear.LimitationsMost studies were small and had methodological limitations; studies used immunoassays of variable accuracy.ConclusionMost adults with SARS-CoV-2 infection confirmed by RT-PCR develop antibodies. Levels of IgM peak early in the disease course and then decline, whereas IgG peaks later and may remain detectable for at least 120 days.Primary Funding SourceAgency for Healthcare Research and Quality. (PROSPERO: CRD42020207098).

21 keywords...

hide…