Correlates of nucleocapsid antibodies and a combination of spike and nucleocapsid antibodies against protection of SARS-CoV-2 infection during Omicron XBB.1.16 and EG.5 predominant wave

Publication date: Feb 21, 2024

Background The role of nucleocapsid (N) antibodies and their combination with spike (S) antibodies against SARS-CoV-2 reinfection remains unclear. We aimed to examine the association between N antibodies, a combination of N and S antibodies, and protection against SARS-CoV-2 reinfection. Methods We conducted a prospective cohort study among staff at a national medical research center in Tokyo and followed them for the incidence of SARS-CoV-2 infection between June and September 2023 (Omicron XBB.1.16/EG.5 predominant wave). At baseline, participants donated blood samples to measure N- and S-specific antibodies in assays from three companies (Roche, Abbott, and Sysmex). Cox regression was used to estimate the hazard ratio (HR) and protection (1-HR*100) against subsequent SARS-CoV-2 infection across these antibody levels. Findings Of the 2549 staff included in the analysis, 237 SARS-CoV-2 infections were identified during follow-up. Among participants with previous infection, higher pre-reinfection N antibodies were associated with a lower risk of reinfection even after adjusting S antibody levels (P for trend90%) against subsequent infection. In addition, a pattern of low pre-reinfection N antibodies but high vaccine-enhanced S antibodies showed high protection (>80%). Interpretation Pre-reinfection N antibody levels correlated with protection against reinfection, independent of S antibodies. If the N antibodies were low, vaccine-boosted S antibodies could enhance the reinfection protection.

Concepts Keywords
Antibodies Antibodies
Diabetes Antibody
June Baseline
Tokyo Cov
Trend90 Covid


Type Source Name
disease MESH SARS-CoV-2 infection
pathway REACTOME SARS-CoV-2 Infection
disease MESH reinfection
drug DRUGBANK Etoperidone
disease IDO blood
disease MESH infection
disease VO vaccine
disease VO vaccination
disease IDO history
disease VO time
disease VO protective antigen
disease VO titer
drug DRUGBANK Ethanol
disease MESH Hospital Infection
disease IDO assay
disease IDO immunosuppression
disease VO frequency
disease VO company
disease VO dose
disease MESH cancer
disease MESH cardiovascular disease
disease MESH hypertension
disease MESH chronic kidney disease
disease MESH lung disease
disease VO nose
disease VO mouth

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