Duration of Effective Antibody Levels After COVID-19
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Duration of Effective Antibody Levels
After COVID-19
Andrea T. Cruz, MD, MPH,a Steven L. Zeichner, MD, PhDb
After having coronavirus disease levels of nAbs and that these levels
2019 (COVID-19), patients develop a remained high for the duration of
humoral immune response thought their 7- to 8-month follow-up period.
to protect against reinfection, but In contrast, lower nAb levels and
antibody levels can decline over more transient nAb responses were
time. Understanding how long seen in school-aged children and
antibody levels remain high enough adults.
to prevent infection is important in
understanding, absent vaccination, These findings are intriguing for
whether children may be vulnerable several reasons. First, nAbs persisted
to COVID-19 and in modeling how in younger children at high levels for
COVID-19 spreads through the several months. This is in contrast to
population. the experience with both adults and
a
Department of Pediatrics, Baylor College of Medicine,
with non–SARS-CoV-2 coronavirus
Houston, Texas; and bDepartments of Pediatrics and
The levels of antibodies capable of infections. In one study, researchers Microbiology, Immunology, and Cancer Biology, School of
neutralizing the virus (neutralizing found that after COVID-19, only one- Medicine, University of Virginia, Charlottesville, Virginia
antibodies [nAbs]) provide a direct third of adults had detectable nAbs Dr Cruz conceptualized the commentary, drafted the
marker of a protective humoral and, even in those patients, nAb initial commentary, and reviewed and revised the
immune response. The nAbs can be levels decayed rapidly over a few
manuscript; Dr Zeichner critically reviewed and revised
the manuscript for important intellectual content; and
measured directly by determining months.5 For non–SARS-CoV-2 all authors approved the final manuscript as submitted
how well a patient’s serum coronaviruses, nAbs wane within
and agree to be accountable for all aspects of the
work.
inactivates virus when a known
several months of infection, resulting Opinions expressed in these commentaries are those of
amount of virus is placed on cells in
in repetitive infections by many the authors and not necessarily those of the American
tissue culture, which is known as a Academy of Pediatrics or its Committees.
coronaviruses that cause a significant
plaque reduction neutralization test. DOI: https://doi.org/10.1542/peds.2021-052589
fraction of viruses causing common
The remarkably safe and effective
colds.6 Reasons for the enhanced Accepted for publication Jun 8, 2021
approved COVID-19 vaccines elicit
persistence of nAbs in younger Address correspondence to: Andrea T. Cruz, Department of
potent antibody responses against Pediatrics, Baylor College of Medicine, 6621 Fannin St, Suite
children is unclear. One explanation A2210, Houston, TX 77030. E-mail: acruz@bcm.edu
portions of the virus mediating
may be that the immune response in PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online,
attachment to host cells and viral 1098-4275).
adults, who have had repetitive
entry, the spike protein and its Copyright © 2021 by the American Academy of Pediatrics
receptor-binding domain. The exposure to endemic coronaviruses,
may target these previous viruses FINANCIAL DISCLOSURE: The authors have indicated
concentration of antibodies a patient they have no financial relationships relevant to this
has against spike protein and and may not respond as easily to article to disclose.
receptor-binding domain provides a SARS-CoV-2 as the relatively less FUNDING: No external funding.
marker of susceptibility to infection experienced (and potentially more
POTENTIAL CONFLICT OF INTEREST: Both authors are
or reinfection.1–3 flexible) immune response seen in associate editors for Pediatrics.
young children. This concept is called COMPANION PAPER: A companion to this article can be
In their study in Pediatrics, Bonfante original antigenic sin.7 Although found online at www.pediatrics.org/cgi/doi/10.1542/
peds.2021-052173.
et al4 report that preschool-aged original antigenic sin may result in a
children with asymptomatic or more robust response to viral strains
previously encountered, antibodies To cite: Cruz AT, Zeichner SL. Duration of Effective
mildly symptomatic severe acute
Antibody Levels After COVID-19. Pediatrics.
respiratory syndrome coronavirus 2 made against a newly encountered 2021;148(3):e2021052589
(SARS-CoV-2) infection had high coronavirus in patients who have
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PEDIATRICS Volume 148, number 3, September 2021:e2021052589 COMMENTARYhad many coronavirus infections that nAb levels are highly patient to control SARS-CoV-2.13 To
may bind suboptimally to strains correlated with immunity.10 The fully understand the durability
with more antigenic drift. mean nAb levels seen after immune responses of children to
vaccination are higher than levels COVID-19 and how these differ
The ability to generate an immune seen in convalescent adults.10,11 from those in adults, it will be
response in younger children was Levels of nAbs decay with time, so necessary to describe pediatric
not contingent on illness severity. In the efficacy of a vaccine will not long-term, cell-mediated immune
adults, several studies have shown remain static over time. This may responses in addition to humoral
that antibody responses were higher be a reason that boosters will be responses.
in more severely ill than in mildly ill necessary, and boosters may also
patients.8 Given that up to 50% of be needed to target newer SARS- Although many aspects of what
children with SARS-CoV-2 have CoV-2 variants for which existing comprises an effective immune
subclinical or mild symptoms,9 the vaccines may provide inadequate response to SARS-CoV-2 require
ability to mount an immune additional study, the work of
protection. Another reason for
response that yields good nAb levels Bonfante et al advances our
previously infected individuals to
for at least several months is understanding, demonstrating a
be vaccinated is that nAbs are only
reassuring because vaccines remain more durable (and likely effective)
part of the host immune response.
unavailable to younger children. response in younger children.
Immunoprotection may stem from
Even after vaccines are approved for Because children constitute an
other arms of the immune system,
the youngest children, barriers to important contribution to the
some of which may be more
vaccine uptake (including vaccine spread of COVID-19 through the
durable (eg, memory B-cell or T-
hesitancy and logistic barriers to population,13 knowledge of the
cell responses). For example, in
widespread global distribution) potential susceptibility of children
one study, researchers evaluated
mean that many children will not to reinfection is important in
how immunity to endemic
benefit from vaccination in the near modeling COVID-19 epidemiology.
future. As such, the data presented coronaviruses may impact host
in this study suggest that reinfection response to SARS-CoV-2. They
may be a less common occurrence, found that, although there was
little evidence of cross-reactive ABBREVIATIONS
given the magnitude and durability
SARS-CoV-2 serum antibodies, COVID-19: coronavirus disease
of the antibody response.
preexisting memory B cells were 2019
This does not mean that children activated during SARS-CoV-2 nAb: neutralizing antibody
who have already had SARS-CoV-2 infection.12 The study by Bonfante SARS-CoV-2: severe acute
should remain unimmunized once et al was focused on the patients’ respiratory
vaccines are approved for younger antibody responses to SARS-CoV-2, syndrome
children. Recent data from but it is important to remember coronavirus 2
vaccinated individuals and that cellular immunity plays an
convalescent adult cohorts indicate important role in the ability of a
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2 CRUZ and ZEICHNERand children: a network prospective [published online ahead of print May 17, 12. Song G, He W-T, Callaghan S, et al. Cross-
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10. Khoury DS, Cromer D, Reylandi A, et al. mRNA-1273 Study Group. Durability of Commun. 2021;12(1):2938
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2021 www.aappublications.org/news by guest on September 15, 2021 3Duration of Effective Antibody Levels After COVID-19
Andrea T. Cruz and Steven L. Zeichner
Pediatrics 2021;148;
DOI: 10.1542/peds.2021-052589 originally published online June 22, 2021;
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References This article cites 10 articles, 1 of which you can access for free at:
http://pediatrics.aappublications.org/content/148/3/e2021052589#BI
BL
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Downloaded from www.aappublications.org/news by guest on September 15, 2021Duration of Effective Antibody Levels After COVID-19
Andrea T. Cruz and Steven L. Zeichner
Pediatrics 2021;148;
DOI: 10.1542/peds.2021-052589 originally published online June 22, 2021;
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/148/3/e2021052589
Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
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