Population antibody responses following COVID-19 vaccination in 212,102 individuals

  1. Helen Ward
  2. Matthew Whitaker
  3. Barnaby Flower
  4. Sonja N. Tang
  5. Christina Atchison
  6. Ara Darzi
  7. Christl A. Donnelly
  8. Alexandra Cann
  9. Peter J. Diggle
  10. Deborah Ashby
  11. Steven Riley
  12. Wendy S. Barclay
  13. Paul Elliott
  14. Graham S. Cooke

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Abstract

Population antibody surveillance helps track immune responses to COVID-19 vaccinations at scale, and identify host factors that may affect antibody production. We analyse data from 212,102 vaccinated individuals within the REACT-2 programme in England, which uses self-administered lateral flow antibody tests in sequential cross-sectional community samples; 71,923 (33.9%) received at least one dose of BNT162b2 vaccine and 139,067 (65.6%) received ChAdOx1. For both vaccines, antibody positivity peaks 4-5 weeks after first dose and then declines. At least 21 days after second dose of BNT162b2, close to 100% of respondents test positive, while for ChAdOx1, this is significantly reduced, particularly in the oldest age groups (72.7% [70.9–74.4] at ages 75 years and above). For both vaccines, antibody positivity decreases with age, and is higher in females and those with previous infection. Antibody positivity is lower in transplant recipients, obese individuals, smokers and those with specific comorbidities. These groups will benefit from additional vaccine doses.

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  1. Version published to 10.1038/s41467-022-28527-x
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    SciScore for 10.1101/2021.07.14.21260497: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: We obtained research ethics approval from the South Central-Berkshire B Research Ethics Committee (IRAS ID: 283787), and Medicines and Healthcare products Regulatory Agency approval for use of the LFIA for research purposes only.
    Sex as a biological variablenot detected.
    RandomizationBriefly, in each round of the study we invited a non-overlapping random community sample of adults aged 18 years or over in England, based on the National Health Service general practitioner registrations list.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    (11) We estimated clinical sensitivity of the LFIA on finger-prick blood (self-read) for IgG antibodies following natural infection at 84.4% (70.5, 93.5) among RT-PCR confirmed cases in healthcare workers, and specificity 98.6% (97.1, 99.4) in pre-pandemic sera.(10,12) Here we report data on vaccine coverage and results of antibody testing based on complete, validated data from round 6 received on 28 May 2021.
    IgG
    suggested: None

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has limitations. While we approached a random sample of the population, it is possible that differential non-response may have resulted in biased estimates of prevalence and vaccine uptake. Nonetheless, we achieved a large sample and relatively high participation (over 25%) amongst those invited to take part and weighted our findings to be representative of the population of England as a whole. Antibodies detected in this study reflected anti-S IgG in response to prior infection and vaccination, but this is only one part of the protective immune response, and therefore we cannot equate presence or absence of antibody with immunity. In addition, although offering distinct advantages in terms of costs, logistics and scale, the LFIA does have limitations. Due to limited sensitivity, it does not detect low levels of antibody which may result in lower antibody prevalence estimates than some other studies (21) and potentially be of clinical significance, for example, as a marker of protection against severe disease and/or hospitalisation; as people read their own test results there will be some classification errors including the missing of faint positive lines in people with low visual acuity. On the other hand, within-study comparisons, for example, by ethnicity or deprivation, should be relatively unaffected by test performance. Nonetheless we adjust our prevalence estimates for the performance of the test, based on previous validation work,(10) as well as presenting t...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.07.14.21260497v1 on medRxiv