Clinical and laboratory considerations: determining an antibody-based composite correlate of risk for reinfection with SARS-CoV-2 or severe COVID-19

Front Public Health. 2023 Dec 28:11:1290402. doi: 10.3389/fpubh.2023.1290402. eCollection 2023.

Abstract

Much of the global population now has some level of adaptive immunity to SARS-CoV-2 induced by exposure to the virus (natural infection), vaccination, or a combination of both (hybrid immunity). Key questions that subsequently arise relate to the duration and the level of protection an individual might expect based on their infection and vaccination history. A multi-component composite correlate of risk (CoR) could inform individuals and stakeholders about protection and aid decision making. This perspective evaluates the various elements that need to be accommodated in the development of an antibody-based composite CoR for reinfection with SARS-CoV-2 or development of severe COVID-19, including variation in exposure dose, transmission route, viral genetic variation, patient factors, and vaccination status. We provide an overview of antibody dynamics to aid exploration of the specifics of SARS-CoV-2 antibody testing. We further discuss anti-SARS-CoV-2 immunoassays, sample matrices, testing formats, frequency of sampling and the optimal time point for such sampling. While the development of a composite CoR is challenging, we provide our recommendations for each of these key areas and highlight areas that require further work to be undertaken.

Keywords: SARS-CoV-2; antibodies; clinical utility; immunity; innate and adaptive immune response; models and modeling; patient-centered care; vaccines.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibodies, Viral
  • COVID-19*
  • Humans
  • Laboratories
  • Reinfection
  • SARS-CoV-2*

Substances

  • Antibodies, Viral

Grants and funding

The authors declare that this study received funding from Roche Diagnostics International Ltd. All authors participated in a SARSCoV-2 expert panel convened between February and June 2022, for which they received an honorarium sponsored by this funder. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article, or in the decision to submit it for publication, but was involved by providing review.