Do Quantitative Levels of Anti-Spike-IgG Antibodies Aid in Predicting
Protection from SARS-CoV-2 Infection? Results from a Longitudinal Study
in a Police Cohort
Abstract
Objectives In a COVID-19 sero-surveillance cohort study with
predominantly healthy and vaccinated individuals, the objectives were
(i) to investigate longitudinally the factors associated with the
quantitative dynamics of anti-spike IgG antibody levels, (ii) to
evaluate whether the antibody levels were associated with protection
from SARS-CoV-2 infection and (iii) to assess whether the association
was different in the pre-Omicron compared with the Omicron period.
Methods The QuantiVac Euroimmun ELISA test was used to quantify
anti-S1 IgG levels. The entire study period (16 months), the 11-month
pre-Omicron period and the cross-sectional analysis prior to the Omicron
surge included 3219, 2310 and 895 reactive serum samples from 949, 919
and 895 study participants, respectively. Mixed-effect linear,
mixed-effect time-to-event and logistic regression models were used to
achieve the objectives. Results Age and time since infection or
vaccination were the only factors associated with a decline of anti-S1
IgG levels. Antibody levels were significantly associated with
protection from SARS-CoV-2 infection, and the association was higher for
the Omicron than for the Alpha and Delta variants. In a prediction
model, it was estimated that >8000 BAU/mL anti-S1 IgG was
required to reduce the risk of infection with Omicron variants by 20%
to 30% for 90 days. Conclusions Anti-S1 IgG antibody levels
are associated with protection from infection. The levels in the
pre-Omicron periods were less significant than during the Omicron surge,
which in turn required very high levels for protection in a statistical
model.