Early and High SARS-CoV-2 Neutralizing Antibodies Are Associated with Severity in COVID-19 Patients from India

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  • 1 Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth Deemed to be University, Katraj-Dhankawadi, Pune, India;
  • 2 Department of Community Medicine, Bharati Vidyapeeth Deemed to be University Medical College, Katraj-Dhankawadi, Pune, India;
  • 3 Department of Critical Care Medicine, Bharati Vidyapeeth Deemed to be University Medical College, Katraj-Dhankawadi, Pune, India;
  • 4 Department of Pediatrics, Bharati Vidyapeeth Deemed to be University Medical College, Katraj-Dhankawadi, Pune, India

Patients with SARS-CoV-2 infection have a wide spectrum of clinical presentations, from asymptomatic infection, to mild illness, to severe disease with recovery or fatal outcome. Immune correlates of protection are not yet clear. To understand the association between presence and titers of neutralizing antibodies (NAb) with recovery, we screened 82 COVID-19 patients classified in mild (n = 56) and severe (n = 26) disease groups on different days post onset of disease and 27 viral RNA–positive asymptomatic contacts examined within 1 week of the identification of index cases. Of 26 patients with severe disease, six died and 20 recovered. Anti-SARS-CoV-2 NAb levels in plasma and serum were measured using a plaque reduction neutralization test with live virus. The proportion of asymptomatic and symptomatic infections was 1:7.8 in males and 1:1 in females, with males predominating the severe disease group (21/26, 80.7%). At the time of presentation, NAb positivity and titers were comparable among groups with asymptomatic and mild infections. Notably, patients with severe disease exhibited higher NAb seropositivity and titers (25 of 26, 96.2%; 866 ± 188) than those in the mild category (39 of 56, 69.6%; 199 ± 50, P < 0.0001) and asymptomatic individuals (21 of 27, 77.8%; 124 ± 28, P = 0.0002). Within first 2 weeks of onset, NAb titers were significantly higher among patients with severe disease than those with mild presentation. Our data suggest that irrespective of fatal outcome, progression to disease severity was associated with induction of early and high levels of NAb. In our patient series, clinical disease, severity and fatality were predominantly seen in males. The role of NAbs in immunopathogenesis or protection needs to be defined.

Author Notes

Address correspondence to Vidya A. Arankalle, Department of Communicable Diseases, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed University), Katraj-Dhankawadi, Pune-411043, India. E-mail: varankalle@yahoo.com

Authors’ addresses: Shubham Shrivastava, Prajakta Rane, Akhilesh Chandra Mishra, and Vidya A. Arankalle, Interactive Research School for Health Affairs, Bharati Vidyapeeth Deemed University Medical College, Communicable Diseases, Pune, Maharashtra, India, E-mails: shubhamniv@gmail.com, raneprajakta8891@gmail.com, acm1750@gmail.com, and varankalle@yahoo.com. Sonali Palkar, Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India, E-mail: palkarsh@gmail.com. Jignesh Shah, Critical Care Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India, E-mail: drshahjignesh78@gmail.com. Sanjay Lalwani, Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India, E-mail: sanjay.lalwani@bharatihospital.com.

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