Longitudinal Serology of SARS-CoV-2-Infected Individuals in India: A Prospective Cohort Study

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  • 1 Translational Health Science and Technology Institute, Faridabad, Haryana, India;
  • 2 St. John’s Medical College and St. John’s Research Institute, Bengaluru, India;
  • 3 ESIC Medical College and Hospital, Faridabad, Haryana, India;
  • 4 Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India;
  • 5 Civil Hospital, Gurugram, India;
  • 6 Civil Hospital, Palwal, India;
  • 7 Dr. Dang’s Laboratory, New Delhi, India;
  • 8 Christian Medical College, Vellore, India

Clinical and epidemiological characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are now widely available, but there are few data regarding longitudinal serology in large cohorts, particularly those from low-income and middle-income countries. We established an ongoing prospective cohort of 3,840 SARS-CoV-2-positive individuals according to RT-PCR in the Delhi-National Capital Region of India to document clinical and immunological characteristics during illness and convalescence. The immunoglobulin G (IgG) responses to the receptor binding domain (RBD) and nucleocapsid were assessed at 0 to 7 days, 10 to 28 days, and 6 to 10 weeks after infection. The clinical predictors of seroconversion were identified by multivariable regression analysis. The seroconversion rates during the postinfection windows of 0 to 7 days, 10 to 28 days, and 6 to 10 weeks were 46%, 84.7%, and 85.3%, respectively (N = 743). The proportion with a serological response increased with the severity of coronavirus disease 2019 (COVID-19). All participants with severe disease, 89.6% with mild to moderate infection, and 77.3% of asymptomatic participants had IgG antibodies to the RBD antigen. The threshold values for the nasopharyngeal viral RNA RT-PCR of a subset of asymptomatic and symptomatic seroconverters were comparable (P = 0.48) to those of nonseroconverters (P = 0.16) (N = 169). This is the first report of longitudinal humoral immune responses to SARS-CoV-2 over a period of 10 weeks in South Asia. The low seropositivity of asymptomatic participants and differences between assays highlight the importance of contextualizing the understanding of population serosurveys.

Author Notes

Members of DBT India Consortium for COVID-19 Research:

Coordinating Institute: Translational Health Science and Technology Institute (THSTI)

Coordinating Principal Investigator: Dr. Shinjini Bhatnagar

Co-Principal Investigator: Dr. Gagandeep Kang

Co-Investigators (Clinical): Drs. Nitya Wadhwa, Uma Chandra Mouli Natchu, Ramachandran Thiruvengadam, Shailaja Sopory, Pallavi Kshetrapal, Bapu Koundinya Desiraju, Vandita Bhartia, Mudita Gosain, Monika Bahl

Co-Investigators (Laboratory): Drs. Gaurav Batra, Guruprasad Medigeshi, Susmita Chaudhuri, Niraj Kumar, Tarun Sharma, Chandresh Sharma, Shailendra Mani, Tripti Shrivastava

International Centre for Genetic Engineering and Biotechnology (ICGEB): Dr. Anmol Chandele

National Institute of Immunology (NII): Drs. Amulya Panda, Nimesh Gupta

Maulana Azad Medical College and Lok Nayak Hospital, New Delhi: Drs. Nandini Sharma, Pragya Sharma, Sonal Saxena, J. C. Passey, Suresh Kumar

ESIC Medical College and Hospital, Faridabad, Haryana: Dr. Anil K Pandey, Asim Das, Nikhil Verma, Nidhi Anand, Sujata Roy Choudhary, Juhi Taneja

Civil Hospital Gurugram (GCH), Haryana: Drs. Deepa Sindhu, Jai Singh Malik

Civil Hospital Palwal (PCH), Haryana: Dr. Brahmdeep Sindhu

Al-Falah School of Medical Science & Research Centre and Hospital, Dhouj, Haryana: Drs. Bhupinder Kaur Anand, Shubham Girdhar

Medanta Hospital, Gurugram, Haryana: Drs. Sushila Kataria, Pooja Sharma

Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Nuh, Haryana: Dr. Yamini

Lady Hardinge Medical College, New Delhi: Drs. Harish K. Pemde, Tanmaya Talukdar

SGT Medical college, Gurugram, Haryana: Drs. Pankaj Abrol, Mukesh Sharma

Dr. Dang’s Lab, New Delhi: Drs. Navin Dang, Manavi Dang, Arjun Dang, Leena Chatterjee, Devjani De

Acknowledgments: We thank the Department of Biotechnology, Government of India, for supporting the consortium. We are grateful to the leadership and administration of all partner institutions in the consortium for their help and support. We thank all the clinical, laboratory, and data management staff for their contributions to this work and the consortium at large. The American Society of Tropical Medicine and Hygiene has waived the Open Access fee for this article due to the ongoing COVID-19 pandemic.

Address correspondence to Shinjini Bhatnagar, Professor of Eminence and Head- Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, India, or Gagandeep Kang, Professor, The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, TN 632004, India. E-mails: shinjini.bhatnagar@thsti.res.in or gkang@cmcvellore.ac.inThese authors contributed equally to this work.

Authors’ addresses: Ramachandran Thiruvengadam, Souvick Chattopadhyay, Farha Mehdi, Bapu Koundinya Desiraju, Susmita Chaudhuri, Savita Singh, Vandita Bhartia, Pallavi Kshetrapal, Nitya Wadhwa, Dharmendra Sharma, Gaurav Batra, Shailaja Sopory, Mudita Gosain, and Shinjini Bhatnagar, Translational Health Science and Technology Institute, Faridabad, Delhi NCR, India, E-mails: ramachandran@thsti.res.in, ouvick@thsti.res.in, farha.mehdi@thsti.res.in, bapukoundinyadesiraju@thsti.res.in, susmita@thsti.res.in, savitasingh@thsti.res.in, vanditabhartia@gmail.com, pallavi.kshetrapal@thsti.res.in, nitya.wadhwa@thsti.res.in dksharma@thsti.res.in, gaurav.batra@thsti.res.in, mouli.natchu@sjri.res.in, ssopory@thsti.res.in, mgosain@thsti.res.in, and shinjini.bhatnagar@thsti.res.in. Anil K. Pandey, Juhi Taneja, and Nidhi Anand, ESIC Medical College and Hospital, Faridabad, Delhi NCR, India, E-mails: registraracademicfbd@gmail.com, drjuhitaneja@gmail.com, and nidhianand28@gmail.com. Nandini Sharma, Pragya Sharma, and Sonal Saxena, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India, E-mails: drnandini1@gmail.com, drpragyas@gmail.com, and sonalsaxena3@gmail.com. Deepa Sindhu and Brahmdeep Sindhu, Civil Hospital, Palwal and Gurugram, India, E-mails: deepajakhar9@gmail.com and bdsindhu@gmail.com. Navin Dang, Dr. Dang’s Laboratory, New Delhi, India, E-mail: drnavindang@gmail.com. Gagandeep Kang, Christian Medical College, Vellore, India, E-mail: gkang@cmcvellore.ac.in.

Financial support: This work was supported by Department of Biotechnology, Government of India (BT/PR40401/BIOBANK/03/2020), and by the Ind-CEPI Coalition for Epidemic Preparedness Innovations (102/IFD/SAN/5477/2018-2019).