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Nucleocapsid antibody positivity as a marker of past SARS-CoV-2 infection in population serosurveillance studies: impact of variant, vaccination, and choice of assay cut-off

By Heather Whitaker, Charlotte Gower, Ashley David Otter, Ruth Simmons, Freja Kirsebom, Louise Letley, Catherine Quinot, Georgina Ireland, Ezra Linley, Sonia Ribeiro, Shamez Ladhani, Jamie Lopez-Bernal, Gayatri Amirthalingam, Mary E Ramsay, Kevin Brown

Posted 26 Oct 2021
medRxiv DOI: 10.1101/2021.10.25.21264964

Serological surveillance studies sometimes use presence of anti-nucleocapsid antibody as a marker of natural SARS-CoV-2 infection. We explore seroconversion rates and antibody titres following Alpha and Delta variant infections, and vaccine breakthrough infections. We find lower seroconversion rates particularly following Alpha-variant vaccine breakthrough infections. We re-evaluate assay performance with a mix of past waned infections and recent breakthrough infections, that is relevant to current serological surveillance.

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