Abstract
Many public health responses and modeled scenarios for COVID-19 outbreaks caused by SARS-CoV-2 assume that infection results in an immune response that protects individuals from future infections or illness for some amount of time. The presence or absence of protective immunity due to infection or vaccination (when available) will affect future transmission and illness severity. Here, we review the scientific literature on antibody immunity to coronaviruses, including SARS-CoV-2 as well as the related SARS-CoV, MERS-CoV and endemic human coronaviruses (HCoVs). We reviewed 2,452 abstracts and identified 491 manuscripts relevant to 5 areas of focus: 1) antibody kinetics, 2) correlates of protection, 3) immunopathogenesis, 4) antigenic diversity and cross-reactivity, and 5) population seroprevalence. While further studies of SARS-CoV-2 are necessary to determine immune responses, evidence from other coronaviruses can provide clues and guide future research.
Highlights
Many public health responses and modeled scenarios for COVID-19 outbreaks caused by SARS-CoV-2 assume that infection results in an immune response that protects individuals from future infections or illness for some amount of time
Most long-term studies found that SARS-CoV and MERS-CoV IgG waned over time, while others found detectable levels of IgG 3 years post symptom onset
Antibody kinetics varied across the severity gradient, with antibodies remaining detectable longer after illness with more severe symptoms
Summary
Many public health responses and modeled scenarios for COVID-19 outbreaks caused by SARS-CoV-2 assume that infection results in an immune response that protects individuals from future infections or illness for some amount of time. Most transmission models of SARS-CoV-2 assume that infection produces immunity to reinfection for durations of at least 1 year[1,2,3] This assumption is relevant to public health officials implementing and managing various nonpharmaceutical interventions, the utility of sera from infected individuals as a therapeutic[4], and the ability for serological tests to identify those who are immune[5]. We conceptualize the stages of exposure and infection at which immunity may play a role in the dynamics of SARS-CoV-2, and how literature describing work on this and other coronaviruses can provide insights into these stages, as follows (see Fig. 1, a visual abstract of our review). Studies that measure these quantities across different age groups can provide evidence, albeit ecological evidence, for or against the proposed mechanisms of immunity at the individual level
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