From first infection to reinfection: Comparing Nucleocapsid antibody kinetics in vaccinated and unvaccinated adults

Determining infection histories of individuals with prior immunity is critical to studying SARS-CoV-2 imprinting and vaccine responses. To better understand the response to infection, we examine nucleocapsid protein antibody dynamics around first and second SARS-CoV-2 infections in vaccinated and unvaccinated adults.

The presence and levels of nucleocapsid-antibodies were measured around first and second SARS-CoV-2 infections. Antibody waning was measured with accelerated failure time models.

After first-infections 95.8 % (88.5-98.6 %) of unvaccinated and 89.4 % (86.5-91.7 %) of vaccinated participants seroconverted. Vaccinated adults had 45.5 % shorter seropositivity (event time ratio = 0.55, 95 %CI: 0.45-0.66). After second-infections, 89.1 % (76.9-95.3 %) of vaccinated and 94.4 % (74.2-99.0 %) of unvaccinated participants had a 4-fold rise in antibody levels. Regardless of vaccination, antibody levels after second-infections are significantly higher than after first-infections.

These findings suggest nucleocapsid serology can inform researchers about past infections regardless of exposure status, and potentially differentiate between initial infections and reinfections.