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

  1. Heather J Whitaker
  2. Charlotte Gower
  3. Ashley D Otter
  4. Ruth Simmons
  5. Freja Kirsebom
  6. Louise Letley
  7. Catherine Quinot
  8. Georgina Ireland
  9. Ezra Linley
  10. Sonia Ribeiro
  11. Shamez Ladhani
  12. Jamie Lopez-Bernal
  13. Gayatri Amirthalingam
  14. Mary E Ramsay
  15. Kevin E Brown
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Abstract

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 levels 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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