Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : April | Volume : 16 | Issue : 4 | Page : OC36 - OC39 Full Version

Antibody Response following Exposure to SARS-CoV-2: Is It a Reliable Marker of Immunity?


Published: April 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52654.16284
Mona Dhakal, Om Prakash Dhakal, Dhurba Bhandari

1. Professor, Department of Medicine, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India. 2. Professor, Department of Medicine, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India. 3. Tutor, Department of Microbiology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India.

Correspondence Address :
Dr. Mona Dhakal,
Professor, Department of Medicine, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India.
E-mail: mona3dhakal@gmail.com

Abstract

Introduction: Infection and vaccination with the viral vector vaccine Covishield are both expected to produce immunity in the body against Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Production of neutralising antibodies as a result of the humoral immune response plays a key role in defending against this deadly infection. A lack of virus-specific antibodies in the serum does not always imply a lack of immunological memory. The immune response mediated by T cells is also important.

Aim: To check for the humoral immune response after exposure to the SARS-CoV-2 virus.

Materials and Methods: This cross-sectional observational study was carried out at Central Referral Hospital (CRH), a tertiary care hospital in Gangtok, Sikkim, India, from May to June 2021. A total of 90 participants were divided into three equal groups; unvaccinated with a history of infection with SARS-CoV-2 in the recent past, vaccinated but no infection and history of vaccination and infection both, respectively. The test was performed with COVISCREEN. It’s a double antigen sandwich immunoassay that can detect total antibodies (IgM+IgG+IgA) simultaneously to the SARS-CoV-2 virus. The Statistical Package for the Social Sciences (SPSS), version 16.0 for Windows, was used to analyse the data.

Results: Overall, 30 (33.3%) participants showed positive antibody tests out of total 90. Participants with prior infection exhibited more antibody responses irrespective of the vaccination status as compared to vaccinated participants with no prior infection, this difference was statistically insignificant (p=0.165).

Conclusion: Both B cell, as well as T cell immune responses following infection and vaccination, need to be evaluated to predict long term immunological memory and protective immunity against future infections with SARS-CoV-2.

Keywords

Agglutination, B cell, Severe acute respiratory syndrome coronavirus-2, T cell, Vaccine

Infection and vaccination with the non replicating viral vector vaccine Covishield is expected to achieve immunity in the body against infection with SARS-CoV-2 (1). Production of neutralising antibodies plays a key role in defending against this deadly infection (2), although the protective efficacy and the duration of the antibody-mediated immune response following primary infections are not known (3). After infection with this virus, protective immunity might extend anywhere from months to years (4). Several studies on Coronavirus disease-2019 (COVID-19) antibodies, as well as other components of the immune system, are now underway. Presently, it is not known whether cell-mediated or humoral immunity, or a combination of both, can protect us.

Immunoglobulin (Ig) M antibodies, which are formed early in an infection, and IgG antibodies, which are more likely to appear later, are the two types of antibodies formed in response to any infection. Antibodies against the Receptor Binding Domain (RBD) may linger in the blood for months or years in individuals recovering from COVID-19 (5), and those directed against the RBD are exceptional indicators of both old and current infection. Antibody isotypes can assist in distinguishing between recent and previous illnesses. IgG antibodies linger for several months after the initial infection and are intimately associated with neutralising antibodies. Hence, IgG level measurements are more accurate in predicting the immune response in the body (6). The antibody levels that may protect against reinfection are unknown. Moreover, differences in laboratory techniques make this even more complex to decide. According to some findings, antibodies to SARS-CoV-2 do not persist in the serum after recovery from illness. Nonetheless, the lack of particular antibodies in the serum does not always imply that immunological memory is absent (7). T cell-mediated immunity may potentially have a role in the prevention of reinfection.

The main challenge with this immunity is that virus-specific T cells are hard to measure in a laboratory test. It’s costly and not widely available. Although, antibodies may not be the sole criteria to check for the body’s immune response and may play only a supporting role in defending against viruses, they are easier to measure in blood tests. In this study, authors aimed to check the humoral immune responses following infection, vaccination, or both in the studied population.

Material and Methods

This cross-sectional observational study was carried out at CRH, which is a tertiary care hospital in Gangtok, Sikkim, India. Sikkim is a small north-eastern state of India. The study period was two months May to June 2021. Prior ethical approval was obtained from the Institutional Ethics Committee (IEC) of the Sikkim Manipal Institute of Medical Sciences (ethical approval no-SMIMS/IEC/2021-38). Before recruitment into the study, informed consent was obtained from each participant.

Inclusion criteria: All consecutive participants >18 years and <65 years of age who consented to participate in the study were included. Clinically stable participants who attended medical Outpatient Department (OPD) in the study period were included.

Exclusion criteria: Participants <18 years or >65 years of age, unwilling, acutely ill or admitted patients, participants with some known immunocompromising conditions like active cancer treatment, consumption of immunosuppressive drugs due to any cause, chronic liver disease, or chronic kidney disease, uncontrolled diabetes mellitus, Human Immunodeficiency Virus (HIV), Acquired Immunodeficiency Syndrome (AIDS), and postsplenectomy were excluded from the study, 13 participants who did not satisfy inclusion criteria were excluded from the study.

Sample size calculation: A sample size of 90 was chosen as the study period was small and, as per the standard statistical rule, a minimum of 30 participants in each category should be included. The prevalence of 50.3% was found in another north-eastern state, Assam, according to the third sero survey report of the Indian Council of Medical Research (ICMR) (8). A random sampling of eligible patients was done.

Study Procedure

A 90 participants, after fulfilling the inclusion criteria, were divided into three groups. Group 1 included unvaccinated participants with a history of infection with SARS-CoV-2 in the past 1-2 months. Group 2 participants were those with a history of vaccination with two doses of non replicating viral vector COVID-19 vaccine, Covishield in the last 3-4 months. Group 3 participants had both a history of vaccination with two doses of Covishield in the last 3-4 months followed by infection in the past 1-2 months. Demographic characteristics like age, sex, marital status, profession, and co-morbidities were noted.

The test was performed with COVISCREEN, a rapid, qualitative test kit. It’s a double antigen sandwich immunoassay that can detect total antibodies (IgM+IgG+IgA) simultaneously to the SARS-CoV-2 virus in serum, plasma and whole blood as per the instruction card of the manufacturer. These antibodies are binding antibodies. This test cannot measure neutralising antibodies. Only the PRNT50 assay can measure those antibodies. The test kit is manufactured by Zephyr Biomedicals in Goa, India. A sensitivity of 100% and a specificity of 99.07% were observed in an in-house study by the company. Antigens that are specific to SARS-CoV-2 are coated as capture in the region ‘T’, a test region, and biotinylated bovine serum albumin in the control region ‘C’, as an assay control. The coloured virus-specific recombinant antigen indicator colloidal particle complexes with the virus antibodies, if present in the specimen, as the test specimen flows through the membrane assembly within the test device. The SARS-CoV-2 recombinant antigens immobilise this complex as it travels through the membrane to the region ‘T’. This is coated as capture on the nitrocellulose membrane, which leads to the formation of a coloured band in the region ‘T’. This confirms a positive test 37result. A negative test is indicated by the absence of the coloured band in the region ‘T’. The unreacted conjugate and the unbound complex, along with the streptavidin colloidal gold conjugate, move further along the membrane. These are then immobilised by the biotinylated bovine serum albumin, which is coated in the region ‘C’ and forms a coloured band. This control band is used to confirm the test results.

To perform the test, 2 mL of blood was drawn and of that, 20 μL were dispensed carefully into the specimen “A” port of the kit and immediately checked for the presence of antibodies. The negative result is indicated by the presence of only one pink, purple coloured band area ‘C’ whereas the presence of viral-specific total (IgM+IgG+IgA) antibodies and a positive test is indicated by the presence of two pink-purple coloured bands both in the region ‘C’ and ‘T’.

Statistical Analysis

The SPSS, version 16.0 for Windows, was used to analyse the data (SPSS 16; Chicago, IL, USA). The Chi-square test was used to compare categorical variables. The p<0.05 was considered statistically significant.

Results

Out of 90 participants, 33 were males and 57 were females. A 21 of the 90 participants were between the ages of 18-20 years, 34 were between the ages of 21-39 years, 32 were between the ages of 40-59 years and three were between the ages of 59-65 years. A total of 54 participants were healthcare professionals and 57 were married. A significant association was found between variables like age, sex, marital status, and profession and the study groups (p<0.05), whereas it was insignificant between comorbidities and the groups (p=0.935) (Table/Fig 1).

Overall, 30 (33.3%) participants showed positive antibody tests. The number of participants with positive antibody tests was similar in group 1 and 3 suggesting that those with prior infection exhibited more antibody response irrespective of the vaccination status as compared to participants with no prior infection and only vaccination. Although, the difference was found to be statistically insignificant at p<0.05 (Table/Fig 2).

Discussion

Infection and vaccination with Covishield both induced antibody responses in the present study. Of the total, only 30 (33%) participants exhibited a positive antibody response following exposure to the virus. Those with prior infection had a higher antibody response as compared to the uninfected population, irrespective of their vaccination status. Antibodies provide immunity against COVID-19. According to a study done by Iyer AS et al., there is a long lasting immune response against SARS-CoV-2, especially after severe infection (6). It provides optimism that the people who have been infected with the virus will acquire long term immunity. According to the research, the IgG levels in COVID-19 patients increased for almost four months. This finding was linked to the presence of protective neutralising antibodies. On measuring serum and/or plasma antibody responses to the RBD of the spike (S) protein of SARS-CoV-2, it was found that anti-S neutralising antibody titres were closely associated with IgG antibodies to the SARS-CoV-2 RBD, which remained nearly constant throughout 75 days after infection. As a result of this antibody response, the likely duration of protection was at least four months. In the present study, only 40% of the participants had positive antibody responses between 1-2 months following infection. This insufficient response was similar to a drop in neutralising antibody titers as well as antibodies against S protein or nucleocapsid (N) protein reported in other studies (9),(10).

According to a report, antibodies against this virus may only be short-lived, raising doubts about the virus’s long term immunity (11). It is predicted to decline because IgG has a half-life of around 21 days (12). In mild cases, a fast drop in antibodies have also been reported (13). These investigations, however, were restricted by small sample numbers. Furthermore, the majority of the samples were taken within two months after the illness (10),(14). According to some studies, antibodies may not be detected after infection (15),(16). In a Japanese study, highly variable antibody responses were observed in various conditions (3). According to this study, when compared to those who did not, patients who received mechanical ventilation or Extracorporeal Membrane Oxygenation (ECMO) had greater neutralising antibody titres. Increased antibody titre was shown to be linked to a higher Body Mass Index (BMI) and fever. Patients with advanced illness had a stronger immune response as well. On the contrary, most patients who did not require oxygen assistance (97%) also had neutralising antibodies, suggesting that even minor infections may elicit long term immunological responses.

In the present study also, low positivity following infection could be due to various reasons, like mild infections, duration of postinfection being less than two months, or other factors discussed in the above studies. The decrease in antibody titres observed in many studies during the relatively early stages of recovery simply reflects a reduction in the number of short-lived plasmablasts. This is a normal immunological reaction and should not be a reason for concern. As a result, long-lived plasma cells in the bone marrow play an active role in keeping neutralising antibodies in the circulation (2). The titres of antibodies may vary according to the severity of the illness and the viral load. In this study, only six participants out of 30 elicited an antibody response between 3-4 months after the second dose of COVID-19 vaccination. It is yet unknown which antibody titers and tests best relate to vaccination effectiveness. On review of the literature, two studies related to a postvaccination antibody response were found. As per the first study, antibody responses induced by the mRNA-1273 vaccine persisted for upto six months after the second dose (17). According to the second study, after a single vaccination, people with recent SARS-CoV-2 infection elicited higher levels of antibodies after three weeks as compared to those without a history of infection. They had antibodies against four SARS-CoV-2 antigens and even higher antibodies with neutralising characteristics (18). In this study also, the antibody response was higher (40%) in participants with a history of vaccination and infection as compared to vaccination alone.

While antibody response has been used as a sign of protection, it is vital to recognise that in this situation, antibody response cannot be equated with immunity. Understanding cell-mediated immunity might aid in understanding the immune response to infection. Antiviral antibody loads that are too high can cause immunological dysregulation, which can be detrimental. So, there is a need to look above and beyond humoral immunity to better predict disease severity and patient prognosis (19).

B cells and T cells can survive even if blood antibody levels are undetectable. Humoral immune maturation is linked to T follicular helper cells. Long term protection against infection requires virus-specific memory T cells and B cells. The presence of follicular T cells indicates the formation of a pool of memory B cells that respond swiftly to reinfection. Certain T cells are drawn from a pool of T cells that have been preconfigured to recognise certain viral antigens. Specific CD4+ T cells trigger a robust B cell response, which leads to antibody affinity maturation. Levels of S protein-specific T lymphocytes are linked to serum IgG and IgA titers (20). Tools for measuring T-cell response may provide a better picture of the immune response generated by infection or vaccination. A T cell response has been detected in individuals infected with this virus approximately one week after symptom onset, whereas an antibody response can be seen between 10-12 days of infection (21),(22).

Limitation(s)

The small sample size was definitely a limiting factor in this study. Serological cross-reactivity across the other coronavirus groups may occur in certain patients with prior exposure to Human coronavirus HKU1 (HCoV-HKU1) or NL63 or OC43 or 229E or SARS-CoV-2 or MERS-CoV etc. False-positive or false-negative findings can occur owing to the presence of interfering chemicals in the specimen or for reasons beyond the control of the manufacturer, such as testing related technical or procedural problems. The immunocompetence of the patient and the viral dose on exposure play a role in the generation of the antibody response and eventually the test result. Long term follow-up of at least six months to a year postinfection and vaccination is required to look for the persistence of antibodies.

Conclusion

The humoral immune response alone is not sufficient to predict long term immunological memory and protective immunity against future infections following exposure to SARS-CoV-2. Both B, as well as a T cell immune response following infection and vaccination, needs to be evaluated.

References

1.
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DOI and Others

DOI: 10.7860/JCDR/2022/52654.16284

Date of Submission: Oct 04, 2021
Date of Peer Review: Nov 24, 2021
Date of Acceptance: Feb 08, 2022
Date of Publishing: Apr 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 08, 2021
• Manual Googling: Feb 04, 2022
• iThenticate Software: Feb 05, 2022 (5%)

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