Time dependent decline of neutralizing antibody titers in COVID-19 patients from Pune, India and evidence of reinfection

Abstract

Purpose To assess modulation of neutralizing antibody titers in COVID-19 patients and understand association of variables such as age, presence of comorbidity, BMI and gender with antibody titers. Methods Patients (n=100) diagnosed from 20th March 2020-17th August 2020 and treated at two large hospitals from Pune, India were included and followed up (clinical and serologic) for varied periods. IgG-anti-SARS-CoV-2 (Spike protein-based ELISA) and neutralizing antibody titers (NAb, PRNT) were determined in all the samples. Results Of the 100 patients enrolled initially (median 60 days of diagnosis), follow up samples were collected from 70 patients (median 106 days of diagnosis). Overall, NAb titers reduced significantly (p < 0.001) and as early as 3-4 months. During two visits, 20% and 7.1% patients reported some symptoms. At the first visit, NAb titers were higher in patients with severe disease (p<0.001), comorbidities (p<0.005), age <50 years (p<0.05) and male gender (p<0.05). Multivariate analysis identified older age (p<0.001), duration post-diagnosis and female gender as independent variables influencing NAb titers (negative correlation, p<0.05). During the follow-up, reduction in NAb titers was recorded in patients with comorbidity (p<0.05), mild disease (p<0.05), age <50years (p<0.05), higher BMI (p<0.05) and male gender (p <0.001). Serology identified six cases of asymptomatic reinfections. Conclusions Decline of NAb titers was associated with age<50 years, mild disease, comorbidities, higher BMI and male gender. At the time of follow up, 8/70 (11.4%) patients lacked neutralizing antibodies. Evidence of 6 probable asymptomatic reinfections suggests waning of immunity, but, probable protection from clinical disease needing hospitalization.