Severe Acute Respiratory Syndrome Coronavirus 2 Infection History and Antibody Response to 3 Coronavirus Disease 2019 Messenger RNA Vaccine Doses

Meghan K. Herring, James K. Romine, Meredith G. Wesley, Katherine D. Ellingson, Sarang K. Yoon, Alberto J. Caban-Martinez, Jennifer Meece, Manjusha Gaglani, Lauren Grant, Lauren E.W. Olsho, Harmony L. Tyner, Allison L. Naleway, Sana M. Khan, Andrew L. Phillips, Natasha Schaefer Solle, Spencer Rose, Josephine Mak, Sammantha B. Fuller, Angela Hunt, Jennifer L. KuntzShawn Beitel, Young M. Yoo, Pearl Q. Zheng, Gayatri Arani, Julie Mayo Lamberte, Taylor Edwards, Mark G. Thompson, Ryan Sprissler, Natalie J. Thornburg, Ashley A. Lowe, Tamara Pilishvili, Jennifer L. Uhrlaub, Karen Lutrick, Jefferey L. Burgess, Ashley L. Fowlkes

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background. Data on antibody kinetics are limited among individuals previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). From a cohort of healthcare personnel and other frontline workers in 6 US states, we assessed antibody waning after messenger RNA (mRNA) dose 2 and response to dose 3 according to SARS-CoV-2 infection history. Methods. Participants submitted sera every 3 months, after SARS-CoV-2 infection, and after each mRNA vaccine dose. Sera were tested for antibodies and reported as area under the serial dilution curve (AUC). Changes in AUC values over time were compared using a linear mixed model. Results. Analysis included 388 participants who received dose 3 by November 2021. There were 3 comparison groups: vaccine only with no known prior SARS-CoV-2 infection (n = 224); infection prior to dose 1 (n = 123); and infection after dose 2 and before dose 3 (n = 41). The interval from dose 2 and dose 3 was approximately 8 months. After dose 3, antibody levels rose 2.5-fold (95% confidence interval [CI] = 2.2–3.0) in group 2 and 2.9-fold (95% CI = 2.6–3.3) in group 1. Those infected within 90 days before dose 3 (and median 233 days [interquartile range, 213–246] after dose 2) did not increase significantly after dose 3. Conclusions. A third dose of mRNA vaccine typically elicited a robust humoral immune response among those with primary vaccination regardless of SARS-CoV-2 infection >3 months prior to boosting. Those with infection <3 months prior to boosting did not have a significant increase in antibody concentrations in response to a booster.

Original languageEnglish (US)
Pages (from-to)1822-1831
Number of pages10
JournalClinical Infectious Diseases
Issue number10
StatePublished - May 15 2023


  • COVID-19
  • antibody kinetics
  • antibody response
  • booster
  • mRNA vaccine

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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