The development of successful COVID-19 vaccines is the beginning of the end of the COVID-19 pandemic. As more and more individuals in the general population get vaccinated, “herd immunity” is developed, and herd immunity can help protect even those who choose not to receive the vaccine. New testing, using antibodies against the spike protein receptor binding domain (S-RBD) protein used in vaccines, is available from US BioTek. This new antibody test can tell the difference between a COVID-19 infection and protection from a successful COVID-19 vaccination.
S-RBD stands for "spike protein receptor binding domain." The COVID-19 S-RBD binds to the ACE2 receptor and allows the virus access to the body's cells. Higher levels of S-RBD antibodies have been shown to block or "neutralize" the COVID-19 virus from getting into cells and causing infection.
Individuals who have recovered from a COVID-19 viral infection usually have high levels of antibodies specific to S-RBD. The "neutralizing" ability of S-RBD antibodies is why all three of the Emergency Use Authorized (EUA) vaccines target the S-RBD, although they use different methods for getting the S-RBD protein information into the body.
While human studies indicate that spike protein and nucleocapsid protein antibodies elevate in response to COVID-19 virus exposure, these antibodies are not as specific as the S-RBD antibodies for preventing COVID-19 infection (or re-infection) or for confirming post-vaccination status. After the virus infects the human body, it creates a large quantity of both “neutralizing” antibodies such as S-RBD and many nonspecific endogenous antibodies.
While a general trend of post-infection increases in spike and nucleocapsid antibodies in association with increased S-RBD antibodies has been observed, measurement of the generalized antibodies is not always predictive of S-RBD status, particularly when the only stimulus is an S-RBD vaccine:
There are several good reasons to measure antibody status before and after a COVID-19 vaccination. Pre/post-vaccination assessment is the only way to be sure that a COVID-19 vaccination was effective. First, not everyone can mount an adequate antibody response to either COVID-19 infection or vaccination, and it is important to protect those that cannot make the needed antibodies.
Second, not everyone needs to be vaccinated immediately. Individuals with natural antibodies from a COVID-19 infection do not require immediate vaccination. After infection, a vaccination only becomes necessary when natural antibody levels begin to drop 3-6 months later. Serial testing can help determine when it’s the right time to vaccinate.
The COVID-19 Immune Response Panel measures both nucleocapsid (N-protein) and S-RBD antibodies. N-protein antibodies do not rise in response to COVID-19 S-RBD vaccinations. The combined serum IgM/IgG tests measure the body’s response to COVID-19 nucleocapsid (N) and spike protein receptor binding domain (S-RBD) exposure. The N and S-RBD antibodies' combination assay has a > 99% positive and negative predictive value 15 days after COVID-19 exposure. This test does not differentiate between IgM and IgG; studies indicate that joint testing is as or more reliable than individual IgM and IgG testing in confirming COVID-19 exposure.
| Interpretation | N-Antibody IgM/IgG | S-RBD Antibody IgM/IgG | |
| Negative | Non-reactive | Non-Reactive | Consider COVID-19 RT-PCR if indicated |
| Equivocal | Reactive | Non-Reactive | Possible COVID-19 exposure. Consider COVID-19 RT-PCR if indicated. |
| Inoculation-Responsive | Non-Reactive | Reactive | Successful response to inoculation by either vaccine or COVID-19 virus. Consider COVID-19 RT-PCR if indicated. |
| Positive | Reactive | Reactive | Exposure to COVID-19 Virus within the last 6 months. Consider COVID-19 RT-PCR if indicated. |
The COVID-19 Vaccine Response Screen measures only the antibody response to the S-RBD protein. Once the baseline immune response has been established, this test can be used post-vaccination to evaluate immune status. The average time for seroconversion has been estimated at 2-3 weeks. However, the strongest antibody responses will likely be seen after the second vaccine dose 6-8 weeks after the first inoculation.
In conclusion
Not everybody needs to be vaccinated right away because those with natural COVID-19 antibodies are protected until antibody levels decline. Those who need to be vaccinated right away can be evaluated before vaccination to screen for a current or prior COVID-19 infection and determine a baseline antibody status. After vaccination, individuals can be evaluated to measure their post-vaccination response, ensuring they have reached adequate protection from future COVID-19 exposures. Don’t guess - assess patient status pre and post vaccination to be sure!
References:
Centers for Disease Control and Prevention
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