Anti-spike protein receptor-binding domain IgG levels after COVID-19 infection or vaccination against SARS-CoV-2 in a seroprevalence study

Abstract Purpose In a country-wide seroprevalence study of COVID-19 in Estonia we aimed to determine the seroprevalence and the dynamics of IgG against SARS-CoV-2 after vaccination or positive PCR-test. Methods Leftover blood samples were selected between February 8 to March 25, 2021, by SYNLAB Estonia from all counties and age groups (0-9, 10-19, 20-59, 60-69, 70-79, 80-100 years) proportionally to the whole Estonian population and tested for IgG against SARS-CoV-2 spike protein receptor-binding domain (anti-S-RBD IgG) using Abbott SARS-CoV-2 IgG II Quant assay. Antibody levels after positive PCR-test or vaccination were described by nonlinear model. Results A total of 2517 samples were tested. Overall seroprevalence (95% CI) was 20.1% (18.5-21.7%), similar in all age groups. If all individuals vaccinated with the first dose at least 14 days before antibody measurement were assumed to be seronegative, the overall seroprevalence was 15.8% (14.4-17.3%), 4-fold larger than the proportion of confirmed COVID-19 cases. According to nonlinear models, age increased anti-S-RBD IgG production after positive PCR-test but decreased after vaccination. The peak of anti-S-RBD IgG in a 52-year-old (median age of PCR-positive and/or vaccinated individuals) was significantly higher after vaccination compared with positive PCR-test (22082 (12897…26875) vs 6732 (2321…8243) AU/mL), but half-life was similar (26.5 (6.9…46.1) vs 38.3 (8.2…68.5) days). Conclusion One year after the start of COVID-19 pandemic the actual prevalence of infection is still underestimated compared with confirmed COVID-19 cases, underlining the importance of seroepidemiological studies. Older individuals have lower anti-S-RBD IgG level after vaccination, but similar decline rate to younger.