Determinants of antibody levels and protection against omicron BQ.1/XBB breakthrough infection

Determinants of antibody levels and protection against omicron BQ.1/XBB breakthrough infection

Abstract Background The ongoing evolution of SARS-CoV-2, particularly through the emergence of new variants, continues to challenge our understanding of immune protection. While antibody levels correlate with protection against earlier variants such as Alpha and Delta, their relationship with Omicro...

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Main Authors: Carla Martín Pérez, Anna Ramírez-Morros, Alfons Jiménez, Marta Vidal, Edwards Pradenas, Diana Barrios, Mar Canyelles, Rocío Rubio, Inocencia Cuamba, Luis Izquierdo, Pere Santamaria, Benjamin Trinité, Josep Vidal-Alaball, Luis M. Molinos-Albert, Julià Blanco, Ruth Aguilar, Anna Ruiz-Comellas, Gemma Moncunill, Carlota Dobaño
Format: Article
Language:English
Published: Nature Portfolio 2025-06-01
Series:Communications Medicine
Online Access:https://doi.org/10.1038/s43856-025-00943-2
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Summary:Abstract Background The ongoing evolution of SARS-CoV-2, particularly through the emergence of new variants, continues to challenge our understanding of immune protection. While antibody levels correlate with protection against earlier variants such as Alpha and Delta, their relationship with Omicron sub-variants remains unclear. Methods To investigate the role of antibody levels and neutralizing activity in preventing breakthrough infections, we analyzed longitudinal SARS-CoV-2 humoral responses and neutralizing activity against the ancestral virus and major emerging variants in a well-characterized cohort of healthcare workers in Spain (N = 405). Results We find that antibody levels and neutralization titers are key indicators of protection against SARS-CoV-2, including the more evasive BQ.1 and XBB Omicron variants. Higher IgG and IgA levels are associated with protection over three 6-month follow-up periods sequentially dominated by BA.1, BA.2, BA.5, BQ.1, and XBB Omicron sub-variants, although the strength of the association between antibody levels and protection declines over time. Conclusions Our findings demonstrate that binding antibody levels and neutralizing responses are valid correlates of protection against more evasive BQ.1 and XBB Omicron variants, although the strength of this association diminishes over time. Additionally, our results underscore the importance of continuous monitoring and updating vaccination strategies to maintain effective protection against emerging SARS-CoV-2 variants.
ISSN:2730-664X

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