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Background <p>Coronavirus disease 2019 (COVID-19) continues to impact populations globally, raising concerns about immunity levels and risks to high-risk groups despite the lifting of the global health emergency in May 2023. While studies have tracked seroprevalence, few have comprehensively assessed long-term antibody persistence and COVID-19 risk, particularly regarding immunity changes due to vaccination and infection. This study aimed to estimate the population prevalence of SARS-CoV-2-specific antibodies, including anti-spike (anti-S) and anti-nucleocapsid (anti-N) antibodies, and to assess the risk of newly confirmed COVID-19 infections in Korea in December 2022. We conducted a follow-up survey and blood testing of 9,945 participants in the Korea Seroprevalence Study of Monitoring of SARS-CoV-2 Antibody Retention and Transmission (K-SEROSMART) Wave 1.</p> Methods <p>The K-SEROSMART Wave 2 study employed a staged approach through public health centers nationwide, using mobile web, telephone, and face-to-face surveys. The follow-up survey (Wave 2) was conducted between December 6 and 27, 2022, four months after the initial survey (Wave 1) conducted in August 2022. Participants self-reported sociodemographic characteristics and health status and provided blood samples for the analysis of anti-spike (anti-S) and anti-nucleocapsid (anti-N) antibodies via electrochemiluminescence immunoassay. Population prevalence estimates were weighted for demographic data. Multivariate Cox proportional hazards regression was used to assess the relationship between anti-S antibody titers from Wave 1 and new COVID-19 cases, adjusting for age and sex.</p> Results <p>A total of 7,528 individuals participated, yielding a follow-up rate of 74.9%. The population-adjusted prevalence rates of anti-S and anti-N antibodies were 98.5% and 70.0%, respectively. The percentage of newly confirmed COVID-19 cases was significantly higher in individuals with anti-S antibody titers below 2,000 U/mL, 2,000–3,999 U/mL, 4,000–5,999 U/mL, 6,000–7,999 U/mL, and 8,000–9,999 U/mL than in those with titers above 18,000 U/mL (hazard ratio [HR] = 9.9, 95% confidence interval [CI] = 7.2–13.5; HR = 8.1, 95% CI = 5.8–11.3; HR = 7.1, 95% CI = 5.0–10.1; HR = 4.2, 95% CI = 2.8–6.3; HR = 2.0, 95% CI = 1.2–3.3, respectively).</p> Conclusions <p>This study demonstrated the feasibility of conducting a seroepidemiological cohort survey on COVID-19 using a nationally representative sample. Additionally, this study quantified anti-S antibody titer levels that are associated with reduced risk of new infections within a community.</p>

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Effect of anti-S antibody titers on newly confirmed cases of COVID-19 in Korea: a community-based cohort study (K-SEROSMART Wave 2)

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月28日

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  • Jina Han,
  • Jung Ae Kim,
  • Hye Jin Baek,
  • Eunbi Noh,
  • Kay O. Lee,
  • June-Woo Lee,
  • Ah-Ra Kim,
  • HyeonNam Do,
  • Soon Young Lee,
  • Dong-Hyun Kim

摘要

Background

Coronavirus disease 2019 (COVID-19) continues to impact populations globally, raising concerns about immunity levels and risks to high-risk groups despite the lifting of the global health emergency in May 2023. While studies have tracked seroprevalence, few have comprehensively assessed long-term antibody persistence and COVID-19 risk, particularly regarding immunity changes due to vaccination and infection. This study aimed to estimate the population prevalence of SARS-CoV-2-specific antibodies, including anti-spike (anti-S) and anti-nucleocapsid (anti-N) antibodies, and to assess the risk of newly confirmed COVID-19 infections in Korea in December 2022. We conducted a follow-up survey and blood testing of 9,945 participants in the Korea Seroprevalence Study of Monitoring of SARS-CoV-2 Antibody Retention and Transmission (K-SEROSMART) Wave 1.

Methods

The K-SEROSMART Wave 2 study employed a staged approach through public health centers nationwide, using mobile web, telephone, and face-to-face surveys. The follow-up survey (Wave 2) was conducted between December 6 and 27, 2022, four months after the initial survey (Wave 1) conducted in August 2022. Participants self-reported sociodemographic characteristics and health status and provided blood samples for the analysis of anti-spike (anti-S) and anti-nucleocapsid (anti-N) antibodies via electrochemiluminescence immunoassay. Population prevalence estimates were weighted for demographic data. Multivariate Cox proportional hazards regression was used to assess the relationship between anti-S antibody titers from Wave 1 and new COVID-19 cases, adjusting for age and sex.

Results

A total of 7,528 individuals participated, yielding a follow-up rate of 74.9%. The population-adjusted prevalence rates of anti-S and anti-N antibodies were 98.5% and 70.0%, respectively. The percentage of newly confirmed COVID-19 cases was significantly higher in individuals with anti-S antibody titers below 2,000 U/mL, 2,000–3,999 U/mL, 4,000–5,999 U/mL, 6,000–7,999 U/mL, and 8,000–9,999 U/mL than in those with titers above 18,000 U/mL (hazard ratio [HR] = 9.9, 95% confidence interval [CI] = 7.2–13.5; HR = 8.1, 95% CI = 5.8–11.3; HR = 7.1, 95% CI = 5.0–10.1; HR = 4.2, 95% CI = 2.8–6.3; HR = 2.0, 95% CI = 1.2–3.3, respectively).

Conclusions

This study demonstrated the feasibility of conducting a seroepidemiological cohort survey on COVID-19 using a nationally representative sample. Additionally, this study quantified anti-S antibody titer levels that are associated with reduced risk of new infections within a community.