ArticleEBioMedicine2023
SARS-CoV-2-specific nasal IgA wanes 9 months after hospitalisation with COVID-19 and is not induced by subsequent vaccination.
Article in EBioMedicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 79 papers, 1 of them a synthesis that pooled it.
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Who cites it
79 citing papers in PubMed, 1 synthesis or guideline pooled it, 115 citations in OpenAlex.
- Immunogenicity and safety of COVID-19 vaccines among people living with HIV: A systematic review and meta-analysis.Epidemiology and infection · 2023Pooled it
- An intranasally administered adenovirus-vectored SARS-CoV-2 vaccine induces robust mucosal secretory IgA.JCI insight · 2024Trial
- Review
- Increased respiratory pathogen positivity and diversity in hospitalized children following the COVID-19 pandemic in Malaysia.New microbes and new infections · 2026Article
- Respiratory mucosal vaccines for emerging viruses: promise and challenges.Journal of virology · 2026Review
- The role of mucosal IgA in protection against influenza A H1N1 virus infection in a real-world setting.EBioMedicine · 2026Article
- Intranasal replicating adenovirus type 4-vectored SARS-CoV-2 vaccines induce durable and efficacious responses in preclinical testing.iScience · 2026Article
- Immunological memory to vaccines.Immunity · 2026Review
- Next-generation mucosal vaccines for respiratory viruses: Immunological correlates, platform design and clinical translation.World journal of virology · 2026Review
- Selective IgA Deficiency and COVID-19 Outcomes: A Nationwide Retrospective Cohort Study.Journal of clinical medicine · 2026Article
- An innovative nasal nanovaccine against SARS-CoV-2 induces systemic and upper airway immunity controlling viral replication.NPJ vaccines · 2026Article
- Intranasal booster drives class switching and homing of memory B cells for mucosal IgA response.JCI insight · 2026Article
- Intranasal Replicating Adenovirus type 4-SARS-CoV-2 Recombinants Induce Superior Immune Response Durability and Efficacy in Preclinical Testing Compared to Standard Intramuscular Vaccines.bioRxiv : the preprint server for biology · 2026Article
- Intranasal S-2P and lentinan formulation confers broad protection against SARS-CoV-2 VOCs via IFN-γ-dominant mechanisms.NPJ vaccines · 2026Article
- Exogenous IFN-α delivered as an intranasal adjunct to systemic vaccination directs vaccine-specific T-cell responses to the upper respiratory tract.Frontiers in immunology · 2026Article
- Early rise in nasal secretory IgA associated with shorter duration of SARS-CoV-2 virus shedding in an acute infection cohort.Frontiers in immunology · 2026Article
- Dynamic impact of bivalent COVID-19 vaccine boosters on systemic and mucosal antibody and T cell immunity.Scientific reports · 2025Observational
- Article
- Intranasal booster induces durable mucosal immunity against SARS-CoV-2 in mice.Scientific reports · 2025Article
- A 22 month prospective assessment of neutralizing and IgG antibody levels against SARS-CoV-2 variants following homologous and heterologous BNT162b2 boosting.Scientific reports · 2025Article
19 more citing papers are in PubMed but not listed here.
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Authors and funding
43 authors at 14 institutions in 2 countries.
Funding
Abstract
backgroundMost studies of immunity to SARS-CoV-2 focus on circulating antibody, giving limited insights into mucosal defences that prevent viral replication and onward transmission. We studied nasal and plasma antibody responses one year after hospitalisation for COVID-19, including a period when SARS-CoV-2 vaccination was introduced.
methodsIn this follow up study, plasma and nasosorption samples were prospectively collected from 446 adults hospitalised for COVID-19 between February 2020 and March 2021 via the ISARIC4C and PHOSP-COVID consortia. IgA and IgG responses to NP and S of ancestral SARS-CoV-2, Delta and Omicron (BA.1) variants were measured by electrochemiluminescence and compared with plasma neutralisation data.
findingsStrong and consistent nasal anti-NP and anti-S IgA responses were demonstrated, which remained elevated for nine months (p < 0.0001). Nasal and plasma anti-S IgG remained elevated for at least 12 months (p < 0.0001) with plasma neutralising titres that were raised against all variants compared to controls (p < 0.0001). Of 323 with complete data, 307 were vaccinated between 6 and 12 months; coinciding with rises in nasal and plasma IgA and IgG anti-S titres for all SARS-CoV-2 variants, although the change in nasal IgA was minimal (1.46-fold change after 10 months, p = 0.011) and the median remained below the positive threshold determined by pre-pandemic controls. Samples 12 months after admission showed no association between nasal IgA and plasma IgG anti-S responses (R = 0.05, p = 0.18), indicating that nasal IgA responses are distinct from those in plasma and minimally boosted by vaccination.
interpretationThe decline in nasal IgA responses 9 months after infection and minimal impact of subsequent vaccination may explain the lack of long-lasting nasal defence against reinfection and the limited effects of vaccination on transmission. These findings highlight the need to develop vaccines that enhance nasal immunity.
fundingThis study has been supported by ISARIC4C and PHOSP-COVID consortia. ISARIC4C is supported by grants from the National Institute for Health and Care Research and the Medical Research Council. Liverpool Experimental Cancer Medicine Centre provided infrastructure support for this research. The PHOSP-COVD study is jointly funded by UK Research and Innovation and National Institute of Health and Care Research. The funders were not involved in the study design, interpretation of data or the writing of this manuscript.
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