Evidence map›Paper›PMID 42685247›Full record

SynthesisPLoS medicine2026

Neutralising antibodies and protection from progression to severe COVID-19: A meta-analysis.

Karen M Elias, Ainslie Mitchell, Eva Stadler, Timothy E Schlub, Shanchita R Khan, Claire Xue, Stephen J Kent, Deborah Cromer, Miles P Davenport, David S Khoury

Abstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in PLoS medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Karen M EliasKirby Institute, University of New South Wales, Sydney, Australia.ORCID https://orcid.org/0009-0000-4989-5552
Ainslie MitchellKirby Institute, University of New South Wales, Sydney, Australia.
Eva StadlerKirby Institute, University of New South Wales, Sydney, Australia.ORCID https://orcid.org/0000-0002-5129-8180
Timothy E SchlubKirby Institute, University of New South Wales, Sydney, Australia.ORCID https://orcid.org/0000-0001-7746-9649
Shanchita R KhanKirby Institute, University of New South Wales, Sydney, Australia.ORCID https://orcid.org/0000-0003-0772-6122
Claire XueSchool of Mathematics and Statistics, University of New South Wales, Sydney, Australia.ORCID https://orcid.org/0009-0002-0870-6668
Stephen J KentDepartment of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.ORCID https://orcid.org/0000-0002-8539-4891
Deborah CromerKirby Institute, University of New South Wales, Sydney, Australia.ORCID https://orcid.org/0000-0002-5276-5094
Miles P DavenportKirby Institute, University of New South Wales, Sydney, Australia.ORCID https://orcid.org/0000-0002-4751-1831
David S KhouryKirby Institute, University of New South Wales, Sydney, Australia.ORCID https://orcid.org/0000-0002-2663-1551

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundVaccine-induced neutralising antibodies are a well-established correlate of protection against acquisition of COVID-19. Vaccine protection from severe COVID-19 remains high, although the role of neutralising antibodies and the contribution of other immune responses to protection from severe outcomes is less clear. Improving understanding of how vaccines prevent severe outcomes is important for future vaccine development. METHODS AND

findingsHere we undertake a systematic search of the literature to obtain estimates of vaccine protection against progression from SARS-CoV-2 infection to severe COVID-19 (hospital or ICU admission). We aggregate results from 25 published clinical studies of vaccine protection from progression to severe outcomes in people with SARS-CoV-2 infection. We match this clinical data to data from 301 studies of post-vaccination neutralisation titres induced by various vaccines against different SARS-CoV-2 variants from the publicly available Stanford University Coronavirus antiviral and resistance database. We then synthesise the data using meta-regression. Neutralising antibody titres were found to be associated with vaccine protection against progression to severe COVID-19 (relative risk (RR) 0.57 per 10-fold increase in GMT, 95% CI [0.51,0.64], p < 0.001). We found that the protection against progression provided by vaccination was higher than that provided by therapeutic passive administration of antibodies, when used to treat individuals with confirmed infection. The main methodological limitations were the fact that neutralisation titres and clinical outcomes were measured in different studies, and the possibility of unmeasured confounding.

conclusionsTogether, this work suggests that vaccine-induced neutralising antibodies are correlated with protection from progression to severe COVID-19 and can account for at least a partial mechanistic role in this protection. However, a protection gap remains between the high levels of protection against progressing to severe COVID-19 afforded by vaccination, compared to that afforded by therapeutic administration of antibodies, suggesting other immune responses may also play a role.

Indexed as

Antibodies, NeutralizingAntibodies, ViralCOVID-19COVID-19 VaccinesDisease ProgressionHumansPandemicsSARS-CoV-2VaccinationAntibodies, NeutralizingAntibodies, ViralCOVID-19 Vaccines

Identifiers

PMID42685247
PMCPMC13537689

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.