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Cover page of the Journal of Health Sciences

 Table of Contents  
Year : 2022  |  Volume : 15  |  Issue : 3  |  Page : 256-260

Seroprevalence of severe acute respiratory syndrome coronavirus 2 immunoglobulin G antibodies among health-care workers prior and after 4–6 weeks of coronavirus disease vaccine administration at tertiary care center of southwest Bihar, India

1 Department of Microbiology, Narayan Medical College, Jamuhar Sasaram, Bihar, India
2 Department of Anesthesiology, Narayan Medical College, Jamuhar Sasaram, Bihar, India
3 Department of General Medicine, Narayan Medical College, Jamuhar Sasaram, Bihar, India
4 Department of Microbiology, SHKM, GMC, Nuh, Haryana, India

Date of Submission28-Jun-2021
Date of Acceptance23-Mar-2022
Date of Web Publication17-Sep-2022

Correspondence Address:
Dr. Mukesh Kumar
Department of Microbiology, Narayan Medical College, Jamuhar Sasaram, Bihar
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/kleuhsj.kleuhsj_179_21

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AIM: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an ongoing global health emergency. To control the spread, a mass vaccination program is initiated. Antibody titer after vaccination can be a better marker to monitor immunological response.
MATERIALS AND METHODS: The study was carried out at the Department of Microbiology, Narayan Medical College and Hospital, Jamuhar Sasaram, southwest Bihar, considering the sample size, type, and collection. First, antibody was tested before vaccination and second antibody value after 28 days of the first dose of COVID vaccine among the health-care workers and housekeeping staff.
RESULTS: A total of 251 subjects were administered with vaccination (Covishield) to check the immunoglobulin g (IgG) responses. The concentration of the SARS-CoV-2 IgG antibody in female patients tended to be higher than in male patients.
CONCLUSION: There is a difference in antibody positivity among males and females. Most of the participants had IgG positivity, because of their profession, vaccination boosted percentage positivity in both males and females. Females have more IgG levels compared to males. Hence, recommend that separate guidelines can be made between males and females for vaccination dosages.

Keywords: 2019 novel coronavirus, coronavirus disease 2019, novel coronavirus pneumonia, severe acute respiratory syndrome coronavirus 2

How to cite this article:
Kumar M, Singh R, Kamendu A, Singh AK, Sangwan J. Seroprevalence of severe acute respiratory syndrome coronavirus 2 immunoglobulin G antibodies among health-care workers prior and after 4–6 weeks of coronavirus disease vaccine administration at tertiary care center of southwest Bihar, India. Indian J Health Sci Biomed Res 2022;15:256-60

How to cite this URL:
Kumar M, Singh R, Kamendu A, Singh AK, Sangwan J. Seroprevalence of severe acute respiratory syndrome coronavirus 2 immunoglobulin G antibodies among health-care workers prior and after 4–6 weeks of coronavirus disease vaccine administration at tertiary care center of southwest Bihar, India. Indian J Health Sci Biomed Res [serial online] 2022 [cited 2022 Sep 25];15:256-60. Available from: https://www.ijournalhs.org/text.asp?2022/15/3/256/356271

  Introduction Top

Coronaviruses are a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS). The virus is now known as the SARS coronavirus 2 (SARS-CoV-2). The disease it causes is called coronavirus disease 2019 (COVID-19). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic. The disease was first identified in December 2019 in Wuhan, the capital of China's Hubei province, and has since spread globally, resulting in the ongoing 2019–2020 coronavirus pandemic. As of April 27, 2020, more than 2.99 million cases have been reported across 185 countries and territories, resulting in more than 207,000 deaths. More than 876,000 people have recovered. Coronaviruses were identified in the mid-1960s and are known to infect humans and a variety of animals (including birds and mammals). Since 2002, two COVID infecting animals have evolved and caused outbreaks in humans: SARS-CoV identified in southern China in 2003, and MERS-CoV identified in Saudi Arabia in 2012. Together, they have caused more than 1600 deaths.

A pioneering study conducted in the city of Shenzhen near Hong Kong by a group of clinicians and scientists from the University of Hong Kong has provided the first concrete evidence for human-to-human transmission of SARS-CoV-2.[1] Several important clinical features of COVID-19 have also been documented in this study. First, an attack rate of 83% within the family context is alarmingly high, indicating the high transmissibility of SARS-CoV-2. Second, the clinical manifestations of COVID-19 in this family range from mild to moderate, with more systematic symptoms and more severe radiological abnormalities seen in older patients. In general, COVID-19 appears to be less severe than SARS.[2] For example, the presentation of diarrhea in two young adults from the same family in a study also suggests the possibility for gastrointestinal involvement in SARS-CoV-2 infection and fecal–oral transmission. The study has set the stage for the control and management of COVID-19.[3] The work was completed timely and the investigators showed great courage and leadership in a very difficult time when the Chinese authority failed to recognize widespread person-to-person transmission of SARS-CoV-19 before January 20, 2020.

COVID-19 is a disease and a causative agent of SARS-CoV, or more popularly known as novel coronavirus, is associated with respiratory disorder in humans which has been declared as a global epidemic and pandemic in the first quarter of the year 2020 by the WHO.[4] As per John Hopkins University[5] and other tracking websites, there are currently more than 1.3 million people infected by the novel coronavirus all around the world and close to 75 thousand deaths are reported from different parts of the world. The top ten countries with maximum number of infected cases are the United States of America, Spain, Italy, Germany, France, China, Iran, United Kingdom, Turkey, and Switzerland. Similarly, there are other mathematical models that were developed for analyzing the trends of COVID-19 outbreak in India. A model[6] for studying the impact of social distancing on age and gender of the patients in India was presented. It compared the country demographics among India, Italy, and China and suggested the most vulnerable age categories and gender groups among all the nations.

Work of medical doctors and frontline health workers was also presented by some studies.[7] It was found that in India, the role of health workers was less stressed as the spread stage of coronavirus was still in phase two or the phase of local transmission rather than the community transmission as compared to other nations such as Italy, Spain, and the USA. However, it was also claimed that Indian health-care infrastructure is not very strong as per the WHO guidelines, and in case of community spread, the Indian government may find it difficult to manage the spread. Some detailed discussion on the nature of the coronavirus was also presented by some studies.[8],[9]

SARS-COV-2 is an enveloped, single-stranded RNA virus of the family Coronaviridae, genus Betacornaviruses, which is responsible for COVID-19 ranging from mild, self-limiting, respiratory tract illness to severe progressive pneumonia, multi-organ failure, and death.

  Materials and Methods Top

The present study was carried out at the Department of Microbiology, Narayan Medical College and Hospital, Jamuhar Sasaram, Bihar. Study is approved by Institutional Ethical Committee. Informed consent was obtained from all the participants. Ethical Clearance was obtained from Naraya medical college and hospital Ethical Committee with Ref no NMCH/IEC/2021/08 dated 17/02/21.

Sample size

A total of 251 subjects were the sample size.

Sample collection

Blood samples were collected in a yellow vacutainer, and the serum was separated and tested as per the protocol of biomerux immunoglobulin g (IgG), and values were noted. Antibody was tested using the VIDAS instrument from biomeru to detect IgG level.

Study type

This assay is intended for use as an aid to determine if individuals may have exposed and infected by the virus and if they have mounted specific anti-SARS-COV-2 IgG immune response.

First antibody was tested before vaccination and the second antibody value was after 28 days of the first dose of the COVID vaccine. Participants were health-care workers (HCWs) such as doctors, nurses, and housekeeping staff. The test was carried out in a fully automated immunoassay system-VIDAS using enzyme-linked fluorescence assay technology. First dose of Covishield mean level of IgG before vaccination and second dose mean level of IgG after 28 days of vaccination were studied.

The anti-SARS-COV-2 IgG test is intended to use as an aid in identifying individuals with an adaptive immune response to SARS-COV-2, indicating recent, past, or prior infection.[5] This test is only for serosurveillence and should not be used to diagnose SARS-COV-2 infection.

  Results Top

A total of 251 subjects were administered with vaccination (Covishield) to check the IgG responses. The healthy patient antibodies were analyzed after vaccination. Out of 251 subjects, 185 were males and 66 were females. The demographic details are shown in [Table 1]. After vaccination, based on the IgG responses, out of 185, 164 males turned to be positive, and out of 66, 65 females tuned to be positive [Table 2]. Two groups of IgG levels between the first dose and the second dose when compared using Wilcoxon test, a significant (P < 0.0001) difference was observed [Figure 1]. When male and female subjects were compared among the groups, the female IgG levels were found to be higher [Figure 2].
Table 1: Demographic details of the participants

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Table 2: IgG levels among male and female

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Figure 1: Comparison between groups Wilcoxon test (P < 0.0001). ***Highly significant

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Figure 2: Paired samples compared with Wilcoxon test and unpaired samples with Mann Whitney test

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  Discussion Top

As of March 2021, 13 vaccines have been approved for the application while over 90 vaccine candidates are under clinical trials. Importantly, challenge studies are conducted against the background of competent volunteers' informed consent, minimization of study risks, and high baseline risks of infection for participants.

In the present study, males and females had 33.5% and 55.03% levels of IgG, respectively, before vaccination. This might be due to the asymptomatic exposure of study participants during the pandemic condition. The presence of antibodies before vaccination also might be due to, hospital exposure as partisans are HCW. After vaccination, it increased to 88.8% and 98.4% among male and female participants, respectively, which might be due to the booster dose, which is the resultant of memory cells formation. In our study, we observed that females have significantly higher levels of antibody compared to males. This was in concordance with a report from Fink and Klein., 2018 on the influenza vaccine.[10] Increased humoral response in females compared with males is genetically well conserved, suggesting an adaptive advantage of elevated antibodies for reproductive success, including for the transfer of protective antibodies to offspring. In another study, it is proved that there will be a decline in antibodies faster in males than in females, which is independent of age and body mass index.[11]

The differences observed are not a one-off thing, but a highly observed problem globally. In fact, a recent study by the Centers for Disease Control and Prevention analyzed data from the first 13.7 million COVID vaccine shots given to people of different age groups. When it came to the side effects, it was observed that a whopping 79.1% were reported from women, as compared to men. Doctors and gender experts say they are not surprised that women have had stronger reactions.

”We have seen this before,” says Megan Donnelly, a doctor of osteopathic medicine and head of women's neurology and the headache center at Novant Health in Charlotte, North Carolina. “If you look at flu vaccine data, it was more women seeing more side effects and severe reactions.” Experts say it is not possible that men are less likely than women to report postvaccine reactions because masculine stereotypes call for men to be stoic.

When paired samples were compared, there was a significant difference between the groups, which was in agreement with Masoomikarimi et al.,[12] few data are reported on the gender differences in immunoglobulins therapy. In particular, it has been described that in the severe status, more female patients had a high level of IgG antibody compared to male patients, and the production of IgG antibody tended to be stronger in female patients in the early phase of COVID-19. The concentration of the SARS-CoV-2 IgG antibody in female patients tended to be higher than male patients in 2–4 weeks after disease onset, and the difference in antibody concentration disappeared after 4 weeks of disease onset.

Since the discovery of human coronaviruses in the 1960s, new types of coronaviruses have kept emerging and have gradually become a serious threat to global public health. Even though there have been almost two decades since the first coronavirus outbreak, the scientific and medical community is not well prepared with effective weapons to combat these pathogens. Besides, multiple therapeutic candidates targeting molecules in the SARS-CoV-2 life cycle and human immune response against COVID-19 have also been rapidly explored, with remdesivir and dexamethasone being the two leading drugs that showed promising clinical evidences in shortening the time to recovery and decreasing mortality rates.[13],[14] These treatment options can be complementary to SARS-CoV-2 vaccines to achieve overall mitigation of the COVID-19 pandemic.

Apart from the efficacy, the accompanying adverse reactions also play an important role in evaluating the availability of these vaccines. In general, there were no severe adverse reactions reported for people who have taken these vaccines and the mild side effects normally include headache, muscle/joint pain, fatigue, and so forth.[15],[16],[17] However, either efficacy or adverse effect needs to be evaluated solely for individuals with different ages, genders, and medical histories.

  Findings Top

This research used existing studies to analyze the pooled prevalence of anti-SARS-CoV-2 IgG antibodies in HCWs employed. The seroprevalence of IgG was compared across age groups, gender, workplace infection risk, and study period. The study also used statistical techniques to estimate the pooled seroprevalence of IgG antibodies in the HCWs while capturing heterogeneity in the estimates. To understand the global pattern of natural immunity against this obdurate virus, the study allowed us to visualize the progression of the seropositive status of IgG antibodies among HCWs before vaccination. Our findings highlight that the immunological landscape has not been changed significantly over time, suggesting a slow progression of long-term SARS-CoV-2 immunity. As the world plans to find a new equilibrium between minimizing the direct impacts of COVID-19 on the infected and indirect impacts on society, such serological study is crucial to providing new insights into disease transmission.

  Conclusion Top

In collusion, authors have administered Covidshield vaccination to a total of 251 high-risk individuals (HCWs). Before vaccination also they had IgG positivity, because of their profession, vaccination boosted percentage positivity in both males and females. Females have more IgG levels compared to males. Hence, recommend that separate guidelines can be made between males and females for vaccination dosages. During serodiagnosis also, there should be a separate cutoff between males and females.


The authors would like to acknowledge all the participants.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.  Back to cited text no. 1
World Health Organization. Coronavirus Disease 2019 (Covid19). Situation Report-73. Vol. 1. Geneva: World Health Organization; 2020. p. 1-19.  Back to cited text no. 2
Zhang T, Wu Q, Zhang Z. Probable pangolin origin of 2019-nCoV associated with outbreak of COVID-19. New York: SSRN eLibrary; 2020. p. 1-6.  Back to cited text no. 3
Boldog P, Tekeli T, Vizi Z, Dénes A, Bartha FA, Röst G. Risk assessment of novel coronavirus COVID-19 outbreaks outside China. J Clin Med 2020;9:571.  Back to cited text no. 4
Roosa K, Lee Y, Luo R, Kirpich A, Rothenberg R, Hyman JM, et al. Real-time forecasts of the COVID-19 epidemic in China from February 5th to February 24th, 2020. Infect Dis Model 2020;5:256-63.  Back to cited text no. 5
Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records. Lancet 2020;395:809-15.  Back to cited text no. 6
Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology 2020;158:1831-3.e3.  Back to cited text no. 7
de Wit E, van Doremalen N, Falzarano D, Munster VJ. SARS and MERS: Recent insights into emerging coronaviruses. Nat Rev Microbiol 2016;14:523-34.  Back to cited text no. 8
Liu Y. Aerodynamic characteristics and RNA concentration of SARS-CoV-2 aerosol in Wuhan hospitals during COVID-19 outbreak. bioRxiv 2020;86:3-8.  Back to cited text no. 9
Fink AL, Klein SL. The evolution of greater humoral immunity in females than males: Implications for vaccine efficacy. Curr Opin Physiol 2018;6:16-20.  Back to cited text no. 10
Grzelak L, Velay A, Madec Y, Gallais F, Staropoli I, Schmidt-Mutter C, et al. Sex differences in the decline of neutralizing antibodies to SARS-CoV-2. medRxiv 2020. doi: https://doi.org/10.1101/2021.02.01.21250493.  Back to cited text no. 11
Masoomikarimi M, Garmabi B, Alizadeh J, Kazemi E, Azari Jafari A, Mirmoeeni S, et al. Advances in immunotherapy for COVID-19: A comprehensive review. Int Immunopharmacol 2021;93:107409.  Back to cited text no. 12
Starr SE, Visintine AM, Tomeh MO, Nahmias AJ. Effects of immunostimulants on resistance of newborn mice to herpes simplex type 2 infection. Proc Soc Exp Biol Med 1976;152:57-60.  Back to cited text no. 13
O'Neill LAJ, Netea MG. BCG-induced trained immunity: Can it offer protection against COVID-19? Nat Rev Immunol 2020;20:335-7.  Back to cited text no. 14
Xia S, Duan K, Zhang Y, Zhao D, Zhang H, Xie Z, et al. Effect of an inactivated vaccine against SARS-CoV-2 on safety and immunogenicity outcomes: Interim analysis of 2 randomized clinical trials. JAMA 2020;324:951-60.  Back to cited text no. 15
Poland GA, Ovsyannikova IG, Kennedy RB. SARS-CoV-2 immunity: Review and applications to phase 3 vaccine candidates. Lancet 2020;396:1595-606.  Back to cited text no. 16
Anderson EJ, Rouphael NG, Widge AT, Jackson LA, Roberts PC, Makhene M, et al. Safety and immunogenicity of SARS-CoV-2 mRNA-1273 vaccine in older adults. N Engl J Med 2020;383:2427-38.  Back to cited text no. 17


  [Figure 1], [Figure 2]

  [Table 1], [Table 2]


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