Association between antibody responses post-vaccination and severe COVID-19 outcomes in Scotland

Macdonald, Calum and Palmateer, Norah and McAuley, Andrew and Lindsay, Laura and Hasan, Taimoor and Hameed, Safraj Shahul and Hall, Elliot and Jeffrey, Karen and Grange, Zoë and Gousias, Petros and Mavin, Sally and Jarvis, Lisa and Cameron, J. Claire and Daines, Luke and Tibble, Holly and Simpson, Colin R. and McCowan, Colin and Katikireddi, Srinivasa Vittal and Rudan, Igor and Fagbamigbe, Adeniyi Francis and Ritchie, Lewis and Swallow, Ben and Moss, Paul and Robertson, Chris and Sheikh, Aziz and Murray, Josie (2024) Association between antibody responses post-vaccination and severe COVID-19 outcomes in Scotland. npj Vaccines, 9 (1). 107. ISSN 2059-0105 (

[thumbnail of Macdonald-etal-NPJV-2024-Association-between-antibody-responses-post-vaccination-and-severe-COVID-19-outcomes]
Text. Filename: Macdonald-etal-NPJV-2024-Association-between-antibody-responses-post-vaccination-and-severe-COVID-19-outcomes.pdf
Final Published Version
License: Creative Commons Attribution 4.0 logo

Download (1MB)| Preview


Several population-level studies have described individual clinical risk factors associated with suboptimal antibody responses following COVID-19 vaccination, but none have examined multimorbidity. Others have shown that suboptimal post-vaccination responses offer reduced protection to subsequent SARS-CoV-2 infection; however, the level of protection from COVID-19 hospitalisation/death remains unconfirmed. We use national Scottish datasets to investigate the association between multimorbidity and testing antibody-negative, examining the correlation between antibody levels and subsequent COVID-19 hospitalisation/death among double-vaccinated individuals. We found that individuals with multimorbidity ( ≥ five conditions) were more likely to test antibody-negative post-vaccination and 13.37 [6.05–29.53] times more likely to be hospitalised/die from COVID-19 than individuals without conditions. We also show a dose-dependent association between post-vaccination antibody levels and COVID-19 hospitalisation or death, with those with undetectable antibody levels at a significantly higher risk (HR 9.21 [95% CI 4.63–18.29]) of these serious outcomes compared to those with high antibody levels