Differential Severe Acute Respiratory Syndrome Coronavirus 2–Specific Humoral Response in Inactivated Virus–Vaccinated, Convalescent, and Breakthrough-Infected Subjects

Abstract Background We sought to identify potential antigens for discerning between humoral responses elicited after vaccination with CoronaVac (a severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] inactivated vaccine), natural infection, or breakthrough infection. Methods Serum samples obtained from volunteers immunized with CoronaVac (2 and 3 doses), breakthrough case patients, and from convalescent individuals were analyzed to determine the immunoglobulin (Ig) G responses against 3 structural and 8 nonstructural SARS-CoV-2 antigens. Results Immunization with CoronaVac induced higher levels of antibodies against the viral membrane (M) protein compared with convalescent subjects both after primary vaccination and after a booster dose. Individuals receiving a booster dose displayed equivalent levels of IgG antibodies against the nucleocapsid (N) protein, similar to convalescent subjects. Breakthrough case patients produced the highest antibody levels against the N and M proteins. Antibodies against nonstructural viral proteins were present in >50% of the convalescent subjects. Conclusions Vaccinated individuals elicited a different humoral response compared to convalescent subjects. The analysis of particular SARS-CoV-2 antigens could be used as biomarkers for determining infection in subjects previously vaccinated with CoronaVac. Immunoglobulin G against severe acute respiratory syndrome coronavirus 2 membrane and nucleocapsid antigens, alone or combined, could serve as potential differential biomarkers for distinguishing CoronaVac-vaccinated breakthrough case patients from CoronaVac–vaccinated individuals with 2–3 doses or coronavirus disease 2019 convalescents.