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there were not sufficient data to assess CoRs of severe COVID-19.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Here, we assessed, in the same vaccinated cohort, Delta- and ancestral-specific Spike IgG and nAb-ID50 at \u223cpeak and over time as CoRs of severe COVID-19 and of Delta COVID-19 over 3.5\u201310 months post \u223cpeak (287 breakthrough Delta cases, including 8 severe; 446 noncases).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Peak antibody levels were much higher for noncases versus severe cases (all inferred Delta), with nAb-ID50 Delta geometric mean 209.5 arbitrary units (AU)\/mL (95% CI: 176.1, 249.1) versus 9.6\u2005AU\/mL (95% CI: 2.4, 38.6), respectively. Frequency of detectable nAb-ID50 titer was 98.3% (97.2, 99.0) for noncases versus 62.5% (22.3, 93.9) for severe cases. All markers were inverse CoRs of severe COVID-19, with a \u223cpeak hazard ratio (HR) of 0.13 (95% CI: .03, .57) per 10-fold nAb-ID50 Delta increase. Severe COVID-19 risk through 305 days postday 35 was 0.0338 (0.0043, 0.206) at the nAb-ID50 Delta 2.5th percentile (8.4\u2005AU\/mL), and 0.002 (0.0000, 0.0108) and 0.0002 (0.0000, 0.0035) at the 50th and 95th percentiles (210, 2522\u2005AU\/mL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Postvaccination NVX-CoV2373 antibody levels are stronger predictors of severe COVID-19 than any-severity Delta COVID-19. Low antibody responses indicate vulnerability to severe COVID-19.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaf558","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T13:33:38Z","timestamp":1760448818000},"page":"e863-e874","source":"Crossref","is-referenced-by-count":1,"title":["Analysis of Antibody Markers as Immune Correlates of Risk of Severe COVID-19 in the PREVENT-19 Efficacy Trial of the NVX-CoV2373 Recombinant Protein Vaccine"],"prefix":"10.1093","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4230-6863","authenticated-orcid":false,"given":"Youyi","family":"Fong","sequence":"first","affiliation":[{"name":"Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center , Seattle, Washington ,","place":["USA"]},{"name":"Public Health Sciences Division, Fred Hutchinson Cancer Center , Seattle, Washington ,","place":["USA"]},{"name":"Department of Biostatistics, University of Washington , Seattle, Washington ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunda","family":"Huang","sequence":"additional","affiliation":[{"name":"Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center , Seattle, Washington ,","place":["USA"]},{"name":"Department of Global Health, University of Washington , Seattle, Washington ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Huang","sequence":"additional","affiliation":[{"name":"Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center , Seattle, Washington ,","place":["USA"]},{"name":"Public Health Sciences Division, Fred Hutchinson Cancer Center , Seattle, Washington ,","place":["USA"]},{"name":"Department of Biostatistics, University of Washington , Seattle, Washington ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wayne","family":"Woo","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Novavax, Inc. , Gaithersburg, Maryland ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"McGarry","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Novavax, Inc. , Gaithersburg, Maryland ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5361-3001","authenticated-orcid":false,"given":"Germ\u00e1n","family":"\u00c1\u00f1ez","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Novavax, Inc. , Gaithersburg, Maryland ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa M","family":"Dunkle","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Novavax, Inc. , Gaithersburg, Maryland ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iksung","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Novavax, Inc. , Gaithersburg, Maryland ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher R","family":"Houchens","sequence":"additional","affiliation":[{"name":"Biomedical Advanced Research and Development Authority , Administration for Strategic Preparedness and Response, U.S. Department of Health and Human Services, Washington, DC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Martins","sequence":"additional","affiliation":[{"name":"Biomedical Advanced Research and Development Authority , Administration for Strategic Preparedness and Response, U.S. Department of Health and Human Services, Washington, DC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lakshmi","family":"Jayashankar","sequence":"additional","affiliation":[{"name":"Biomedical Advanced Research and Development Authority , Administration for Strategic Preparedness and Response, U.S. Department of Health and Human Services, Washington, DC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flora","family":"Castellino","sequence":"additional","affiliation":[{"name":"Biomedical Advanced Research and Development Authority , Administration for Strategic Preparedness and Response, U.S. Department of Health and Human Services, Washington, DC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christos J","family":"Petropoulos","sequence":"additional","affiliation":[{"name":"LabCorp-Monogram Biosciences , South San Francisco, California ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Leith","sequence":"additional","affiliation":[{"name":"Nexelis , Seattle, Washington ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deanne","family":"Haugaard","sequence":"additional","affiliation":[{"name":"Nexelis , Seattle, Washington 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,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8687-9703","authenticated-orcid":false,"given":"Carina A","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Division of Pediatric Infectious Diseases, University of South Florida, Morsani College of Medicine , Tampa, Florida ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6476-3934","authenticated-orcid":false,"given":"Milagritos","family":"Tapia","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8079-9382","authenticated-orcid":false,"given":"Christine B","family":"Turley","sequence":"additional","affiliation":[{"name":"Atrium Health Wake Forest School of Medicine , Charlotte, North Carolina ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7740-1636","authenticated-orcid":false,"given":"Carmen D","family":"Zorrilla","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Department, School of Medicine, University of Puerto Rico, Medical Sciences Campus , San Juan ,","place":["Puerto Rico"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stuart H","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases, Sacramento, University of California Davis Medical Center , California ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan E","family":"Kline","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota Medical School , Minneapolis, Minnesota ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Barranco","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Ponce Health Sciences University , Ponce ,","place":["Puerto Rico"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence","family":"Corey","sequence":"additional","affiliation":[{"name":"Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center , Seattle, Washington ,","place":["USA"]},{"name":"Department of Laboratory Medicine and Pathology, University of Washington , Seattle, Washington ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9480-2714","authenticated-orcid":false,"given":"Kathleen M","family":"Neuzil","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dean","family":"Follmann","sequence":"additional","affiliation":[{"name":"Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3831-5828","authenticated-orcid":false,"given":"Julie A","family":"Ake","sequence":"additional","affiliation":[{"name":"U.S. Military HIV Research Program, Center for Infectious Disease Research, Walter Reed Army Institute of Research , Silver Spring, Maryland ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3620-3059","authenticated-orcid":false,"given":"Cynthia L","family":"Gay","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University of North Carolina School of Medicine , Chapel Hill, North Carolina ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen L","family":"Kotloff","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Jones","sequence":"additional","affiliation":[{"name":"Biomedical Advanced Research and Development Authority , Administration for Strategic Preparedness and Response, U.S. Department of Health and Human Services, Washington, DC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard A","family":"Koup","sequence":"additional","affiliation":[{"name":"Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruben O","family":"Donis","sequence":"additional","affiliation":[{"name":"Biomedical Advanced Research and Development Authority , Administration for Strategic Preparedness and Response, U.S. Department of Health and Human Services, Washington, DC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2662-9427","authenticated-orcid":false,"given":"Peter B","family":"Gilbert","sequence":"additional","affiliation":[{"name":"Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center , Seattle, Washington ,","place":["USA"]},{"name":"Public Health Sciences Division, Fred Hutchinson Cancer Center , Seattle, Washington ,","place":["USA"]},{"name":"Department of Biostatistics, University of Washington , Seattle, Washington ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,10,25]]},"reference":[{"key":"2026043013123453800_ciaf558-B1","doi-asserted-by":"crossref","first-page":"2320","DOI":"10.1056\/NEJMoa2026920","article-title":"Phase 1-2 trial of a SARS-CoV-2 recombinant spike protein nanoparticle vaccine","volume":"383","author":"Keech","year":"2020","journal-title":"N Engl J Med"},{"key":"2026043013123453800_ciaf558-B2","doi-asserted-by":"crossref","first-page":"e1003769","DOI":"10.1371\/journal.pmed.1003769","article-title":"Different dose regimens of a SARS-CoV-2 recombinant spike protein vaccine (NVX-CoV2373) in younger and older adults: a phase 2 randomized placebo-controlled trial","volume":"18","author":"Formica","year":"2021","journal-title":"PLoS Med"},{"key":"2026043013123453800_ciaf558-B3","doi-asserted-by":"crossref","first-page":"e309","DOI":"10.1016\/S2352-3018(22)00041-8","article-title":"Immunogenicity and 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