Changes in SARS-CoV-2–specific IgG after a fourth dose of COVID-19 vaccine. Total IgG in WHO BAUs against SARS-CoV-2 nucleocapsid, S1 RBD, and full-length spike before and after a fourth dose of the vaccine among SOTRs. The box plots represent the IQR. The median is represented by a solid horizontal line in the box. The lower and upper whiskers represent 1.5 times the IQR beyond the quartiles. Each dot represents an individual sample. Gray lines between dots indicate change after a fourth dose. Dashed horizontal lines represent seropositivity cutoffs as determined by the test manufacturer based on convalescent and prepandemic samples. Statistical differences between measurements were determined by the paired Wilcoxon signed-rank test. P values of <0.05 were considered significant. (*** indicates P < 0.001, ns indicates P > 0.05). BAU, binding antibody unit; COVID-19, coronavirus disease 2019; IgG, immunoglobulin G; IQR, interquartile range; RBD, receptor-binding domain antibody; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SOTR, solid organ transplant recipient; WHO, World Health Organization.