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Vaccine-induced correlate of protection against fatal COVID-19 in older and frail adults during waves of neutralization-resistant variants of concern: an observational study
BACKGROUND: To inform future preventive measures including repeated vaccinations, we have searched for a clinically useful immune correlate of protection against fatal COVID-19 among nursing homes residents. METHODS: We performed repeated capillary blood sampling with analysis of S-binding IgG in an...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10163377/ https://www.ncbi.nlm.nih.gov/pubmed/37363799 http://dx.doi.org/10.1016/j.lanepe.2023.100646 |
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author | Vikström, Linnea Fjällström, Peter Gwon, Yong-Dae Sheward, Daniel J. Wigren-Byström, Julia Evander, Magnus Bladh, Oscar Widerström, Micael Molnar, Christian Rasmussen, Gunlög Bennet, Louise Åberg, Mikael Björk, Jonas Tevell, Staffan Thålin, Charlotte Blom, Kim Klingström, Jonas Murrell, Ben Ahlm, Clas Normark, Johan Johansson, Anders F. Forsell, Mattias N.E. |
author_facet | Vikström, Linnea Fjällström, Peter Gwon, Yong-Dae Sheward, Daniel J. Wigren-Byström, Julia Evander, Magnus Bladh, Oscar Widerström, Micael Molnar, Christian Rasmussen, Gunlög Bennet, Louise Åberg, Mikael Björk, Jonas Tevell, Staffan Thålin, Charlotte Blom, Kim Klingström, Jonas Murrell, Ben Ahlm, Clas Normark, Johan Johansson, Anders F. Forsell, Mattias N.E. |
author_sort | Vikström, Linnea |
collection | PubMed |
description | BACKGROUND: To inform future preventive measures including repeated vaccinations, we have searched for a clinically useful immune correlate of protection against fatal COVID-19 among nursing homes residents. METHODS: We performed repeated capillary blood sampling with analysis of S-binding IgG in an open cohort of nursing home residents in Sweden. We analyzed immunological and registry data from 16 September 2021 to 31 August 2022 with follow-up of deaths to 30 September 2022. The study period included implementation of the 3rd and 4th mRNA monovalent vaccine doses and Omicron virus waves. FINDINGS: A total of 3012 nursing home residents with median age 86 were enrolled. The 3rd mRNA dose elicited a 99-fold relative increase of S-binding IgG in blood and corresponding increase of neutralizing antibodies. The 4th mRNA vaccine dose boosted levels 3.8-fold. Half-life of S-binding IgG was 72 days. A total 528 residents acquired their first SARS-CoV-2 infection after the 3rd or the 4th vaccine dose and the associated 30-day mortality was 9.1%. We found no indication that levels of vaccine-induced antibodies protected against infection with Omicron VOCs. In contrast, the risk of death was inversely correlated to levels of S-directed IgG below the 20th percentile. The death risk plateaued at population average above the lower 35th percentile of S-binding IgG. INTERPRETATION: In the absence of neutralizing antibodies that protect from infection, quantification of S-binding IgG post vaccination may be useful to identify the most vulnerable for fatal COVID-19 among the oldest and frailest. This information is of importance for future strategies to protect vulnerable populations against neutralization resistant variants of concern. FUNDING: 10.13039/501100004359Swedish Research Council, 10.13039/501100004063SciLifeLab via Knut and Alice Wallenberg Foundation, 10.13039/501100001858VINNOVA. Swedish Healthcare Regions, and Erling Persson Foundation. |
format | Online Article Text |
id | pubmed-10163377 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-101633772023-05-08 Vaccine-induced correlate of protection against fatal COVID-19 in older and frail adults during waves of neutralization-resistant variants of concern: an observational study Vikström, Linnea Fjällström, Peter Gwon, Yong-Dae Sheward, Daniel J. Wigren-Byström, Julia Evander, Magnus Bladh, Oscar Widerström, Micael Molnar, Christian Rasmussen, Gunlög Bennet, Louise Åberg, Mikael Björk, Jonas Tevell, Staffan Thålin, Charlotte Blom, Kim Klingström, Jonas Murrell, Ben Ahlm, Clas Normark, Johan Johansson, Anders F. Forsell, Mattias N.E. Lancet Reg Health Eur Articles BACKGROUND: To inform future preventive measures including repeated vaccinations, we have searched for a clinically useful immune correlate of protection against fatal COVID-19 among nursing homes residents. METHODS: We performed repeated capillary blood sampling with analysis of S-binding IgG in an open cohort of nursing home residents in Sweden. We analyzed immunological and registry data from 16 September 2021 to 31 August 2022 with follow-up of deaths to 30 September 2022. The study period included implementation of the 3rd and 4th mRNA monovalent vaccine doses and Omicron virus waves. FINDINGS: A total of 3012 nursing home residents with median age 86 were enrolled. The 3rd mRNA dose elicited a 99-fold relative increase of S-binding IgG in blood and corresponding increase of neutralizing antibodies. The 4th mRNA vaccine dose boosted levels 3.8-fold. Half-life of S-binding IgG was 72 days. A total 528 residents acquired their first SARS-CoV-2 infection after the 3rd or the 4th vaccine dose and the associated 30-day mortality was 9.1%. We found no indication that levels of vaccine-induced antibodies protected against infection with Omicron VOCs. In contrast, the risk of death was inversely correlated to levels of S-directed IgG below the 20th percentile. The death risk plateaued at population average above the lower 35th percentile of S-binding IgG. INTERPRETATION: In the absence of neutralizing antibodies that protect from infection, quantification of S-binding IgG post vaccination may be useful to identify the most vulnerable for fatal COVID-19 among the oldest and frailest. This information is of importance for future strategies to protect vulnerable populations against neutralization resistant variants of concern. FUNDING: 10.13039/501100004359Swedish Research Council, 10.13039/501100004063SciLifeLab via Knut and Alice Wallenberg Foundation, 10.13039/501100001858VINNOVA. Swedish Healthcare Regions, and Erling Persson Foundation. Elsevier 2023-05-06 /pmc/articles/PMC10163377/ /pubmed/37363799 http://dx.doi.org/10.1016/j.lanepe.2023.100646 Text en © 2023 The Author(s) https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Articles Vikström, Linnea Fjällström, Peter Gwon, Yong-Dae Sheward, Daniel J. Wigren-Byström, Julia Evander, Magnus Bladh, Oscar Widerström, Micael Molnar, Christian Rasmussen, Gunlög Bennet, Louise Åberg, Mikael Björk, Jonas Tevell, Staffan Thålin, Charlotte Blom, Kim Klingström, Jonas Murrell, Ben Ahlm, Clas Normark, Johan Johansson, Anders F. Forsell, Mattias N.E. Vaccine-induced correlate of protection against fatal COVID-19 in older and frail adults during waves of neutralization-resistant variants of concern: an observational study |
title | Vaccine-induced correlate of protection against fatal COVID-19 in older and frail adults during waves of neutralization-resistant variants of concern: an observational study |
title_full | Vaccine-induced correlate of protection against fatal COVID-19 in older and frail adults during waves of neutralization-resistant variants of concern: an observational study |
title_fullStr | Vaccine-induced correlate of protection against fatal COVID-19 in older and frail adults during waves of neutralization-resistant variants of concern: an observational study |
title_full_unstemmed | Vaccine-induced correlate of protection against fatal COVID-19 in older and frail adults during waves of neutralization-resistant variants of concern: an observational study |
title_short | Vaccine-induced correlate of protection against fatal COVID-19 in older and frail adults during waves of neutralization-resistant variants of concern: an observational study |
title_sort | vaccine-induced correlate of protection against fatal covid-19 in older and frail adults during waves of neutralization-resistant variants of concern: an observational study |
topic | Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10163377/ https://www.ncbi.nlm.nih.gov/pubmed/37363799 http://dx.doi.org/10.1016/j.lanepe.2023.100646 |
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