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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
Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
Umeå University, Faculty of Medicine, Department of Clinical Microbiology.ORCID iD: 0000-0002-0703-4188
The Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Solna, Sweden.
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2023 (English)In: The Lancet Regional Health: Europe, E-ISSN 2666-7762, Vol. 30, article id 100646Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Elsevier, 2023. Vol. 30, article id 100646
Keywords [en]
Correlate of protection, COVID-19, Immune monitoring of vulnerable populations, Longevity of vaccination, Open cohort study, Vaccination, Vulnerable population
National Category
Infectious Medicine Immunology in the medical area
Identifiers
URN: urn:nbn:se:umu:diva-208263DOI: 10.1016/j.lanepe.2023.100646Scopus ID: 2-s2.0-85156247971OAI: oai:DiVA.org:umu-208263DiVA, id: diva2:1758908
Funder
Swedish Research CouncilScience for Life Laboratory, SciLifeLabKnut and Alice Wallenberg FoundationVinnovaSwedish Association of Local Authorities and RegionsFamiljen Erling-Perssons StiftelseAvailable from: 2023-05-24 Created: 2023-05-24 Last updated: 2023-07-14Bibliographically approved

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Vikström, LinneaFjällström, PeterGwon, Yong-DaeWigren-Byström, JuliaEvander, MagnusWiderström, MicaelAhlm, ClasNormark, JohanJohansson, Anders F.Forsell, Mattias N. E.

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Vikström, LinneaFjällström, PeterGwon, Yong-DaeWigren-Byström, JuliaEvander, MagnusWiderström, MicaelAhlm, ClasNormark, JohanJohansson, Anders F.Forsell, Mattias N. E.
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The Lancet Regional Health: Europe
Infectious MedicineImmunology in the medical area

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