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Shakinah S, Aini MH, Sekartini R, Soedjatmiko, Medise BE, Gunardi H, Yuniar I, Indawati W, Koesnoe S, Harimurti K, Maria S, Wirahmadi A, Sari RM, Setyaningsih L, Surachman F. Immunogenicity Assessment of the SARS-CoV-2 Protein Subunit Recombinant Vaccine (CoV2-IB 0322) in a Substudy of a Phase 3 Trial in Indonesia. Vaccines (Basel) 2024; 12:371. [PMID: 38675753 PMCID: PMC11053672 DOI: 10.3390/vaccines12040371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND COVID-19 is one of the most devastating pandemics of the 21st century. Vaccination is one of the most effective prevention methods in combating COVID-19, and one type of vaccine being developed was the protein subunit recombinant vaccine. We evaluated the efficacy of the CoV2-IB 0322 vaccine in Depok, Indonesia. METHODS This study aimed to assess the humoral and cellular immune response of the CoV2-IB 0322 vaccine compared to an active control vaccine (COVOVAX™ Vaccine). A total of 120 subjects were enrolled and randomized into two groups, with 60 subjects in each group. Participants received either two doses of the CoV2-IB 0322 vaccine or two doses of the control vaccine with a 28-day interval between doses. Safety assessments were conducted through onsite monitoring and participant-reported adverse events. Immunogenicity was evaluated by measuring IgG anti-RBD SARS-CoV-2 and IgG-neutralizing antibodies. Cellular immunity was assessed by specific T-cell responses. Whole blood samples were collected at baseline, 14 days, 6 months, and 12 months after the second dose for cellular immunity evaluation. RESULTS Both vaccines showed high seropositive rates, with neutralizing antibody and IgG titers peaking 14 days after the second dose and declining by 12 months. The seroconversion rate of anti-S IgG was 100% in both groups, but the rate of neutralizing antibody seroconversion was lower in the CoV2-IB 0322 vaccine group at 14 days after the second dose (p = 0.004). The CoV2-IB 0322 vaccine showed higher IgG GMT levels 6 and 12 months after the second dose (p < 0.001 and p = 0.01). T-cell responses, evaluated by IFN-γ, IL-2, and IL-4 production by CD4+ and CD8+ T-cells, showed similar results without significant differences between both groups, except for %IL-2/CD4+ cells 6 months after the second dose (p = 0.038). CONCLUSION Both vaccines showed comparable B- and T-cell immunological response that diminish over time.
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Affiliation(s)
- Sharifah Shakinah
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jalan Diponegoro No 71, Jakarta 10340, Indonesia; (S.S.); (S.M.)
| | - Muhammad Hafiz Aini
- Department of Internal Medicine, Universitas Indonesia Hospital, Jl. Prof. DR. Bahder Djohan, Depok 16424, Indonesia
| | - Rini Sekartini
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jalan Diponegoro No 71, Jakarta 10340, Indonesia; (R.S.); (S.); (W.I.)
| | - Soedjatmiko
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jalan Diponegoro No 71, Jakarta 10340, Indonesia; (R.S.); (S.); (W.I.)
| | - Bernie Endyarni Medise
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jalan Diponegoro No 71, Jakarta 10340, Indonesia; (R.S.); (S.); (W.I.)
| | - Hartono Gunardi
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jalan Diponegoro No 71, Jakarta 10340, Indonesia; (R.S.); (S.); (W.I.)
| | - Irene Yuniar
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jalan Diponegoro No 71, Jakarta 10340, Indonesia; (R.S.); (S.); (W.I.)
| | - Wahyuni Indawati
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jalan Diponegoro No 71, Jakarta 10340, Indonesia; (R.S.); (S.); (W.I.)
| | - Sukamto Koesnoe
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jalan Diponegoro No 71, Jakarta 10340, Indonesia; (S.S.); (S.M.)
| | - Kuntjoro Harimurti
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jalan Diponegoro No 71, Jakarta 10340, Indonesia; (S.S.); (S.M.)
| | - Suzy Maria
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jalan Diponegoro No 71, Jakarta 10340, Indonesia; (S.S.); (S.M.)
| | - Angga Wirahmadi
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jalan Diponegoro No 71, Jakarta 10340, Indonesia; (R.S.); (S.); (W.I.)
| | - Rini Mulia Sari
- PT Bio Farma, Jalan Pasteur No. 28, Bandung 40161, Indonesia (L.S.); (F.S.)
| | - Lilis Setyaningsih
- PT Bio Farma, Jalan Pasteur No. 28, Bandung 40161, Indonesia (L.S.); (F.S.)
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Suntronwong N, Kanokudom S, Auphimai C, Thongmee T, Assawakosri S, Vichaiwattana P, Yorsaeng R, Duangchinda T, Chantima W, Pakchotanon P, Nilyanimit P, Srimuan D, Thatsanathorn T, Sudhinaraset N, Wanlapakorn N, Poovorawan Y. Long-Term Dynamic Changes in Hybrid Immunity over Six Months after Inactivated and Adenoviral Vector Vaccination in Individuals with Previous SARS-CoV-2 Infection. Vaccines (Basel) 2024; 12:180. [PMID: 38400163 PMCID: PMC10891631 DOI: 10.3390/vaccines12020180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Numerous studies have largely focused on short-term immunogenicity in recovered individuals post mRNA vaccination. However, understanding the long-term durability, particularly in inactivated and adenoviral vectored vaccines, remains limited. We evaluated antibody responses, omicron variant neutralization, and IFN-γ responses in 119 previously infected individuals vaccinated with CoronaVac or ChAdOx1 up to six months post-vaccination. Both vaccines elicited robust immune responses in recovered individuals, surpassing those who were infection-naïve, and these persisted above pre-vaccination levels for six months. However, antibody levels declined over time (geometric mean ratio (GMR) = 0.52 for both vaccines). Notably, neutralizing activities against omicron declined faster in ChAdOx1 (GMR = 0.6) compared to CoronaVac recipients (GMR = 1.03). While the first dose of ChAdOx1 adequately induced immune responses in recovered individuals, a second dose demonstrated advantages in omicron variant neutralization and slower decline. Although both vaccines induced T cell responses, the median IFN-γ level at six months returned to pre-vaccination levels. However, more individuals exhibited reactive T cell responses. Extending the interval (13-15 months) between infection and vaccination could enhance antibody levels and broaden neutralization. Together, these findings demonstrate a robust humoral and cellular response that was sustained for at least six months after vaccination, thus guiding optimal vaccination strategies based on prior infection and vaccine platforms.
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Affiliation(s)
- Nungruthai Suntronwong
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; (N.S.); (S.K.); (C.A.); (T.T.); (S.A.); (P.V.); (R.Y.); (P.N.); (D.S.); (T.T.); (N.S.); (N.W.)
| | - Sitthichai Kanokudom
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; (N.S.); (S.K.); (C.A.); (T.T.); (S.A.); (P.V.); (R.Y.); (P.N.); (D.S.); (T.T.); (N.S.); (N.W.)
- Center of Excellence in Osteoarthritis and Musculoskeleton, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Chompoonut Auphimai
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; (N.S.); (S.K.); (C.A.); (T.T.); (S.A.); (P.V.); (R.Y.); (P.N.); (D.S.); (T.T.); (N.S.); (N.W.)
| | - Thanunrat Thongmee
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; (N.S.); (S.K.); (C.A.); (T.T.); (S.A.); (P.V.); (R.Y.); (P.N.); (D.S.); (T.T.); (N.S.); (N.W.)
| | - Suvichada Assawakosri
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; (N.S.); (S.K.); (C.A.); (T.T.); (S.A.); (P.V.); (R.Y.); (P.N.); (D.S.); (T.T.); (N.S.); (N.W.)
- Center of Excellence in Osteoarthritis and Musculoskeleton, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Preeyaporn Vichaiwattana
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; (N.S.); (S.K.); (C.A.); (T.T.); (S.A.); (P.V.); (R.Y.); (P.N.); (D.S.); (T.T.); (N.S.); (N.W.)
| | - Ritthideach Yorsaeng
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; (N.S.); (S.K.); (C.A.); (T.T.); (S.A.); (P.V.); (R.Y.); (P.N.); (D.S.); (T.T.); (N.S.); (N.W.)
| | - Thaneeya Duangchinda
- Molecular Biology of Dengue and Flaviviruses Research Team, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Development Agency, NSTDA, Pathum Thani 12120, Thailand; (T.D.); (P.P.)
| | - Warangkana Chantima
- Division of Dengue Hemorrhagic Fever Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
- Siriraj Center of Research Excellence in Dengue and Emerging Pathogens, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Pattarakul Pakchotanon
- Molecular Biology of Dengue and Flaviviruses Research Team, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Development Agency, NSTDA, Pathum Thani 12120, Thailand; (T.D.); (P.P.)
| | - Pornjarim Nilyanimit
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; (N.S.); (S.K.); (C.A.); (T.T.); (S.A.); (P.V.); (R.Y.); (P.N.); (D.S.); (T.T.); (N.S.); (N.W.)
| | - Donchida Srimuan
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; (N.S.); (S.K.); (C.A.); (T.T.); (S.A.); (P.V.); (R.Y.); (P.N.); (D.S.); (T.T.); (N.S.); (N.W.)
| | - Thaksaporn Thatsanathorn
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; (N.S.); (S.K.); (C.A.); (T.T.); (S.A.); (P.V.); (R.Y.); (P.N.); (D.S.); (T.T.); (N.S.); (N.W.)
| | - Natthinee Sudhinaraset
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; (N.S.); (S.K.); (C.A.); (T.T.); (S.A.); (P.V.); (R.Y.); (P.N.); (D.S.); (T.T.); (N.S.); (N.W.)
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; (N.S.); (S.K.); (C.A.); (T.T.); (S.A.); (P.V.); (R.Y.); (P.N.); (D.S.); (T.T.); (N.S.); (N.W.)
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; (N.S.); (S.K.); (C.A.); (T.T.); (S.A.); (P.V.); (R.Y.); (P.N.); (D.S.); (T.T.); (N.S.); (N.W.)
- The Royal Society of Thailand (FRS(T)), Sanam Sueapa, Dusit, Bangkok 10330, Thailand
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Wachter F, Knieling F, Raming R, Simon D, Woelfle J, Hoerning A, Neubert A, Rauh M, Regensburger AP. Routine Surveillance of SARS-CoV-2 Serostatus in Pediatrics Allows Monitoring of Humoral Response. Microorganisms 2023; 11:2919. [PMID: 38138063 PMCID: PMC10745477 DOI: 10.3390/microorganisms11122919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/22/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
The occurrence of SARS-CoV-2 infections during the pandemic was mainly based on PCR testing of symptomatic patients. However, with new variants, vaccinations, and the changing of the clinical disease severity, knowledge about general immunity is elusive. For public health systems, timely knowledge of these conditions is essential, but it is particularly scarce for the pediatric population. Therefore, in this study, we wanted to investigate the spike and nucleocapsid seroprevalence in pediatric patients using routine residual blood tests collected during the pandemic. This prospective observational study was conducted over seven one-month periods. Herein, the latest four time periods (November 2021, January 2022, March 2022, and May 2022) are depicted. Each patient of a tertiary-care center in Germany was anonymized after collection of clinical diagnosis (ICD-10) and then routinely tested for the respective spike and nucleocapsid SARS-CoV-2 antibody titer. A total of 3235 blood samples from four time periods were included. Spike seroprevalence rose from 37.6% to 51.9% to 70.5% to 85.1% and nucleocapsid seroprevalence from 11.6% to 17.0% to 36.7% to 58.1% in May 2022. In detail, significant changes in seroprevalence between age groups but not between sex or diagnosis groups were found. Quantitative measures revealed rising spike and constant nucleocapsid antibody levels over the pandemic with a half-life of 102 days for spike and 45 days for nucleocapsid antibodies. Routine laboratory assessment of SARS-CoV-2 in residual blood specimens of pediatric hospitals enables monitoring of the seroprevalence and may allow inferences about general immunity in this cohort.
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Affiliation(s)
- Felix Wachter
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.W.); (R.R.)
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.W.); (R.R.)
| | - Roman Raming
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.W.); (R.R.)
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.W.); (R.R.)
| | - André Hoerning
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.W.); (R.R.)
| | - Antje Neubert
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.W.); (R.R.)
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.W.); (R.R.)
| | - Adrian P. Regensburger
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.W.); (R.R.)
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Masood KI, Qaiser S, Abidi SH, Khan E, Mahmood SF, Hussain A, Ghous Z, Imtiaz K, Ali N, Hasan M, Memon HA, Yameen M, Ali S, Baloch S, Lakhani G, Alves PM, Iqbal NT, Ahmed K, Iqbal J, Bhutta ZA, Hussain R, Rottenberg M, Simas JP, Veldhoen M, Ghias K, Hasan Z. Humoral and T cell responses to SARS-CoV-2 reveal insights into immunity during the early pandemic period in Pakistan. BMC Infect Dis 2023; 23:846. [PMID: 38041026 PMCID: PMC10691108 DOI: 10.1186/s12879-023-08829-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Protection against SARS-CoV-2 is mediated by humoral and T cell responses. Pakistan faced relatively low morbidity and mortality from COVID-19 through the pandemic. To examine the role of prior immunity in the population, we studied IgG antibody response levels, virus neutralizing activity and T cell reactivity to Spike protein in a healthy control group (HG) as compared with COVID-19 cases and individuals from the pre-pandemic period (PP). METHODS HG and COVID-19 participants were recruited between October 2020 and May 2021. Pre-pandemic sera was collected before 2018. IgG antibodies against Spike and its Receptor Binding Domain (RBD) were determined by ELISA. Virus neutralization activity was determined using a PCR-based micro-neutralization assay. T cell - IFN-γ activation was assessed by ELISpot. RESULTS Overall, the magnitude of anti-Spike IgG antibody levels as well as seropositivity was greatest in COVID-19 cases (90%) as compared with HG (39.8%) and PP (12.2%). During the study period, Pakistan experienced three COVID-19 waves. We observed that IgG seropositivity to Spike in HG increased from 10.3 to 83.5% during the study, whilst seropositivity to RBD increased from 7.5 to 33.3%. IgG antibodies to Spike and RBD were correlated positively in all three study groups. Virus neutralizing activity was identified in sera of COVID-19, HG and PP. Spike reactive T cells were present in COVID-19, HG and PP groups. Individuals with reactive T cells included those with and without IgG antibodies to Spike. CONCLUSIONS Antibody and T cell responses to Spike protein in individuals from the pre-pandemic period suggest prior immunity against SARS-CoV-2, most likely from cross-reactive responses. The rising seroprevalence observed in healthy individuals through the pandemic without known COVID-19 may be due to the activation of adaptive immunity from cross-reactive memory B and T cells. This may explain the more favourable COVID-19 outcomes observed in this population.
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Affiliation(s)
- Kiran Iqbal Masood
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O.Box 3500, Karachi, 74800, Pakistan
| | - Shama Qaiser
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O.Box 3500, Karachi, 74800, Pakistan
| | - Syed Hani Abidi
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Erum Khan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O.Box 3500, Karachi, 74800, Pakistan
| | | | - Areeba Hussain
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O.Box 3500, Karachi, 74800, Pakistan
| | - Zara Ghous
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O.Box 3500, Karachi, 74800, Pakistan
| | - Khekahsan Imtiaz
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O.Box 3500, Karachi, 74800, Pakistan
| | - Natasha Ali
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O.Box 3500, Karachi, 74800, Pakistan
| | - Muhammad Hasan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O.Box 3500, Karachi, 74800, Pakistan
| | - Haris Ali Memon
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O.Box 3500, Karachi, 74800, Pakistan
| | - Maliha Yameen
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O.Box 3500, Karachi, 74800, Pakistan
| | - Shiza Ali
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O.Box 3500, Karachi, 74800, Pakistan
| | - Sadaf Baloch
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O.Box 3500, Karachi, 74800, Pakistan
| | - Gulzar Lakhani
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Paula M Alves
- iBET - Instituto de Biologia Experimental E Tecnológica, Oeiras, Portugal
| | - Najeeha Talat Iqbal
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
- Department of Pediatrics, Aga Khan University, Karachi, Pakistan
| | - Kumail Ahmed
- Department of Pediatrics, Aga Khan University, Karachi, Pakistan
| | - Junaid Iqbal
- Department of Pediatrics, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Rabia Hussain
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O.Box 3500, Karachi, 74800, Pakistan
| | - Martin Rottenberg
- Department of Microbiology and Tumor Cell Biology, Karolinska Institute, Stockholm, Sweden
| | - J Pedro Simas
- Católica Biomedical Research, Católica Medical School, Universidade Católica Portuguesa, Palma de Cima, 1649-023, Lisboa, Portugal
| | - Marc Veldhoen
- Instituto de Medicina Molecular | João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Kulsoom Ghias
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Zahra Hasan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O.Box 3500, Karachi, 74800, Pakistan.
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Uusküla A, Pisarev H, Tisler A, Meister T, Suija K, Huik K, Abroi A, Kalda R, Kolde R, Fischer K. Risk of SARS-CoV-2 infection and hospitalization in individuals with natural, vaccine-induced and hybrid immunity: a retrospective population-based cohort study from Estonia. Sci Rep 2023; 13:20347. [PMID: 37989858 PMCID: PMC10663482 DOI: 10.1038/s41598-023-47043-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023] Open
Abstract
A large proportion of the world's population has some form of immunity against SARS-CoV-2, through either infection ('natural'), vaccination or both ('hybrid'). This retrospective cohort study used data on SARS-CoV-2, vaccination, and hospitalization from national health system from February 2020 to June 2022 and Cox regression modelling to compare those with natural immunity to those with no (Cohort1, n = 94,982), hybrid (Cohort2, n = 47,342), and vaccine (Cohort3, n = 254,920) immunity. In Cohort 1, those with natural immunity were at lower risk for infection during the Delta (aHR 0.17, 95%CI 0.15-0.18) and higher risk (aHR 1.24, 95%CI 1.18-1.32) during the Omicron period than those with no immunity. Natural immunity conferred substantial protection against COVID-19-hospitalization. Cohort 2-in comparison to natural immunity hybrid immunity offered strong protection during the Delta (aHR 0.61, 95%CI 0.46-0.80) but not the Omicron (aHR 1.05, 95%CI 0.93-1.1) period. COVID-19-hospitalization was extremely rare among individuals with hybrid immunity. In Cohort 3, individuals with vaccine-induced immunity were at higher risk than those with natural immunity for infection (Delta aHR 4.90, 95%CI 4.48-5.36; Omicron 1.13, 95%CI 1.06-1.21) and hospitalization (Delta aHR 7.19, 95%CI 4.02-12.84). These results show that risk of infection and severe COVID-19 are driven by personal immunity history and the variant of SARS-CoV-2 causing infection.
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Affiliation(s)
- Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, 50411, Tartu, Estonia.
| | - Heti Pisarev
- Department of Family Medicine and Public Health, University of Tartu, 50411, Tartu, Estonia
| | - Anna Tisler
- Department of Family Medicine and Public Health, University of Tartu, 50411, Tartu, Estonia
| | - Tatjana Meister
- Department of Family Medicine and Public Health, University of Tartu, 50411, Tartu, Estonia
| | - Kadri Suija
- Department of Family Medicine and Public Health, University of Tartu, 50411, Tartu, Estonia
| | - Kristi Huik
- Institute of Biomedicine and Translational Medicine, University of Tartu, 50411, Tartu, Estonia
| | - Aare Abroi
- Institute of Technology, University of Tartu, 50411, Tartu, Estonia
| | - Ruth Kalda
- Department of Family Medicine and Public Health, University of Tartu, 50411, Tartu, Estonia
| | - Raivo Kolde
- Institute of Computer Science, University of Tartu, 51009, Tartu, Estonia
| | - Krista Fischer
- Institute of Mathematics and Statistics, University of Tartu, 51009, Tartu, Estonia
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Joshi D, Nyhoff LE, Zarnitsyna VI, Moreno A, Manning K, Linderman S, Burrell AR, Stephens K, Norwood C, Mantus G, Ahmed R, Anderson EJ, Staat MA, Suthar MS, Wrammert J. Infants and young children generate more durable antibody responses to SARS-CoV-2 infection than adults. iScience 2023; 26:107967. [PMID: 37822504 PMCID: PMC10562792 DOI: 10.1016/j.isci.2023.107967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/25/2023] [Accepted: 09/15/2023] [Indexed: 10/13/2023] Open
Abstract
As SARS-CoV-2 becomes endemic, it is critical to understand immunity following early-life infection. We evaluated humoral responses to SARS-CoV-2 in 23 infants/young children. Antibody responses to SARS-CoV-2 spike antigens peaked approximately 30 days after infection and were maintained up to 500 days with little apparent decay. While the magnitude of humoral responses was similar to an adult cohort recovered from mild/moderate COVID-19, both binding and neutralization titers to WT SARS-CoV-2 were more durable in infants/young children, with spike and RBD IgG antibody half-life nearly 4X as long as in adults. IgG subtype analysis revealed that while IgG1 formed the majority of the response in both groups, IgG3 was more common in adults and IgG2 in infants/young children. These findings raise important questions regarding differential regulation of humoral immunity in infants/young children and adults and could have broad implications for the timing of vaccination and booster strategies in this age group.
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Affiliation(s)
- Devyani Joshi
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA
- Centers for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA, USA
| | - Lindsay E. Nyhoff
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA
- Centers for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA, USA
| | | | - Alberto Moreno
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA
- Emory National Primate Research Center, Atlanta, GA, USA
- Department of Medicine, Emory University, School of Medicine, Atlanta, GA, USA
| | - Kelly Manning
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA
- Emory National Primate Research Center, Atlanta, GA, USA
| | - Susanne Linderman
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA
- Department of Microbiology and Immunology, Emory University, Atlanta, GA, USA
| | - Allison R. Burrell
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Environmental and Public Health Sciences, Division of Epidemiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kathy Stephens
- Centers for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA, USA
| | - Carson Norwood
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA
- Centers for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA, USA
| | - Grace Mantus
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA
- Centers for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA, USA
| | - Rafi Ahmed
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA
- Department of Microbiology and Immunology, Emory University, Atlanta, GA, USA
| | - Evan J. Anderson
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA
- Centers for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA, USA
- Department of Medicine, Emory University, School of Medicine, Atlanta, GA, USA
| | - Mary A. Staat
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mehul S. Suthar
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA
- Centers for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA, USA
- Department of Microbiology and Immunology, Emory University, Atlanta, GA, USA
- Emory National Primate Research Center, Atlanta, GA, USA
| | - Jens Wrammert
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA
- Centers for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA, USA
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Bansal A, Trieu MC, Mohn KGI, Madsen A, Olofsson JS, Sandnes HH, Sævik M, Søyland H, Hansen L, Onyango TB, Tøndel C, Brokstad KA, Syre H, Riis ÅG, Langeland N, Cox RJ. Risk assessment and antibody responses to SARS-CoV-2 in healthcare workers. Front Public Health 2023; 11:1164326. [PMID: 37546332 PMCID: PMC10402899 DOI: 10.3389/fpubh.2023.1164326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/22/2023] [Indexed: 08/08/2023] Open
Abstract
Background Preventing infection in healthcare workers (HCWs) is crucial for protecting healthcare systems during the COVID-19 pandemic. Here, we investigated the seroepidemiology of SARS-CoV-2 in HCWs in Norway with low-transmission settings. Methods From March 2020, we recruited HCWs at four medical centres. We determined infection by SARS-CoV-2 RT-PCR and serological testing and evaluated the association between infection and exposure variables, comparing our findings with global data in a meta-analysis. Anti-spike IgG antibodies were measured after infection and/or vaccination in a longitudinal cohort until June 2021. Results We identified a prevalence of 10.5% (95% confidence interval, CI: 8.8-12.3) in 2020 and an incidence rate of 15.0 cases per 100 person-years (95% CI: 12.5-17.8) among 1,214 HCWs with 848 person-years of follow-up time. Following infection, HCWs (n = 63) mounted durable anti-spike IgG antibodies with a half-life of 4.3 months since their seropositivity. HCWs infected with SARS-CoV-2 in 2020 (n = 46) had higher anti-spike IgG titres than naive HCWs (n = 186) throughout the 5 months after vaccination with BNT162b2 and/or ChAdOx1-S COVID-19 vaccines in 2021. In a meta-analysis including 20 studies, the odds ratio (OR) for SARS-CoV-2 seropositivity was significantly higher with household contact (OR 12.6; 95% CI: 4.5-35.1) and occupational exposure (OR 2.2; 95% CI: 1.4-3.2). Conclusion We found high and modest risks of SARS-CoV-2 infection with household and occupational exposure, respectively, in HCWs, suggesting the need to strengthen infection prevention strategies within households and medical centres. Infection generated long-lasting antibodies in most HCWs; therefore, we support delaying COVID-19 vaccination in primed HCWs, prioritising the non-infected high-risk HCWs amid vaccine shortage.
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Affiliation(s)
- Amit Bansal
- Department of Clinical Science, Influenza Centre, University of Bergen, Bergen, Norway
| | - Mai-Chi Trieu
- Department of Clinical Science, Influenza Centre, University of Bergen, Bergen, Norway
| | - Kristin G. I. Mohn
- Department of Clinical Science, Influenza Centre, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Anders Madsen
- Department of Clinical Science, Influenza Centre, University of Bergen, Bergen, Norway
| | - Jan Stefan Olofsson
- Department of Clinical Science, Influenza Centre, University of Bergen, Bergen, Norway
| | | | - Marianne Sævik
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Hanne Søyland
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Lena Hansen
- Department of Clinical Science, Influenza Centre, University of Bergen, Bergen, Norway
| | | | - Camilla Tøndel
- Department of Clinical Science, Influenza Centre, University of Bergen, Bergen, Norway
- Department of Paediatrics, Haukeland University Hospital, Bergen, Norway
| | - Karl Albert Brokstad
- Department of Clinical Science, Influenza Centre, University of Bergen, Bergen, Norway
- Department of Safety, Chemistry and Biomedical Laboratory Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Heidi Syre
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Åse Garløv Riis
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Nina Langeland
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Rebecca Jane Cox
- Department of Clinical Science, Influenza Centre, University of Bergen, Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
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Merid Y, Tekleselasie W, Tesfaye E, Gadisa A, Fentahun D, Abate A, Alemu A, Mihret A, Mulu A, Gelanew T. SARS-CoV-2 Infection-and mRNA Vaccine-induced Humoral Immunity among Schoolchildren in Hawassa, Ethiopia. Front Immunol 2023; 14:1163688. [PMID: 37398668 PMCID: PMC10308774 DOI: 10.3389/fimmu.2023.1163688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
Background With the persisting low vaccination intake, particularly in children of low-and middle-income countries (LMICs), seroepidemiological studies are urgently needed to guide and tailor COVID-19 pandemic response efforts in schools and to put mitigation strategies in place for a future post-pandemic resurgence. However, there is limited data on SARS-CoV-2 infection-induced and vaccine-induced humoral immunity in schoolchildren in LMICs, including Ethiopia. Methods As the spike receptor binding domain (RBD) is the major target for neutralization antibodies and useful to predict the correlates of protection, we used an in-house anti-RBD IgG ELISA to assess and compare infection-induced antibody response at two-time points and BNT162b2 (BNT) vaccine-induced antibody response at a one-time point in schoolchildren in Hawassa, Ethiopia. In addition, we measured and compared the levels of binding IgA antibodies to spike RBD of SARS-CoV-2 Wild type, Delta, and Omicron variants in a small subset of unvaccinated and BNT-vaccinated schoolchildren. Results When we compare SARS-CoV-2 infection-induced seroprevalences among unvaccinated school children (7-19 years) at the two blood sampling points with a 5-month interval, we observed an over 10% increase, from 51.8% (219/419) in the first week of December 2021 (post-Delta wave) to 67.4% (60/89) by the end of May 2022 (post-Omicron wave). Additionally, we found a significant correlation (p = 0.001) between anti-RBD IgG seropositivity and a history of having COVID-19-like symptoms. Compared to the levels of SARS-CoV-2 infection-induced anti-RBD IgG antibodies before vaccination, higher levels of BNT vaccine-induced anti-RBD IgG antibodies were observed even in SARS-CoV-2 infection-naïve schoolchildren of all age groups (p = 0.0001). Importantly, one dose of the BNT vaccine was shown to be adequate to elicit a strong antibody response in schoolchildren with pre-existing anti-RBD IgG antibodies comparable to that of SARS-CoV-2 infection-naive schoolchildren receiving two doses of BNT vaccine, suggesting a single dose administration of the BNT vaccine could be considered for schoolchildren who had prior SARS-CoV-2 infection when a shortage of vaccine supply is a limiting factor to administer two doses irrespective of their serostatus. Despite the small sample size of study participants, the BNT vaccine is shown to be immunogenic and safe for schoolchildren. Irrespective of schoolchildren's vaccination status, we observed a similar pattern of significantly higher levels of IgA antibodies to Delta-RBD than to Omicron-RBD (p < 0.001) in a randomly selected subset of schoolchildren, yet comparable to Wuhan-RBD, suggesting these schoolchildren were more likely to have had SARS-CoV-2 infection with Delta variant. Additionally, we noted a broader IgA antibody reactivity to SARS-CoV-2 variants in vaccinated schoolchildren with prior SARS-CoV-2 infection, supporting the superiority of hybrid immunity. Conclusion Our serological data indicate a significant increase in SARS-CoV-2 seroprevalence in children at a post-Omicron five-month follow-up compared to a post-Delta enrolment. Despite the small sample size of study participants, the BNT vaccine is shown to be immunogenic and safe for schoolchildren. Hybrid immunity would likely provide a broader humoral immunity against Wuhan strain, Delta, and Omicron variants than natural infection or vaccination alone does. However, future longitudinal cohort studies in SARS-CoV-2-naïve and COVID-19-recovered schoolchildren receiving the BNT vaccine are needed for a better understanding of the kinetics, breadth, and durability of BNT vaccine-induced multivariant-cross reactive immunity.
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Affiliation(s)
- Yared Merid
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Emnet Tesfaye
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Anteneh Gadisa
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | | | - Aynalem Alemu
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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9
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Das D, Raha FK, Adnan KM, Siraj MR, Shapla MJ, Shumy F, Haque ME, Khan MH, Sanyal S, Hosen MI, Nabi AHMN, Sanyal M, Chakraborty S, Amin MZ. Dynamic antibody response in SARS-CoV-2 infected patients and COVID-19 vaccine recipients alongside vaccine effectiveness in comorbid and multimorbid groups. Heliyon 2023; 9:e16349. [PMID: 37251854 PMCID: PMC10199753 DOI: 10.1016/j.heliyon.2023.e16349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 04/05/2023] [Accepted: 05/12/2023] [Indexed: 05/31/2023] Open
Abstract
Objectives Underlying medical conditions are critical risk factors for COVID-19 susceptibility and its rapid clinical manifestation. Therefore, the preexisting burden of non-communicable diseases (NCDs) makes the preparedness for COVID-19 more challenging for low- and middle-income countries (LMICs). These countries have relied on vaccination campaigns as an effective measure to tackle COVID-19. In this study, we investigated the impact of comorbidities on humoral antibody responses against the specific receptor-binding domain (RBD) of SARS-CoV2. Methods A total of 1005 patients were selected for the SARS-CoV-2 specific immunoglobulin G (IgG1, IgG2, IgG3, and IgG4 subclasses) and total antibody (TAb) tests (IgG and IgM), of which 912 serum samples were ultimately selected based on the specimen cutoff analyte value. Patients with multimorbidity (N = 60) were recruited for follow-up studies from the initial cohort, and their immune response (IgG and TAb) was measured at multiple time points after the second dose of vaccination. Siemens Dimension Vista SARS-CoV-2 IgG (CV2G) and SARS-CoV-2 TAb assay (CV2T) were used to carry out the serology test. Results Out of a total of 912 participants, vaccinated individuals (N = 711) had detectable antibody responses up to 7-8 months. The synergistic effect of natural infection and vaccine response was also studied. Participants with breakthrough infections (N = 49) mounted a greater antibody response compared to individuals with normal vaccination response (N = 397) and those who were naturally infected before receiving the second dose of vaccine (N = 132). Investigation of the impact of comorbidities revealed that diabetes mellitus (DM) (N = 117) and kidney disease (N = 50) had a significant negative impact on the decline of the humoral antibody response against SARS-CoV-2. IgG and TAb declined more rapidly in diabetic and kidney disease patients compared to the other four comorbid groups. Follow-up studies demonstrated that antibody response rapidly declined within 4 months after receiving the second dose. Conclusion The generalized immunization schedule for COVID-19 needs to be adjusted for high-risk comorbid groups, and a booster dose must be administered early within 4 months after receiving the second dose.
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Affiliation(s)
- Depro Das
- Systems Cell-Signalling Laboratory, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
| | - Fahmida Khanam Raha
- Systems Cell-Signalling Laboratory, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
| | | | | | | | | | | | | | | | - Md Ismail Hosen
- Clinical Biochemistry and Translational Medicine Laboratory, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
| | - AHM Nurun Nabi
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
| | | | - Sajib Chakraborty
- Systems Cell-Signalling Laboratory, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
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Joshi D, Nyhoff LE, Zarnitsyna VI, Moreno A, Manning K, Linderman S, Burrell AR, Stephens K, Norwood C, Mantus G, Ahmed R, Anderson EJ, Staat MA, Suthar MS, Wrammert J. Infants and young children generate more durable antibody responses to SARS-CoV-2 infection than adults. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.10.23288360. [PMID: 37090559 PMCID: PMC10120804 DOI: 10.1101/2023.04.10.23288360] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Since the emergence of SARS-CoV-2, research has shown that adult patients mount broad and durable immune responses to infection. However, response to infection remains poorly studied in infants/young children. In this study, we evaluated humoral responses to SARS-CoV-2 in 23 infants/young children before and after infection. We found that antibody responses to SARS-CoV-2 spike antigens peaked approximately 30 days after infection and were maintained up to 500 days with little apparent decay. While the magnitude of humoral responses was similar to an adult cohort recovered from mild/moderate COVID-19, both binding and neutralization titers to WT SARS-CoV-2 were more durable in infants/young children, with Spike and RBD IgG antibody half-life nearly 4X as long as in adults. The functional breadth of adult and infant/young children SARS-CoV-2 responses were comparable, with similar reactivity against panel of recent and previously circulating viral variants. Notably, IgG subtype analysis revealed that while IgG1 formed the majority of both adults' and infants/young children's response, IgG3 was more common in adults and IgG2 in infants/young children. These findings raise important questions regarding differential regulation of humoral immunity in infants/young children and adults and could have broad implications for the timing of vaccination and booster strategies in this age group.
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11
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Stoddard M, Yuan L, Sarkar S, Mangalaganesh S, Nolan RP, Bottino D, Hather G, Hochberg NS, White LF, Chakravarty A. Heterogeneity in Vaccinal Immunity to SARS-CoV-2 Can Be Addressed by a Personalized Booster Strategy. Vaccines (Basel) 2023; 11:806. [PMID: 37112718 PMCID: PMC10140995 DOI: 10.3390/vaccines11040806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 04/08/2023] Open
Abstract
SARS-CoV-2 vaccinations were initially shown to substantially reduce risk of severe disease and death. However, pharmacokinetic (PK) waning and rapid viral evolution degrade neutralizing antibody (nAb) binding titers, causing loss of vaccinal protection. Additionally, there is inter-individual heterogeneity in the strength and durability of the vaccinal nAb response. Here, we propose a personalized booster strategy as a potential solution to this problem. Our model-based approach incorporates inter-individual heterogeneity in nAb response to primary SARS-CoV-2 vaccination into a pharmacokinetic/pharmacodynamic (PK/PD) model to project population-level heterogeneity in vaccinal protection. We further examine the impact of evolutionary immune evasion on vaccinal protection over time based on variant fold reduction in nAb potency. Our findings suggest viral evolution will decrease the effectiveness of vaccinal protection against severe disease, especially for individuals with a less durable immune response. More frequent boosting may restore vaccinal protection for individuals with a weaker immune response. Our analysis shows that the ECLIA RBD binding assay strongly predicts neutralization of sequence-matched pseudoviruses. This may be a useful tool for rapidly assessing individual immune protection. Our work suggests vaccinal protection against severe disease is not assured and identifies a potential path forward for reducing risk to immunologically vulnerable individuals.
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Affiliation(s)
| | - Lin Yuan
- Fractal Therapeutics, Lexington, MA 02420, USA
| | - Sharanya Sarkar
- Department of Microbiology and Immunology, Dartmouth College, Hanover, NH 03755, USA
| | - Shruthi Mangalaganesh
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3800, Australia
| | | | - Dean Bottino
- Takeda Pharmaceuticals, Cambridge, MA 02139, USA
| | | | - Natasha S. Hochberg
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02215, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA 02215, USA
- Boston Medical Center, Boston, MA 02118, USA
| | - Laura F. White
- School of Public Health, Boston University, Boston, MA 02118, USA
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12
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Tsai DY, Wang CH, Schiro PG, Chen N, Tseng JY. Tracking B Cell Memory to SARS-CoV-2 Using Rare Cell Analysis System. Vaccines (Basel) 2023; 11:vaccines11040735. [PMID: 37112647 PMCID: PMC10145117 DOI: 10.3390/vaccines11040735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Rapid mutations within SARS-CoV-2 are driving immune escape, highlighting the need for in-depth and routine analysis of memory B cells (MBCs) to complement the important but limited information from neutralizing antibody (nAb) studies. In this study, we collected plasma samples and peripheral blood mononuclear cells (PBMCs) from 35 subjects and studied the nAb titers and the number of antigen-specific memory B cells at designated time points before and after vaccination. We developed an assay to use the MiSelect R II System with a single-use microfluidic chip to directly detect the number of spike-receptor-binding domain (RBD)-specific MBCs in PBMCs. Our results show that the number of spike-RBD-specific MBCs detected by the MiSelect R II System is highly correlated with the level of nAbs secreted by stimulated PBMCs, even 6 months after vaccination when nAbs were generally not present in plasma. We also found antigen-specific cells recognizing Omicron spike-RBD were present in PBMCs from booster vaccination of subjects, but with a high variability in the number of B cells. The MiSelect R II System provided a direct, automated, and quantitative method to isolate and analyze subsets of rare cells for tracking cellular immunity in the context of a rapidly mutating virus.
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Affiliation(s)
- Dong-Yan Tsai
- MiCareo Taiwan Co., Ltd., 5F, No. 69, Ln. 77, Xing Ai Rd., Neihu Dist., Taipei City 114, Taiwan
| | - Chun-Hung Wang
- MiCareo Taiwan Co., Ltd., 5F, No. 69, Ln. 77, Xing Ai Rd., Neihu Dist., Taipei City 114, Taiwan
| | - Perry G. Schiro
- MiCareo Taiwan Co., Ltd., 5F, No. 69, Ln. 77, Xing Ai Rd., Neihu Dist., Taipei City 114, Taiwan
| | - Nathan Chen
- Adimmune Corporation, No. 3, Sec.1, Tanxing Rd., Tanzi Dist., Taichung City 427, Taiwan
| | - Ju-Yu Tseng
- MiCareo Taiwan Co., Ltd., 5F, No. 69, Ln. 77, Xing Ai Rd., Neihu Dist., Taipei City 114, Taiwan
- Correspondence: ; Tel.: +886-2-27923976
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13
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Hybrid Immunity to SARS-CoV-2 from Infection and Vaccination-Evidence Synthesis and Implications for New COVID-19 Vaccines. Biomedicines 2023; 11:biomedicines11020370. [PMID: 36830907 PMCID: PMC9953148 DOI: 10.3390/biomedicines11020370] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
COVID-19 has taken a severe toll on the global population through infections, hospitalizations, and deaths. Elucidating SARS-CoV-2 infection-derived immunity has led to the development of multiple effective COVID-19 vaccines and their implementation into mass-vaccination programs worldwide. After ~3 years, a substantial proportion of the human population possesses immunity from infection and/or vaccination. With waning immune protection over time against emerging SARS-CoV-2 variants, it is essential to understand the duration of protection, breadth of coverage, and effects on reinfection. This targeted review summarizes available research literature on SARS-CoV-2 infection-derived, vaccination-elicited, and hybrid immunity. Infection-derived immunity has shown 93-100% protection against severe COVID-19 outcomes for up to 8 months, but reinfection is observed with some virus variants. Vaccination elicits high levels of neutralizing antibodies and a breadth of CD4+ and CD8+ T-cell responses. Hybrid immunity enables strong, broad responses, with high-quality memory B cells generated at 5- to 10-fold higher levels, versus infection or vaccination alone and protection against symptomatic disease lasting for 6-8 months. SARS-CoV-2 evolution into more transmissible and immunologically divergent variants has necessitated the updating of COVID-19 vaccines. To ensure continued protection against SARS-CoV-2 variants, regulators and vaccine technical committees recommend variant-specific or bivalent vaccines.
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14
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García-García A, Fortuny C, Fumadó V, Jordan I, Ruiz-López L, González-Navarro EA, Egri N, Esteve-Solé A, Luo Y, Vlagea A, Cabedo MM, Launes C, Soler A, Codina A, Juan M, Pascal M, Deyà-Martínez A, Alsina L. Acute and long-term immune responses to SARS-CoV-2 infection in unvaccinated children and young adults with inborn errors of immunity. Front Immunol 2023; 14:1084630. [PMID: 36742319 PMCID: PMC9896004 DOI: 10.3389/fimmu.2023.1084630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023] Open
Abstract
Purpose To describe SARS-CoV-2 infection outcome in unvaccinated children and young adults with inborn errors of immunity (IEI) and to compare their specific acute and long-term immune responses with a sex-, age-, and severity-matched healthy population (HC). Methods Unvaccinated IEI patients up to 22 years old infected with SARS-CoV-2 were recruited along with a cohort of HC. SARS-CoV-2 serology and ELISpot were performed in the acute phase of infection (up to 6 weeks) and at 3, 6, 9, and 12 months. Results Twenty-five IEI patients (median age 14.3 years, min.-max. range 4.5-22.8; 15/25 males; syndromic combined immunodeficiencies: 48.0%, antibody deficiencies: 16.0%) and 17 HC (median age 15.3 years, min.-max. range 5.4-20.0; 6/17 males, 35.3%) were included. Pneumonia occurred in 4/25 IEI patients. In the acute phase SARS-CoV-2 specific immunoglobulins were positive in all HC but in only half of IEI in whom it could be measured (n=17/25): IgG+ 58.8% (10/17) (p=0.009); IgM+ 41.2% (7/17)(p<0.001); IgA+ 52.9% (9/17)(p=0.003). Quantitative response (index) was also lower compared with HC: IgG IEI (3.1 ± 4.4) vs. HC (3.5 ± 1.5)(p=0.06); IgM IEI (1.9 ± 2.4) vs. HC (3.9 ± 2.4)(p=0.007); IgA IEI (3.3 ± 4.7) vs. HC (4.6 ± 2.5)(p=0.04). ELISpots positivity was qualitatively lower in IEI vs. HC (S-ELISpot IEI: 3/11, 27.3% vs. HC: 10/11, 90.9%; p=0.008; N-ELISpot IEI: 3/9, 33.3% vs. HC: 11/11, 100%; p=0.002) and also quantitatively lower (S-ELISpot IEI: mean index 3.2 ± 5.0 vs. HC 21.2 ± 17.0; p=0.001; N-ELISpot IEI: mean index 9.3 ± 16.6 vs. HC: 39.1 ± 23.7; p=0.004). As for long term response, SARS-CoV-2-IgM+ at 6 months was qualitatively lower in IEI(3/8, 37.5% vs. 9/10 HC: 90.0%; p=0.043), and quantitatively lower in all serologies IgG, M, and A (IEI n=9, 1.1 ± 0.9 vs. HC n=10, 2.1 ± 0.9, p=0.03; IEI n=9, 1.3 ± 1.5 vs. HC n=10, 2.9 ± 2.8, p=0.02; and IEI n=9, 0.6 ± 0.5 vs. HC n=10, 1.7 ± 0.8, p=0.002 -respectively) but there were no differences at remaining time points. Conclusions Our IEI pediatric cohort had a higher COVID-19 pneumonia rate than the general age-range population, with lower humoral and cellular responses in the acute phase (even lower compared to the reported IEI serological response after SARS-CoV-2 vaccination), and weaker humoral responses at 6 months after infection compared with HC.
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Affiliation(s)
- Ana García-García
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain.,Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Claudia Fortuny
- Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Paediatric Infectious Diseases Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,CIBER of Epidemiology and Public Health, Madrid, Spain.,Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Victoria Fumadó
- Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Paediatric Infectious Diseases Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,CIBER of Epidemiology and Public Health, Madrid, Spain.,Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Iolanda Jordan
- Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain.,Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Laura Ruiz-López
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain.,Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Natalia Egri
- Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Ana Esteve-Solé
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain.,Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Yiyi Luo
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain.,Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Alexandru Vlagea
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain.,Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Manel Monsonís Cabedo
- Department of Microbiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Cristian Launes
- Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Paediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain.,Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Aleix Soler
- Paediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anna Codina
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Pathology Department and Biobank Department, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, Spain
| | - Manel Juan
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain.,Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Immunotherapy Platform, Hospital Sant Joan de Déu-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Mariona Pascal
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain.,Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Spanish Network for Allergy - RETIC de Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
| | - Angela Deyà-Martínez
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain.,Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Laia Alsina
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain.,Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain.,Immunotherapy Platform, Hospital Sant Joan de Déu-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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15
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Cinicola BL, Piano Mortari E, Zicari AM, Agrati C, Bordoni V, Albano C, Fedele G, Schiavoni I, Leone P, Fiore S, Capponi M, Conti MG, Petrarca L, Stefanelli P, Spalice A, Midulla F, Palamara AT, Quinti I, Locatelli F, Carsetti R. The BNT162b2 vaccine induces humoral and cellular immune memory to SARS-CoV-2 Wuhan strain and the Omicron variant in children 5 to 11 years of age. Front Immunol 2022; 13:1094727. [PMID: 36591287 PMCID: PMC9797965 DOI: 10.3389/fimmu.2022.1094727] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
SARS-CoV-2 mRNA vaccines prevent severe COVID-19 by generating immune memory, comprising specific antibodies and memory B and T cells. Although children are at low risk of severe COVID-19, the spreading of highly transmissible variants has led to increasing in COVID-19 cases and hospitalizations also in the youngest, but vaccine coverage remains low. Immunogenicity to mRNA vaccines has not been extensively studied in children 5 to 11 years old. In particular, cellular immunity to the wild-type strain (Wuhan) and the cross-reactive response to the Omicron variant of concern has not been investigated. We assessed the humoral and cellular immune response to the SARS-CoV-2 BNT162b2 vaccine in 27 healthy children. We demonstrated that vaccination induced a potent humoral and cellular immune response in all vaccinees. By using spike-specific memory B cells as a measurable imprint of a previous infection, we found that 50% of the children had signs of a past, undiagnosed infection before vaccination. Children with pre-existent immune memory generated significantly increased levels of specific antibodies, and memory T and B cells, directed against not only the wild type virus but also the omicron variant.
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Affiliation(s)
- Bianca Laura Cinicola
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy,Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - E Piano Mortari
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy,B cell unit, Immunology Research Area, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Anna Maria Zicari
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Chiara Agrati
- Department of Pediatric Hematology and Oncology and Cell and Gene Therapy, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Veronica Bordoni
- Department of Pediatric Hematology and Oncology and Cell and Gene Therapy, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Christian Albano
- B cell unit, Immunology Research Area, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Giorgio Fedele
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Ilaria Schiavoni
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Pasqualina Leone
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Fiore
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Martina Capponi
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Giulia Conti
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Laura Petrarca
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Alberto Spalice
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Fabio Midulla
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology and Cell and Gene Therapy, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy,Catholic University of the Sacred Hearth, Rome, Italy
| | - Rita Carsetti
- B cell unit, Immunology Research Area, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy,*Correspondence: Rita Carsetti,
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16
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Ebrahim F, Tabal S, Lamami Y, Alhudiri IM, El Meshri SE, Al Dwigen S, Arfa R, Alboeshi A, Alemam HA, Abuhtna F, Altrhouni R, Milad MB, Elgriw NA, Ruaua MA, Abusrewil Z, Harroush W, Jallul M, Ali FS, Eltaib F, Elzagheid A. Anti-SARS-CoV-2 IgG Antibodies Post-COVID-19 or Post-Vaccination in Libyan Population: Comparison of Four Vaccines. Vaccines (Basel) 2022; 10:vaccines10122002. [PMID: 36560411 PMCID: PMC9785033 DOI: 10.3390/vaccines10122002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/13/2022] [Accepted: 11/21/2022] [Indexed: 11/26/2022] Open
Abstract
Measurement of strength and durability of SARS-COV-2 antibody response is important to understand the waning dynamics of immune response to both vaccines and infection. The study aimed to evaluate the level of IgG antibodies against SARS-CoV-2 and their persistence in recovered, naïve, and vaccinated individuals. We investigated anti-spike RBD IgG antibody responses in 10,000 individuals, both following infection with SARS-CoV-2 and immunization with SARS-COV-2 AstraZeneca, Sputnik V, Sinopharm, and Sinovac. The mean levels of anti-spike IgG antibodies were higher in vaccinated participants with prior COVID-19 than in individuals without prior COVID-19. Overall, antibody titers in recovered vaccinee and naïve vaccinee persisted beyond 20 weeks. Vaccination with adenoviral-vector vaccines (AstraZeneca and Sputnik V) generates higher antibody titers than with killed virus vaccine (Sinopharm and Sinovac). Approximately two-thirds of asymptomatic unvaccinated individuals had developed virus-specific antibodies. A single dose of vaccine is likely to provide greater protection against SARS-CoV-2 infection in individuals with apparent prior SARS-CoV-2 infection, than in SARS-CoV-2-naive individuals. In addition, the high number of seropositivity among asymptomatic unvaccinated individuals showed that the number of infections are probably highly underestimated. Those vaccinated with inactivated vaccine may require more frequent boosters than those vaccinated with adenoviral vaccine. These findings are important for formulating public health vaccination strategies during COVID-19 pandemic.
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Affiliation(s)
- Fawzi Ebrahim
- Libyan Biotechnology Research Center, Tripoli P.O. Box 30313, Libya
- Correspondence:
| | - Salah Tabal
- Libyan Biotechnology Research Center, Tripoli P.O. Box 30313, Libya
| | - Yosra Lamami
- Libyan Biotechnology Research Center, Tripoli P.O. Box 30313, Libya
| | - Inas M. Alhudiri
- Libyan Biotechnology Research Center, Tripoli P.O. Box 30313, Libya
| | | | - Samira Al Dwigen
- Libyan Biotechnology Research Center, Tripoli P.O. Box 30313, Libya
| | - Ramadan Arfa
- Information Technology Department, Tripoli University, Tripoli P.O. Box 13275, Libya
| | - Asma Alboeshi
- Libyan Biotechnology Research Center, Tripoli P.O. Box 30313, Libya
| | - Hafsa A. Alemam
- Libyan Biotechnology Research Center, Tripoli P.O. Box 30313, Libya
| | - Fauzia Abuhtna
- Libyan Biotechnology Research Center, Tripoli P.O. Box 30313, Libya
| | | | - Mohamed B. Milad
- Libyan Biotechnology Research Center, Tripoli P.O. Box 30313, Libya
| | - Nada A. Elgriw
- Libyan Biotechnology Research Center, Tripoli P.O. Box 30313, Libya
| | - Mahmoud A. Ruaua
- Libyan Biotechnology Research Center, Tripoli P.O. Box 30313, Libya
| | | | - Warda Harroush
- Libyan Biotechnology Research Center, Tripoli P.O. Box 30313, Libya
| | - Mwada Jallul
- Libyan Biotechnology Research Center, Tripoli P.O. Box 30313, Libya
| | - Fouziyah S. Ali
- Libyan Biotechnology Research Center, Tripoli P.O. Box 30313, Libya
| | - Farag Eltaib
- Libyan Biotechnology Research Center, Tripoli P.O. Box 30313, Libya
| | - Adam Elzagheid
- Libyan Biotechnology Research Center, Tripoli P.O. Box 30313, Libya
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17
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Desikan R, Linderman SL, Davis C, Zarnitsyna VI, Ahmed H, Antia R. Vaccine models predict rules for updating vaccines against evolving pathogens such as SARS-CoV-2 and influenza in the context of pre-existing immunity. Front Immunol 2022; 13:985478. [PMID: 36263031 PMCID: PMC9574365 DOI: 10.3389/fimmu.2022.985478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
Currently, vaccines for SARS-CoV-2 and influenza viruses are updated if the new vaccine induces higher antibody-titers to circulating variants than current vaccines. This approach does not account for complex dynamics of how prior immunity skews recall responses to the updated vaccine. We: (i) use computational models to mechanistically dissect how prior immunity influences recall responses; (ii) explore how this affects the rules for evaluating and deploying updated vaccines; and (iii) apply this to SARS-CoV-2. Our analysis of existing data suggests that there is a strong benefit to updating the current SARS-CoV-2 vaccines to match the currently circulating variants. We propose a general two-dose strategy for determining if vaccines need updating as well as for vaccinating high-risk individuals. Finally, we directly validate our model by reanalysis of earlier human H5N1 influenza vaccine studies.
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Affiliation(s)
- Rajat Desikan
- Clinical Pharmacology Modeling & Simulation, GlaxoSmithKline (GSK), Stevenage, Hertfordshire, United Kingdom
- *Correspondence: Rajat Desikan, ; Rustom Antia,
| | - Susanne L. Linderman
- Department of Microbiology and Immunology, Emory University, Atlanta, GA, United States
| | - Carl Davis
- Department of Microbiology and Immunology, Emory University, Atlanta, GA, United States
| | | | - Hasan Ahmed
- Department of Biology, Emory University, Atlanta, GA, United States
| | - Rustom Antia
- Department of Biology, Emory University, Atlanta, GA, United States
- *Correspondence: Rajat Desikan, ; Rustom Antia,
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18
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Lapointe HR, Mwimanzi F, Cheung PK, Sang Y, Yaseen F, Kalikawe R, Datwani S, Waterworth R, Umviligihozo G, Ennis S, Young L, Dong W, Kirkby D, Burns L, Leung V, Holmes DT, DeMarco ML, Simons J, Matic N, Montaner JS, Brumme CJ, Prystajecky N, Niikura M, Lowe CF, Romney MG, Brockman MA, Brumme ZL. Serial infection with SARS-CoV-2 Omicron BA.1 and BA.2 following three-dose COVID-19 vaccination. Front Immunol 2022; 13:947021. [PMID: 36148225 PMCID: PMC9485663 DOI: 10.3389/fimmu.2022.947021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
SARS-CoV-2 Omicron infections are common among individuals who are vaccinated or have recovered from prior variant infection, but few reports have immunologically assessed serial Omicron infections. We characterized SARS-CoV-2 humoral responses in an individual who acquired laboratory-confirmed Omicron BA.1.15 ten weeks after a third dose of BNT162b2, and BA.2 thirteen weeks later. Responses were compared to 124 COVID-19-naive vaccinees. One month post-second and -third vaccine doses, the participant's wild-type and BA.1-specific IgG, ACE2-displacement and virus neutralization activities were average for a COVID-19-naive triple-vaccinated individual. BA.1 infection boosted the participant's responses to the cohort ≥95th percentile, but even this strong "hybrid" immunity failed to protect against BA.2. Reinfection increased BA.1 and BA.2-specific responses only modestly. Though vaccines clearly protect against severe disease, results highlight the continued importance of maintaining additional protective measures to counteract the immune-evasive Omicron variant, particularly as vaccine-induced immune responses naturally decline over time.
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Affiliation(s)
- Hope R. Lapointe
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Francis Mwimanzi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Peter K. Cheung
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Yurou Sang
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Fatima Yaseen
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Rebecca Kalikawe
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Sneha Datwani
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Rachel Waterworth
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Siobhan Ennis
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Landon Young
- Division of Medical Microbiology and Virology, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Winnie Dong
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Don Kirkby
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Laura Burns
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, BC, Canada
| | - Victor Leung
- Division of Medical Microbiology and Virology, St. Paul’s Hospital, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Daniel T. Holmes
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mari L. DeMarco
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Janet Simons
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nancy Matic
- Division of Medical Microbiology and Virology, St. Paul’s Hospital, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julio S.G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chanson J. Brumme
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Natalie Prystajecky
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, Canada
| | - Masahiro Niikura
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Christopher F. Lowe
- Division of Medical Microbiology and Virology, St. Paul’s Hospital, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marc G. Romney
- Division of Medical Microbiology and Virology, St. Paul’s Hospital, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mark A. Brockman
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Zabrina L. Brumme
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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19
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Parisi SG, Mengoli C, Basso M, Vicenti I, Gatti F, Scaggiante R, Fiaschi L, Giammarino F, Iannetta M, Malagnino V, Zago D, Dragoni F, Zazzi M. Long-Term Longitudinal Analysis of Neutralizing Antibody Response to Three Vaccine Doses in a Real-Life Setting of Previously SARS-CoV-2 Infected Healthcare Workers: A Model for Predicting Response to Further Vaccine Doses. Vaccines (Basel) 2022; 10:vaccines10081237. [PMID: 36016125 PMCID: PMC9416151 DOI: 10.3390/vaccines10081237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/22/2022] [Accepted: 07/30/2022] [Indexed: 02/04/2023] Open
Abstract
We report the time course of neutralizing antibody (NtAb) response, as measured by authentic virus neutralization, in healthcare workers (HCWs) with a mild or asymptomatic SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection diagnosed at the onset of the pandemic, with no reinfection throughout and after a three-dose schedule of the BNT162b2 mRNA vaccine with an overall follow-up of almost two years since infection. Forty-eight HCWs (median age 47 years, all immunocompetent) were evaluated: 29 (60.4%) were asymptomatic. NtAb serum was titrated at eight subsequent time points: T1 and T2 were after natural infection, T3 on the day of the first vaccine dose, T4 on the day of the second dose, T5, T6, and T7 were between the second and third dose, and T8 followed the third dose by a median of 34 days. NtAb titers at all postvaccination time points (T4 to T8) were significantly higher than all those at prevaccination time points (T1 to T3). The highest NtAb increase was following the first vaccine dose while subsequent doses did not further boost NtAb titers. However, the third vaccine dose appeared to revive waning immunity. NtAb levels were positively correlated at most time points suggesting an important role for immunogenetics.
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Affiliation(s)
- Saverio Giuseppe Parisi
- Department of Molecular Medicine, University of Padova, Via Gabelli, 63, 35100 Padova, Italy; (C.M.); (M.B.); (F.G.); (D.Z.)
- Correspondence: ; Tel.: +39-04-9827-23441
| | - Carlo Mengoli
- Department of Molecular Medicine, University of Padova, Via Gabelli, 63, 35100 Padova, Italy; (C.M.); (M.B.); (F.G.); (D.Z.)
| | - Monica Basso
- Department of Molecular Medicine, University of Padova, Via Gabelli, 63, 35100 Padova, Italy; (C.M.); (M.B.); (F.G.); (D.Z.)
| | - Ilaria Vicenti
- Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, 53100 Siena, Italy; (I.V.); (L.F.); (F.G.); (F.D.); (M.Z.)
| | - Francesca Gatti
- Department of Molecular Medicine, University of Padova, Via Gabelli, 63, 35100 Padova, Italy; (C.M.); (M.B.); (F.G.); (D.Z.)
| | | | - Lia Fiaschi
- Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, 53100 Siena, Italy; (I.V.); (L.F.); (F.G.); (F.D.); (M.Z.)
| | - Federica Giammarino
- Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, 53100 Siena, Italy; (I.V.); (L.F.); (F.G.); (F.D.); (M.Z.)
| | - Marco Iannetta
- Infectious Disease Unit, Department of System Medicine, Tor Vergata University and Hospital, Via Montpellier 1, 00133 Rome, Italy; (M.I.); (V.M.)
| | - Vincenzo Malagnino
- Infectious Disease Unit, Department of System Medicine, Tor Vergata University and Hospital, Via Montpellier 1, 00133 Rome, Italy; (M.I.); (V.M.)
| | - Daniela Zago
- Department of Molecular Medicine, University of Padova, Via Gabelli, 63, 35100 Padova, Italy; (C.M.); (M.B.); (F.G.); (D.Z.)
- Department of Medicine, University of Udine, Via Colugna 50, 33100 Udine, Italy
| | - Filippo Dragoni
- Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, 53100 Siena, Italy; (I.V.); (L.F.); (F.G.); (F.D.); (M.Z.)
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, 53100 Siena, Italy; (I.V.); (L.F.); (F.G.); (F.D.); (M.Z.)
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20
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Hemmi T, Ainai A, Hashiguchi T, Tobiume M, Kanno T, Iwata-Yoshikawa N, Iida S, Sato Y, Miyamoto S, Ueno A, Sano K, Saito S, Shiwa-Sudo N, Nagata N, Tamura K, Suzuki R, Hasegawa H, Suzuki T. Intranasal vaccination induced cross-protective secretory IgA antibodies against SARS-CoV-2 variants with reducing the potential risk of lung eosinophilic immunopathology. Vaccine 2022; 40:5892-5903. [PMID: 36064667 PMCID: PMC9439873 DOI: 10.1016/j.vaccine.2022.08.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/02/2022] [Accepted: 08/21/2022] [Indexed: 11/17/2022]
Abstract
To control the coronavirus disease 2019 (COVID-19) pandemic, there is a need to develop vaccines to prevent infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. One candidate is a nasal vaccine capable of inducing secretory IgA antibodies in the mucosa of the upper respiratory tract, the initial site of infection. However, regarding the development of COVID-19 vaccines, there is concern about the potential risk of inducing lung eosinophilic immunopathology as a vaccine-associated enhanced respiratory disease as a result of the T helper 2 (Th2)-dominant adaptive immune response. In this study, we investigated the protective effect against virus infection induced by intranasal vaccination of recombinant trimeric spike protein derived from SARS-CoV-2 adjuvanted with CpG oligonucleotides, ODN2006, in mouse model. The intranasal vaccine combined with ODN2006 successfully induced not only systemic spike-specific IgG antibodies, but also secretory IgA antibodies in the nasal mucosa. Secretory IgA antibodies showed high protective ability against SARS-CoV-2 variants (Alpha, Beta and Gamma variants) compared to IgG antibodies in the serum. The nasal vaccine of this formulation induced a high number of IFN-γ-secreting cells in the draining cervical lymph nodes and a lower spike-specific IgG1/IgG2a ratio compared to that of subcutaneous vaccination with alum as a typical Th2 adjuvant. These features are consistent with the induction of the Th1 adaptive immune response. In addition, mice intranasally vaccinated with ODN2006 showed less lung eosinophilic immunopathology after viral challenge than mice subcutaneously vaccinated with alum adjuvant. Our findings indicate that intranasal vaccine adjuvanted with ODN2006 could be a candidate that can prevent the infection of antigenically different variant viruses, reducing the risk of vaccine-associated enhanced respiratory disease.
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21
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Chivu-Economescu M, Vremera T, Ruta SM, Grancea C, Leustean M, Chiriac D, David A, Matei L, Diaconu CC, Gatea A, Ilie C, Radu I, Cornienco AM, Iancu LS, Cirstoiu C, Pop CS, Petru R, Strambu V, Malciolu S, Popescu CP, Florescu SA, Rafila A, Furtunescu FL, Pistol A. Assessment of the Humoral Immune Response Following COVID-19 Vaccination in Healthcare Workers: A One Year Longitudinal Study. Biomedicines 2022; 10:1526. [PMID: 35884831 PMCID: PMC9312940 DOI: 10.3390/biomedicines10071526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 11/17/2022] Open
Abstract
The continuous variability of SARS-CoV-2 and the rapid waning of specific antibodies threatens the efficacy of COVID-19 vaccines. We aimed to evaluate antibody kinetics one year after SARS-CoV-2 vaccination with an mRNA vaccine in healthcare workers (HCW), with or without a booster. A marked decline in anti-Spike(S)/Receptor Binding Domain (RBD) antibody levels was registered during the first eight months post-vaccination, followed by a transitory increase after the booster. At three months post-booster an increased antibody level was maintained only in HCW vaccinated after a prior infection, who also developed a higher and long-lasting level of anti-S IgA antibodies. Still, IgG anti-nucleocapsid (NCP) fades five months post-SARS-CoV-2 infection. Despite the decline in antibodies one-year post-vaccination, 68.2% of HCW preserved the neutralization capacity against the ancestral variant, with a decrease of only 17.08% in the neutralizing capacity against the Omicron variant. Nevertheless, breakthrough infections were present in 6.65% of all participants, without any correlation with the previous level of anti-S/RBD IgG. Protection against the ancestral and Omicron variants is maintained at least three months after a booster in HCW, possibly reflecting a continuous antigenic stimulation in the professional setting.
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Affiliation(s)
- Mihaela Chivu-Economescu
- Stefan S. Nicolau Institute of Virology, Romanian Academy, 030304 Bucharest, Romania; (M.C.-E.); (C.G.); (D.C.); (L.M.); (C.C.D.)
| | - Teodora Vremera
- National Institute of Public Health Bucharest, 050463 Bucharest, Romania; (T.V.); (M.L.); (A.D.); (A.G.); (C.I.); (I.R.); (A.M.C.)
- ECDC Fellowship Programme, Public Health Microbiology Path (EUPHEM), European Centre for Disease Prevention and Control (ECDC), 16973 Solna, Sweden
| | - Simona Maria Ruta
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (C.S.P.); (R.P.); (V.S.); (C.P.P.); (S.A.F.); (A.R.); (F.L.F.); (A.P.)
| | - Camelia Grancea
- Stefan S. Nicolau Institute of Virology, Romanian Academy, 030304 Bucharest, Romania; (M.C.-E.); (C.G.); (D.C.); (L.M.); (C.C.D.)
| | - Mihaela Leustean
- National Institute of Public Health Bucharest, 050463 Bucharest, Romania; (T.V.); (M.L.); (A.D.); (A.G.); (C.I.); (I.R.); (A.M.C.)
| | - Daniela Chiriac
- Stefan S. Nicolau Institute of Virology, Romanian Academy, 030304 Bucharest, Romania; (M.C.-E.); (C.G.); (D.C.); (L.M.); (C.C.D.)
| | - Adina David
- National Institute of Public Health Bucharest, 050463 Bucharest, Romania; (T.V.); (M.L.); (A.D.); (A.G.); (C.I.); (I.R.); (A.M.C.)
| | - Lilia Matei
- Stefan S. Nicolau Institute of Virology, Romanian Academy, 030304 Bucharest, Romania; (M.C.-E.); (C.G.); (D.C.); (L.M.); (C.C.D.)
| | - Carmen C. Diaconu
- Stefan S. Nicolau Institute of Virology, Romanian Academy, 030304 Bucharest, Romania; (M.C.-E.); (C.G.); (D.C.); (L.M.); (C.C.D.)
| | - Adina Gatea
- National Institute of Public Health Bucharest, 050463 Bucharest, Romania; (T.V.); (M.L.); (A.D.); (A.G.); (C.I.); (I.R.); (A.M.C.)
| | - Ciprian Ilie
- National Institute of Public Health Bucharest, 050463 Bucharest, Romania; (T.V.); (M.L.); (A.D.); (A.G.); (C.I.); (I.R.); (A.M.C.)
| | - Iuliana Radu
- National Institute of Public Health Bucharest, 050463 Bucharest, Romania; (T.V.); (M.L.); (A.D.); (A.G.); (C.I.); (I.R.); (A.M.C.)
| | - Ana Maria Cornienco
- National Institute of Public Health Bucharest, 050463 Bucharest, Romania; (T.V.); (M.L.); (A.D.); (A.G.); (C.I.); (I.R.); (A.M.C.)
| | - Luminita Smaranda Iancu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Regional Center of Public Health Iași, 700465 Iași, Romania
| | - Catalin Cirstoiu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (C.S.P.); (R.P.); (V.S.); (C.P.P.); (S.A.F.); (A.R.); (F.L.F.); (A.P.)
- University Emergency Hospital, 050098 Bucharest, Romania
| | - Corina Silvia Pop
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (C.S.P.); (R.P.); (V.S.); (C.P.P.); (S.A.F.); (A.R.); (F.L.F.); (A.P.)
- University Emergency Hospital, 050098 Bucharest, Romania
| | - Radu Petru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (C.S.P.); (R.P.); (V.S.); (C.P.P.); (S.A.F.); (A.R.); (F.L.F.); (A.P.)
- Dr. Carol Davila Nephrology Clinical Hospital, 010731 Bucharest, Romania
| | - Victor Strambu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (C.S.P.); (R.P.); (V.S.); (C.P.P.); (S.A.F.); (A.R.); (F.L.F.); (A.P.)
- Dr. Carol Davila Nephrology Clinical Hospital, 010731 Bucharest, Romania
| | - Stefan Malciolu
- Victor Babes Hospital for Infectious and Tropical Diseases, 030303 Bucharest, Romania;
| | - Corneliu Petru Popescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (C.S.P.); (R.P.); (V.S.); (C.P.P.); (S.A.F.); (A.R.); (F.L.F.); (A.P.)
- Victor Babes Hospital for Infectious and Tropical Diseases, 030303 Bucharest, Romania;
| | - Simin Aysel Florescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (C.S.P.); (R.P.); (V.S.); (C.P.P.); (S.A.F.); (A.R.); (F.L.F.); (A.P.)
- Victor Babes Hospital for Infectious and Tropical Diseases, 030303 Bucharest, Romania;
| | - Alexandru Rafila
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (C.S.P.); (R.P.); (V.S.); (C.P.P.); (S.A.F.); (A.R.); (F.L.F.); (A.P.)
- National Institute of Infectious Diseases “Matei Bals”, 021105 Bucharest, Romania
| | - Florentina Ligia Furtunescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (C.S.P.); (R.P.); (V.S.); (C.P.P.); (S.A.F.); (A.R.); (F.L.F.); (A.P.)
| | - Adriana Pistol
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (C.S.P.); (R.P.); (V.S.); (C.P.P.); (S.A.F.); (A.R.); (F.L.F.); (A.P.)
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