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Wrynla XH, Bates TA, Trank-Greene M, Wahedi M, Hinchliff A, Curlin ME, Tafesse FG. Immune imprinting and vaccine interval determine antibody responses to monovalent XBB.1.5 COVID-19 vaccination. COMMUNICATIONS MEDICINE 2025; 5:182. [PMID: 40382525 PMCID: PMC12085693 DOI: 10.1038/s43856-025-00898-4] [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: 10/01/2024] [Accepted: 05/07/2025] [Indexed: 05/20/2025] Open
Abstract
BACKGROUND As COVID-19 becomes endemic and vaccines are annually adapted, exposure intervals and immune imprinting become critical considerations for vaccination strategy. Imprinting by the ancestral spike protein affected bivalent Wuhan-Hu-1/BA.4-5 vaccine responses. We assess the persistence of imprinting in antibody responses to the more recent XBB.1.5 monovalent formulation. METHODS We quantified live virus-neutralizing antibodies by focus reduction neutralization test and ancestral spike receptor-binding isotype titers by immunosorbent assay in individuals before and after XBB.1.5 vaccination. We compared responses between those who previously received three to four doses of Wuhan-Hu-1 vaccine and one dose of bivalent Wuhan-Hu-1/BA.4-5 (bivalent recipients) and those who received three to four doses of Wuhan-Hu-1 (bivalent non-recipients). RESULTS We report that before XBB.1.5 vaccination, bivalent non-recipients have decreased breadth and potency of neutralization. At post-vaccination, non-recipients exhibit greater boosting of neutralizing antibodies against XBB.1.5 (18.4X versus 6.2X), EG.5.1 (30.9X versus 7.0X), and JN.1 (9.2X versus 3.7X) variants with comparable breadth and trends toward greater potency. Greater boosting in non-recipients is similarly observed for spike-binding IgA and total IgG/A/M but not IgG nor IgM. Bivalent non-recipients had longer intervals between vaccination, which may enhance antibody responses; however, bivalent receipt and interval are tightly linked, preventing isolation of individual contributions to boosting. Nonetheless, back-boosting of ancestral SARS-CoV-2 titers in both participant groups provides interval-independent evidence that imprinting persists. CONCLUSIONS Our findings indicate that immune imprinting continues to affect humoral immunity elicited by the XBB.1.5 vaccine. Both imprinting and exposure intervals are important phenomena underlying immunogenicity of future variant-adapted COVID-19 vaccines.
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Affiliation(s)
- Xammy Huu Wrynla
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, USA
- Department of Molecular Microbiology and Immunology, Oregon Health and Science University, Portland, OR, USA
| | - Timothy A Bates
- Department of Molecular Microbiology and Immunology, Oregon Health and Science University, Portland, OR, USA
| | - Mila Trank-Greene
- Department of Molecular Microbiology and Immunology, Oregon Health and Science University, Portland, OR, USA
| | - Mastura Wahedi
- Department of Occupational Health, Oregon Health and Science University, Portland, OR, USA
| | - Audrey Hinchliff
- Department of Molecular Microbiology and Immunology, Oregon Health and Science University, Portland, OR, USA
| | - Marcel E Curlin
- Department of Occupational Health, Oregon Health and Science University, Portland, OR, USA.
- Division of Infectious Diseases, Oregon Health and Science University, Portland, OR, USA.
| | - Fikadu G Tafesse
- Department of Molecular Microbiology and Immunology, Oregon Health and Science University, Portland, OR, USA.
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2
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Augello M, Bono V, Rovito R, Tavelli A, Santoro A, Tincati C, Vergori A, Azzini AM, Righi E, Spiteri G, Porru S, Meschi S, Notari S, Maggi F, Antinori A, Tacconelli E, d'Arminio Monforte A, Marchetti G. Long-term immune responses to SARS-CoV-2 Omicron BA.4/5 mRNA booster in people living with HIV. COMMUNICATIONS MEDICINE 2025; 5:92. [PMID: 40148493 PMCID: PMC11950219 DOI: 10.1038/s43856-025-00799-6] [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: 05/17/2024] [Accepted: 03/07/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Variant-adapted vaccines are recommended in vulnerable populations to address the waning immunity and the emergence of immune-escaping SARS-CoV-2 variants, yet data about immune responses to such vaccines in people living with HIV (PLWH) are limited. We therefore aimed to assess long-term immune responses to an original-BA.4/5 mRNA booster in this population. METHODS In this prospective longitudinal study, PLWH receiving either an original-BA.4/5 bivalent booster or an original monovalent booster and HIV-negative healthcare workers (HCWs) receiving a bivalent booster were enrolled and sampled before (T0), 1 month (T1), and 4-9 months (T2) after the vaccine administration. SARS-CoV-2-specific T and B cells, RBD-binding antibodies, and RBD-blocking antibodies against both wild type (WT) and omicron BA.4/5 virus were determined. RESULTS The bivalent booster is able to transiently increase both humoral and polyfunctional T cell responses in PLWH, with humoral responses comparable to those observed in HCWs. While T cell responses are cross-reactive against viral variants and stable over time, humoral immunity is imprinted to the ancestral virus and wanes quickly. Furthermore, whilst previous SARS-CoV-2 infection does not affect the trajectory of vaccine-elicited immune responses, markers of HIV-related T cell dysfunction are associated with lower antibody peak responses and higher antibody waning. Lastly, the bivalent booster was superior to the monovalent one in inducing BA.4/5-reactive RBD-blocking antibodies. CONCLUSIONS The original-BA.4/5 bivalent booster is highly immunogenic in PLWH and superior to the monovalent one in inducing humoral responses against the BA.4/5 virus, although HIV-related T cell dysfunction markers are associated with blunted and less durable antibody immunity.
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Affiliation(s)
- Matteo Augello
- Clinic of Infectious Diseases and Tropical Medicine, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Valeria Bono
- Clinic of Infectious Diseases and Tropical Medicine, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Roberta Rovito
- Clinic of Infectious Diseases and Tropical Medicine, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Andrea Santoro
- Clinic of Infectious Diseases and Tropical Medicine, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Camilla Tincati
- Clinic of Infectious Diseases and Tropical Medicine, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Alessandra Vergori
- Viral Immunodeficiencies Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - Anna Maria Azzini
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elda Righi
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Gianluca Spiteri
- Occupational Medicine Unit, Verona Hospital, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Stefano Porru
- Occupational Medicine Unit, Verona Hospital, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Silvia Meschi
- Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - Stefania Notari
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - Andrea Antinori
- Viral Immunodeficiencies Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Giulia Marchetti
- Clinic of Infectious Diseases and Tropical Medicine, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy.
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3
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Sukik L, Chemaitelly H, Ayoub HH, Coyle P, Tang P, Hasan MR, Yassine HM, Al Thani AA, Al-Kanaani Z, Al-Kuwari E, Jeremijenko A, Kaleeckal AH, Latif AN, Shaik RM, Abdul-Rahim HF, Nasrallah GK, Al-Kuwari MG, Butt A, Al-Romaihi HE, Al-Thani MH, Al-Khal A, Bertollini R, Abu-Raddad LJ. Protection conferred by SARS-CoV-2 infection across a spectrum of reinfection symptoms and severities. BMJ Open Respir Res 2025; 12:e002718. [PMID: 40139840 PMCID: PMC11950940 DOI: 10.1136/bmjresp-2024-002718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 03/14/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND SARS-CoV-2 infection is associated with protection against reinfection. This study analysed this protection across different reinfection symptoms and severities, comparing the preomicron and omicron eras. METHODS A nationwide, matched, test-negative, case-control study was conducted in Qatar from 5 February 2020 to 12 March 2024. The preomicron analysis used a sample of 509 949 positive and 8 494 782 negative tests, while the omicron analysis included 682 257 positive and 6 904 044 negative tests. Data were sourced from Qatar's national databases for COVID-19 laboratory testing, vaccination, hospitalisation and death. RESULTS Effectiveness of preomicron infection against preomicron reinfection was estimated at 80.9% (95% CI: 79.1% to 82.6%) for asymptomatic reinfection, 87.5% (95% CI: 86.1% to 88.9%) for symptomatic reinfection, 97.8% (95% CI: 95.7% to 98.9%) for severe COVID-19 reinfection, 100.0% (95% CI: 97.5% to 100.0%) for critical COVID-19 reinfection and 88.1% (95% CI: 50.3% to 97.2%) for fatal COVID-19 reinfection. For omicron infection against omicron reinfection, the estimates were 46.4% (95% CI: 36.9% to 54.4%) for asymptomatic reinfection, 52.8% (95% CI: 44.4% to 60.0%) for symptomatic reinfection, 100.0% (95% CI: 55.4% to 100.0%) for severe COVID-19 reinfection, 100.0% (95% CI: 15.1% to 100.0%) for critical COVID-19 reinfection, and 75.2% (95% CI: -58.8% to 97.5%) for fatal COVID-19 reinfection. Effectiveness over time since previous infection showed no discernible decline in protection against all forms of reinfection in the preomicron era, but a rapid decline against asymptomatic and symptomatic reinfections in the omicron era. CONCLUSIONS A gradient of protection against reinfection is evident, with the highest protection observed against severe forms of COVID-19. Over time, this gradient becomes more pronounced, as protection against asymptomatic and symptomatic reinfections decreases, while protection against severe outcomes remains strong.
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Affiliation(s)
- Layan Sukik
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Houssein H Ayoub
- Mathematics Program, Department of Mathematics, Statistics, and Physics, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Peter Coyle
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- Hamad Medical Corporation, Doha, Qatar
- Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, UK
| | - Patrick Tang
- Department of Pathology, Sidra Medicine, Doha, Qatar
| | - Mohammad R Hasan
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Hadi M Yassine
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
| | - Asmaa A Al Thani
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
| | | | | | | | | | | | | | - Hanan F Abdul-Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Gheyath K Nasrallah
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
| | | | - Adeel Butt
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, USA
- Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | | | | | | | | | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, USA
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
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Chemaitelly H, Ayoub HH, Coyle P, Tang P, Hasan MR, Yassine HM, Al Thani AA, Al-Kanaani Z, Al-Kuwari E, Jeremijenko A, Kaleeckal AH, Latif AN, Shaik RM, Abdul-Rahim HF, Nasrallah GK, Al-Kuwari MG, Butt AA, Al-Romaihi HE, Al-Thani MH, Al-Khal A, Bertollini R, Abu-Raddad LJ. Differential protection against SARS-CoV-2 reinfection pre- and post-Omicron. Nature 2025; 639:1024-1031. [PMID: 39910292 PMCID: PMC11946897 DOI: 10.1038/s41586-024-08511-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 10/16/2024] [Indexed: 02/07/2025]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly evolved over short timescales, leading to the emergence of more transmissible variants such as Alpha and Delta1-3. The arrival of the Omicron variant marked a major shift, introducing numerous extra mutations in the spike gene compared with earlier variants1,2. These evolutionary changes have raised concerns regarding their potential impact on immune evasion, disease severity and the effectiveness of vaccines and treatments1,3. In this epidemiological study, we identified two distinct patterns in the protective effect of natural infection against reinfection in the Omicron versus pre-Omicron eras. Before Omicron, natural infection provided strong and durable protection against reinfection, with minimal waning over time. However, during the Omicron era, protection was robust only for those recently infected, declining rapidly over time and diminishing within a year. These results demonstrate that SARS-CoV-2 immune protection is shaped by a dynamic interaction between host immunity and viral evolution, leading to contrasting reinfection patterns before and after Omicron's first wave. This shift in patterns suggests a change in evolutionary pressures, with intrinsic transmissibility driving adaptation pre-Omicron and immune escape becoming dominant post-Omicron, underscoring the need for periodic vaccine updates to sustain immunity.
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Affiliation(s)
- Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA.
| | - Houssein H Ayoub
- Mathematics Program, Department of Mathematics, Statistics and Physics, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Peter Coyle
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- Hamad Medical Corporation, Doha, Qatar
- Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, UK
| | - Patrick Tang
- Department of Pathology, Sidra Medicine, Doha, Qatar
| | - Mohammad R Hasan
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Hadi M Yassine
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
| | - Asmaa A Al Thani
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
| | | | | | | | | | | | | | - Hanan F Abdul-Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Gheyath K Nasrallah
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
| | | | - Adeel A Butt
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
- Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | | | | | | | | | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA.
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar.
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5
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Wrynla XH, Bates TA, Trank-Greene M, Wahedi M, Hinchliff A, Curlin ME, Tafesse FG. Immune imprinting and vaccination interval underly XBB.1.5 monovalent vaccine immunogenicity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2025:2025.02.09.25321965. [PMID: 40034787 PMCID: PMC11875258 DOI: 10.1101/2025.02.09.25321965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2025]
Abstract
As COVID-19 transitions into endemicity and vaccines are annually updated to circulating SARS-CoV-2 lineages such as JN.1, exposure intervals and immune imprinting become critical considerations for vaccination strategy. Imprinting by the ancestral spike protein has been observed with the bivalent Wuhan-Hu-1/BA.4-5 vaccine and its persistence can be further evaluated in the context of the more recent XBB.1.5 monovalent vaccine. We assessed antibody responses in individuals who received three to four doses of Wuhan-Hu-1, one dose of bivalent Wuhan-Hu-1/BA.4-5, and one dose of XBB.1.5 vaccine (bivalent recipients). We compared these to individuals who received three to four doses of Wuhan-Hu-1 and one dose of XBB.1.5 vaccine without prior bivalent vaccination (bivalent non-recipients). Before XBB.1.5 vaccination, bivalent non-recipients demonstrated decreased breadth and potency of neutralizing antibodies compared to recipients, but at post-vaccination exhibited greater boosting of neutralizing antibodies against XBB.1.5 (18.4X versus 6.2X), EG.5.1 (30.9X versus 7.0X), and JN.1 (9.2X versus 3.7X) variants with trends toward higher neutralizing titers and comparable variant cross-neutralization. Increased boosting in non-recipients were similarly observed for IgA and total IgG/A/M isotypes binding the spike receptor-binding domain but not IgG nor IgM. Bivalent non-recipients had longer intervals between exposures, which has been reported to enhance antibody boosting; however, bivalent receipt and interval were tightly linked variables, preventing the isolation of individual contributions to boosting. Nonetheless, significant "back-boosting" of ancestral SARS-CoV-2 titers upon XBB.1.5 vaccination in both participant groups indicate that immune imprinting continues to affect contemporary vaccines. Altogether, our findings highlight imprinting and exposure intervals as important phenomena underlying variant-adapted COVID-19 vaccine immunogenicity.
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6
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Chemaitelly H, Ayoub H, Coyle P, Tang P, Hasan M, Yassine H, Al Thani A, Al‐Kanaani Z, Al‐Kuwari E, Jeremijenko A, Kaleeckal A, Latif A, Shaik R, Abdul‐Rahim H, Nasrallah G, Al‐Kuwari M, Butt A, Al‐Romaihi H, Al‐Thani M, Al‐Khal A, Bertollini R, Abu‐Raddad L. BNT162b2 Versus mRNA-1273 Vaccines: Comparative Analysis of Long-Term Protection Against SARS-CoV-2 Infection and Severe COVID-19 in Qatar. Influenza Other Respir Viruses 2024; 18:e13357. [PMID: 39343986 PMCID: PMC11439586 DOI: 10.1111/irv.13357] [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: 04/21/2024] [Revised: 06/19/2024] [Accepted: 07/04/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND This study provides a head-to-head comparison of the protection provided by the BNT162b2 and mRNA-1273 vaccines against SARS-CoV-2 infection and against severe COVID-19, covering primary series and third dose/booster vaccinations over up to 3 years of follow-up, both before and after the emergence of the omicron variant. METHODS Two national, matched, retrospective cohort studies were conducted on Qatar's vaccinated population from December 16, 2020, to February 18, 2024. Subgroup analyses by pre-vaccination SARS-CoV-2 infection history, as well as sensitivity analyses, were also conducted. RESULTS The adjusted hazard ratio (AHR) comparing infection incidence in those vaccinated with BNT162b2 versus mRNA-1273 was 1.03 (95% CI: 1.02-1.05) after the primary series and 1.11 (95% CI: 1.09-1.13) after the third (booster) dose. The corresponding AHRs for any severe, critical, or fatal COVID-19 were 1.31 (95% CI: 0.81-2.11) and 1.00 (95% CI: 0.20-4.94), respectively. Subgroup analyses by prior infection status hinted at a dose-dependent immune imprinting effect, where a combination of two types of immunity, pre-omicron and omicron, offered greater protection against infection than one type alone, with this effect being amplified by the higher antigen dose of mRNA-1273 compared to BNT162b2. Sensitivity analyses confirmed the study findings. CONCLUSIONS BNT162b2 provided slightly less protection against infection than mRNA-1273 following both primary series and booster vaccinations while offering comparable protection against severe COVID-19 outcomes. The findings suggested that the vaccine antigen dose in interaction with infection history may determine the extent of immune protection against infection.
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Affiliation(s)
- Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine–QatarCornell UniversityDohaQatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–QatarCornell University, Qatar Foundation – Education CityDohaQatar
- Department of Population Health Sciences, Weill Cornell MedicineCornell UniversityNew YorkNew YorkUSA
| | - Houssein H. Ayoub
- Mathematics Program, Department of Mathematics and Statistics, College of Arts and SciencesQatar UniversityDohaQatar
| | - Peter Coyle
- Department of Biomedical Science, College of Health Sciences, QU HealthQatar UniversityDohaQatar
- Hamad Medical CorporationDohaQatar
- Wellcome‐Wolfson Institute for Experimental MedicineQueens UniversityBelfastUK
| | | | - Mohammad R. Hasan
- Department of Pathology and Molecular MedicineMcMaster UniversityHamiltonCanada
| | - Hadi M. Yassine
- Department of Biomedical Science, College of Health Sciences, QU HealthQatar UniversityDohaQatar
- Biomedical Research Center, QU HealthQatar UniversityDohaQatar
| | - Asmaa A. Al Thani
- Department of Biomedical Science, College of Health Sciences, QU HealthQatar UniversityDohaQatar
- Biomedical Research Center, QU HealthQatar UniversityDohaQatar
| | | | | | | | | | | | | | - Hanan F. Abdul‐Rahim
- Department of Public Health, College of Health Sciences, QU HealthQatar UniversityDohaQatar
| | - Gheyath K. Nasrallah
- Department of Biomedical Science, College of Health Sciences, QU HealthQatar UniversityDohaQatar
- Biomedical Research Center, QU HealthQatar UniversityDohaQatar
| | | | - Adeel A. Butt
- Department of Population Health Sciences, Weill Cornell MedicineCornell UniversityNew YorkNew YorkUSA
- Hamad Medical CorporationDohaQatar
- Department of Medicine, Weill Cornell MedicineCornell UniversityNew YorkNew YorkUSA
| | | | | | | | | | - Laith J. Abu‐Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine–QatarCornell UniversityDohaQatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–QatarCornell University, Qatar Foundation – Education CityDohaQatar
- Department of Population Health Sciences, Weill Cornell MedicineCornell UniversityNew YorkNew YorkUSA
- Department of Public Health, College of Health Sciences, QU HealthQatar UniversityDohaQatar
- College of Health and Life SciencesHamad bin Khalifa UniversityDohaQatar
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7
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Jiang J, Lau EHY, Zhou Z, Yin G, Lin Y, Cowling BJ, Lam KF. Assessing the Impact of Primary-Series Infection and Booster Vaccination on Protection against Omicron in Hong Kong: A Population-Based Observational Study. Vaccines (Basel) 2024; 12:1014. [PMID: 39340044 PMCID: PMC11435694 DOI: 10.3390/vaccines12091014] [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: 08/02/2024] [Revised: 08/31/2024] [Accepted: 09/03/2024] [Indexed: 09/30/2024] Open
Abstract
This study aimed to assess the real-world effectiveness of vaccines and hybrid immunity in preventing infections during the Omicron prevalent period in Hong Kong. This study analyzed vaccination records and COVID-19 confirmed case records from 1 January 2022 to 28 January 2023 and included a total of 7,165,862 individuals with vaccination or infection records. This study found that an additional vaccine dose offered increased protection against Omicron BA.1/2 and BA.4 infections for individuals without prior infections in general. Hybrid immunity, acquired through vaccination and natural infection, was found to be significantly stronger than that provided by vaccines alone. The Comirnaty Original/Omicron BA.4/5 bivalent vaccine, introduced in December 2022, was associated with a lower risk of BA.4 infection when administered as a booster dose after three doses of CoronaVac. However, individuals with four doses of the CoronaVac vaccine did not exhibit a significantly lower risk of infection compared to those with three doses during the BA.4 dominant period. This study highlights the importance of promoting booster shot uptake and encouraging vaccination among those who have recovered from COVID-19 infections. The potential immune imprinting effect associated with the Comirnaty and CoronaVac vaccine underscores the need for continued surveillance and research to optimize vaccination strategies for emerging variants.
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Affiliation(s)
- Jialiang Jiang
- Department of Statistics and Actuarial Science, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Eric Ho Yin Lau
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, New Territories, Hong Kong SAR, China
| | - Ziyi Zhou
- Department of Statistics and Actuarial Science, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Guosheng Yin
- Department of Statistics and Actuarial Science, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Yun Lin
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, New Territories, Hong Kong SAR, China
| | - Benjamin John Cowling
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, New Territories, Hong Kong SAR, China
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Kwok Fai Lam
- Department of Statistics and Actuarial Science, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore 169857, Singapore
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Poh XY, Lee IR, Tan CW, Chavatte JM, Fong SW, Goh YS, Rouers A, Wong N, Torres-Ruesta A, Mah SYY, Yeoh AYY, Gandhi M, Rahman N, Chin YQ, Lim JJ, Yoong TJK, Rao S, Chia PY, Ong SWX, Lee TH, Sadarangani SP, Lin RJH, Lim DRX, Chia W, Renia L, Ren EC, Lin RTP, Lye DC, Wang LF, Ng LFP, Young BE. First SARS-CoV-2 Omicron infection as an effective immune booster among mRNA vaccinated individuals: final results from the first phase of the PRIBIVAC randomised clinical trial. EBioMedicine 2024; 107:105275. [PMID: 39137572 PMCID: PMC11367514 DOI: 10.1016/j.ebiom.2024.105275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 07/14/2024] [Accepted: 07/27/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Understanding how SARS-CoV-2 breakthrough infections impacts the breadth of immune responses against existing and pre-emergent SARS-CoV-2 strains is needed to develop an evidence-based long-term immunisation strategy. METHODS We performed a randomised, controlled trial to assess the immunogenicity of homologous (BNT162b2) versus heterologous (mRNA-1273) booster vaccination in 100 BNT162b2-vaccinated infection-naïve individuals enrolled from October 2021. Post hoc analysis was performed to assess the impact of SARS-CoV-2 infection on humoral and cellular immune responses against wild-type SARS-CoV-2 and/or Omicron subvariants. FINDINGS 93 participants completed the study at day 360. 71% (66/93) of participants reported first SARS-CoV-2 Omicron infection by the end of the study with similar proportions of infections between homologous and heterologous booster groups (72.3% [34/47] vs 69.6% [32/46]; p = 0.82). Mean wildtype SARS-CoV-2 anti-S-RBD antibody level was significantly higher in heterologous booster group compared with homologous group at day 180 (14,588 IU/mL; 95% CI, 10,186-20,893 vs 7447 IU/mL; 4646-11,912; p = 0.025). Participants who experienced breakthrough infections during the Omicron BA.1/2 wave had significantly higher anti-S-RBD antibody levels against wildtype SARS-CoV-2 and antibody neutralisation against BA.1 and pre-emergent BA.5 compared with infection-naïve participants. Regardless of hybrid immunity status, wildtype SARS-CoV-2 anti-S-RBD antibody level declined significantly after six months post-booster or post-SARS-CoV-2 infection. INTERPRETATION Booster vaccination with mRNA-1273 was associated with significantly higher antibody levels compared with BNT162b2. Antibody responses are narrower and decline faster among uninfected, vaccinated individuals. Boosters may be more effective if administered shortly before infection outbreaks and at least six months after last infection or booster. FUNDING Singapore NMRC, USFDA, MRC.
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Affiliation(s)
| | - I Russel Lee
- National Centre for Infectious Diseases, Singapore
| | - Chee Wah Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jean-Marc Chavatte
- National Centre for Infectious Diseases, Singapore; National Public Health Laboratory, Singapore
| | - Siew Wai Fong
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, 138648, Singapore
| | - Yun Shan Goh
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, 138648, Singapore
| | - Angeline Rouers
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, 138648, Singapore
| | - Nathan Wong
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, 138648, Singapore
| | - Anthony Torres-Ruesta
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, 138648, Singapore
| | - Shirley Y Y Mah
- Emerging Infectious Diseases Programme, Duke-NUS Medical School, Singapore
| | - Aileen Y Y Yeoh
- Emerging Infectious Diseases Programme, Duke-NUS Medical School, Singapore
| | - Mihir Gandhi
- Biostatistics, Singapore Clinical Research Institute, Singapore; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Nabilah Rahman
- Biostatistics, Singapore Clinical Research Institute, Singapore; Saw Swee Hock School of Public Health, Singapore
| | - Yi Qing Chin
- National Centre for Infectious Diseases, Singapore
| | | | | | - Suma Rao
- National Centre for Infectious Diseases, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Po Ying Chia
- National Centre for Infectious Diseases, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Sean W X Ong
- National Centre for Infectious Diseases, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Tau Hong Lee
- National Centre for Infectious Diseases, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Sapna P Sadarangani
- National Centre for Infectious Diseases, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ray J H Lin
- National Centre for Infectious Diseases, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Daniel R X Lim
- National Centre for Infectious Diseases, Singapore; National Public Health Laboratory, Singapore
| | - Wanni Chia
- Emerging Infectious Diseases Programme, Duke-NUS Medical School, Singapore
| | - Laurent Renia
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, 138648, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; School of Biological Sciences, Nanyang Technological University, Singapore
| | - Ee Chee Ren
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Immunology Network, Singapore
| | - Raymond T P Lin
- National Centre for Infectious Diseases, Singapore; National Public Health Laboratory, Singapore
| | - David C Lye
- National Centre for Infectious Diseases, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Lin-Fa Wang
- Emerging Infectious Diseases Programme, Duke-NUS Medical School, Singapore
| | - Lisa F P Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, 138648, Singapore.
| | - Barnaby E Young
- National Centre for Infectious Diseases, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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Sukik L, Chemaitelly H, Ayoub HH, Coyle P, Tang P, Yassine HM, Al Thani AA, Hasan MR, Al-Kanaani Z, Al-Kuwari E, Jeremijenko A, Kaleeckal AH, Latif AN, Shaik RM, Abdul-Rahim HF, Nasrallah GK, Al-Kuwari MG, Butt AA, Al-Romaihi HE, Al-Thani MH, Al-Khal A, Bertollini R, Abdel-Rahman ME, Abu-Raddad LJ. Effectiveness of two and three doses of COVID-19 mRNA vaccines against infection, symptoms, and severity in the pre-omicron era: A time-dependent gradient. Vaccine 2024; 42:3307-3320. [PMID: 38616439 DOI: 10.1016/j.vaccine.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Vaccines were developed and deployed to combat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aimed to characterize patterns in the protection provided by the BNT162b2 and mRNA-1273 mRNA vaccines against a spectrum of SARS-CoV-2 infection symptoms and severities. METHODS A national, matched, test-negative, case-control study was conducted in Qatar between January 1 and December 18, 2021, utilizing a sample of 238,896 PCR-positive tests and 6,533,739 PCR-negative tests. Vaccine effectiveness was estimated against asymptomatic, symptomatic, severe coronavirus disease 2019 (COVID-19), critical COVID-19, and fatal COVID-19 infections. Data sources included Qatar's national databases for COVID-19 laboratory testing, vaccination, hospitalization, and death. RESULTS Effectiveness of two-dose BNT162b2 vaccination was 75.6% (95% CI: 73.6-77.5) against asymptomatic infection and 76.5% (95% CI: 75.1-77.9) against symptomatic infection. Effectiveness against each of severe, critical, and fatal COVID-19 infections surpassed 90%. Immediately after the second dose, all categories-namely, asymptomatic, symptomatic, severe, critical, and fatal COVID-19-exhibited similarly high effectiveness. However, from 181 to 270 days post-second dose, effectiveness against asymptomatic and symptomatic infections declined to below 40%, while effectiveness against each of severe, critical, and fatal COVID-19 infections remained consistently high. However, estimates against fatal COVID-19 often had wide 95% confidence intervals. Analogous patterns were observed in three-dose BNT162b2 vaccination and two- and three-dose mRNA-1273 vaccination. Sensitivity analyses confirmed the results. CONCLUSION A gradient in vaccine effectiveness exists and is linked to the symptoms and severity of infection, providing higher protection against more symptomatic and severe cases. This gradient intensifies over time as vaccine immunity wanes after the last vaccine dose. These patterns appear consistent irrespective of the vaccine type or whether the vaccination involves the primary series or a booster.
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Affiliation(s)
- Layan Sukik
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Houssein H Ayoub
- Mathematics Program, Department of Mathematics and Statistics, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Peter Coyle
- Hamad Medical Corporation, Doha, Qatar; Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar; Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, United Kingdom
| | - Patrick Tang
- Department of Pathology, Sidra Medicine, Doha, Qatar
| | - Hadi M Yassine
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Asmaa A Al Thani
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Mohammad R Hasan
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | | | | | | | | | | | | | - Hanan F Abdul-Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Gheyath K Nasrallah
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | | | - Adeel A Butt
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA; Hamad Medical Corporation, Doha, Qatar; Department of Medicine, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | | | | | | | | | - Manar E Abdel-Rahman
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar; Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA; College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar.
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10
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Hansen CH. Evidence of immune imprinting or the effect of selection bias? SCIENCE ADVANCES 2023; 9:eadk5668. [PMID: 37792936 PMCID: PMC10550216 DOI: 10.1126/sciadv.adk5668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
People with booster vaccinations appear more prone to reinfection than those with primary series vaccination only; however, selection bias in the study design complicates interpretation.
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Affiliation(s)
- Christian H. Hansen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
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