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Kirwan PD, Hall VJ, Foulkes S, Otter AD, Munro K, Sparkes D, Howells A, Platt N, Broad J, Crossman D, Norman C, Corrigan D, Jackson CH, Cole M, Brown CS, Atti A, Islam J, Presanis AM, Charlett A, De Angelis D, Hopkins S. Effect of second booster vaccinations and prior infection against SARS-CoV-2 in the UK SIREN healthcare worker cohort. Lancet Reg Health Eur 2024; 36:100809. [PMID: 38111727 PMCID: PMC10727938 DOI: 10.1016/j.lanepe.2023.100809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/20/2023]
Abstract
Background The protection of fourth dose mRNA vaccination against SARS-CoV-2 is relevant to current global policy decisions regarding ongoing booster roll-out. We aimed to estimate the effect of fourth dose vaccination, prior infection, and duration of PCR positivity in a highly-vaccinated and largely prior-COVID-19 infected cohort of UK healthcare workers. Methods Participants underwent fortnightly PCR and regular antibody testing for SARS-CoV-2 and completed symptoms questionnaires. A multi-state model was used to estimate vaccine effectiveness (VE) against infection from a fourth dose compared to a waned third dose, with protection from prior infection and duration of PCR positivity jointly estimated. Findings 1298 infections were detected among 9560 individuals under active follow-up between September 2022 and March 2023. Compared to a waned third dose, fourth dose VE was 13.1% (95% CI 0.9 to 23.8) overall; 24.0% (95% CI 8.5 to 36.8) in the first 2 months post-vaccination, reducing to 10.3% (95% CI -11.4 to 27.8) and 1.7% (95% CI -17.0 to 17.4) at 2-4 and 4-6 months, respectively. Relative to an infection >2 years ago and controlling for vaccination, 63.6% (95% CI 46.9 to 75.0) and 29.1% (95% CI 3.8 to 43.1) greater protection against infection was estimated for an infection within the past 0-6, and 6-12 months, respectively. A fourth dose was associated with greater protection against asymptomatic infection than symptomatic infection, whilst prior infection independently provided more protection against symptomatic infection, particularly if the infection had occurred within the previous 6 months. Duration of PCR positivity was significantly lower for asymptomatic compared to symptomatic infection. Interpretation Despite rapid waning of protection, vaccine boosters remain an important tool in responding to the dynamic COVID-19 landscape; boosting population immunity in advance of periods of anticipated pressure, such as surging infection rates or emerging variants of concern. Funding UK Health Security Agency, Medical Research Council, NIHR HPRU Oxford, Bristol, and others.
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Affiliation(s)
- Peter D. Kirwan
- MRC Biostatistics Unit, University of Cambridge, United Kingdom
| | | | | | | | | | | | | | | | | | - David Crossman
- School of Medicine, University of St Andrews, United Kingdom
| | | | | | | | | | | | - Ana Atti
- UK Health Security Agency, United Kingdom
| | | | | | | | - Daniela De Angelis
- MRC Biostatistics Unit, University of Cambridge, United Kingdom
- UK Health Security Agency, United Kingdom
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2
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Atti A, Insalata F, Carr EJ, Otter AD, Foulkes S, Wu MY, Cole MJ, Linley E, Semper A, Brooks T, Hopkins S, Charlett A, Beale R, Hall V. Antibody correlates of protection against Delta infection after vaccination: A nested case-control within the UK-based SIREN study. J Infect 2023; 87:420-427. [PMID: 37689394 DOI: 10.1016/j.jinf.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/07/2023] [Accepted: 07/15/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVES To investigate serological correlates of protection against SARS-CoV-2 B.1.617.2 (Delta) infection after two vaccinations. METHODS We performed a case-control study, where cases were Delta infections after the second vaccine dose and controls were vaccinated, never infected participants, matched by age, gender and region. Sera were tested for anti-SARS-CoV-2 Spike antibody levels (anti-S) and neutralising antibody titres (nAbT), using live virus microneutralisation against Ancestral, Delta and Omicron (BA.1, B.1.1.529). We modelled the decay of anti-S and nAbT for both groups, inferring levels at matched calendar times since the second vaccination. We assessed differences in inferred antibody titres between groups and used conditional logistic regression to explore the relationship between titres and odds of infection. RESULTS In total, 130 sequence-confirmed Delta cases and 318 controls were included. Anti-S and Ancestral nAbT decayed similarly between groups, but faster in cases for Delta nAbT (p = 0.02) and Omicron nAbT (p = 0.002). At seven days before infection, controls had higher anti-S levels (p < 0.0001) and nAbT (p < 0.0001; all variants) at matched calendar time. A two-fold increase in anti-S levels was associated with a 29% ([95% CI 14-42%]; p = 0.001) reduction in odds of Delta infection. Delta nAbT>40 were associated with reduced odds of Delta infection (89%, [69-96%]; p < 0.0001), with additional benefits for titres >100 (p = 0.009) and >400 (p = 0.007). CONCLUSIONS We have identified correlates of protection against SARS-CoV-2 Delta, with potential implications for vaccine deployment, development, and public health response.
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Affiliation(s)
- Ana Atti
- UK Health Security Agency, Nobel House, 17 Smith Square, London SW1P 3JR, UK.
| | - Ferdinando Insalata
- UK Health Security Agency, Nobel House, 17 Smith Square, London SW1P 3JR, UK
| | - Edward J Carr
- UK Health Security Agency, Nobel House, 17 Smith Square, London SW1P 3JR, UK; The Francis Crick Institute, 1 Midland Rd, London NW1 1AT, UK; UCL Dept of Renal Medicine, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - Ashley D Otter
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Sarah Foulkes
- UK Health Security Agency, Nobel House, 17 Smith Square, London SW1P 3JR, UK
| | - Mary Y Wu
- The Francis Crick Institute, 1 Midland Rd, London NW1 1AT, UK; Covid Surveillance Unit, The Francis Crick Institute, London, UK
| | - Michelle J Cole
- UK Health Security Agency, Nobel House, 17 Smith Square, London SW1P 3JR, UK
| | - Ezra Linley
- UK Health Security Agency, Manchester Royal Infirmary, Oxford Road, Manchester M139WL, UK
| | - Amanda Semper
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Tim Brooks
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Susan Hopkins
- UK Health Security Agency, Nobel House, 17 Smith Square, London SW1P 3JR, UK
| | - Andre Charlett
- UK Health Security Agency, Nobel House, 17 Smith Square, London SW1P 3JR, UK
| | - Rupert Beale
- The Francis Crick Institute, 1 Midland Rd, London NW1 1AT, UK; UCL Dept of Renal Medicine, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK; Genotype-to-Phenotype UK National Virology Consortium (G2P-UK), UK
| | - Victoria Hall
- UK Health Security Agency, Nobel House, 17 Smith Square, London SW1P 3JR, UK
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3
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Neale I, Ali M, Kronsteiner B, Longet S, Abraham P, Deeks AS, Brown A, Moore SC, Stafford L, Dobson SL, Plowright M, Newman TAH, Wu MY, Carr EJ, Beale R, Otter AD, Hopkins S, Hall V, Tomic A, Payne RP, Barnes E, Richter A, Duncan CJA, Turtle L, de Silva TI, Carroll M, Lambe T, Klenerman P, Dunachie S. CD4+ and CD8+ T cells and antibodies are associated with protection against Delta vaccine breakthrough infection: a nested case-control study within the PITCH study. mBio 2023; 14:e0121223. [PMID: 37655880 PMCID: PMC10653804 DOI: 10.1128/mbio.01212-23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/26/2023] [Indexed: 09/02/2023] Open
Abstract
IMPORTANCE Defining correlates of protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine breakthrough infection informs vaccine policy for booster doses and future vaccine designs. Existing studies demonstrate humoral correlates of protection, but the role of T cells in protection is still unclear. In this study, we explore antibody and T cell immune responses associated with protection against Delta variant vaccine breakthrough infection in a well-characterized cohort of UK Healthcare Workers (HCWs). We demonstrate evidence to support a role for CD4+ and CD8+ T cells as well as antibodies against Delta vaccine breakthrough infection. In addition, our results suggest a potential role for cross-reactive T cells in vaccine breakthrough.
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Affiliation(s)
- Isabel Neale
- Peter Medawar Building for Pathogen Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- NDM Centre For Global Health Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Mohammad Ali
- Peter Medawar Building for Pathogen Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- NDM Centre For Global Health Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Barbara Kronsteiner
- Peter Medawar Building for Pathogen Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- NDM Centre For Global Health Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Stephanie Longet
- Nuffield Department of Medicine, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Priyanka Abraham
- Peter Medawar Building for Pathogen Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- NDM Centre For Global Health Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Alexandra S. Deeks
- Peter Medawar Building for Pathogen Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Anthony Brown
- Peter Medawar Building for Pathogen Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Shona C. Moore
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Lizzie Stafford
- Nuffield Department of Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Susan L. Dobson
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Megan Plowright
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Thomas A. H. Newman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Mary Y. Wu
- Covid Surveillance Unit, The Francis Crick Institute, London, United Kingdom
| | - Crick COVID Immunity Pipeline
- Covid Surveillance Unit, The Francis Crick Institute, London, United Kingdom
- The Francis Crick Institute, London, United Kingdom
| | | | - Rupert Beale
- The Francis Crick Institute, London, United Kingdom
- UCL Department of Renal Medicine, Royal Free Hospital, London, United Kingdom
| | | | | | | | - Adriana Tomic
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, Massachusetts, USA
- Department of Microbiology, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Rebecca P. Payne
- Translational and Clinical Research Institute Immunity and Inflammation Theme, Newcastle University, Newcastle, United Kingdom
| | - Eleanor Barnes
- Peter Medawar Building for Pathogen Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Translational Gastroenterology Unit, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Alex Richter
- Institute of Immunology and Immunotherapy, College of Medical and Dental Science, University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Christopher J. A. Duncan
- Translational and Clinical Research Institute Immunity and Inflammation Theme, Newcastle University, Newcastle, United Kingdom
- Department of Infection and Tropical Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Lance Turtle
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Thushan I. de Silva
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Miles Carroll
- Nuffield Department of Medicine, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Teresa Lambe
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
- Chinese Academy of Medical Science (CAMS) Oxford Institute (COI), University of Oxford, Oxford, United Kingdom
| | - Paul Klenerman
- Peter Medawar Building for Pathogen Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Translational Gastroenterology Unit, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Susanna Dunachie
- Peter Medawar Building for Pathogen Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- NDM Centre For Global Health Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - On behalf of the PITCH Consortium
- Peter Medawar Building for Pathogen Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- NDM Centre For Global Health Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Nuffield Department of Medicine, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Covid Surveillance Unit, The Francis Crick Institute, London, United Kingdom
- The Francis Crick Institute, London, United Kingdom
- UCL Department of Renal Medicine, Royal Free Hospital, London, United Kingdom
- UK Health Security Agency, Porton Down, United Kingdom
- UK Health Security Agency, London, United Kingdom
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, Massachusetts, USA
- Department of Microbiology, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
- Translational and Clinical Research Institute Immunity and Inflammation Theme, Newcastle University, Newcastle, United Kingdom
- Translational Gastroenterology Unit, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Institute of Immunology and Immunotherapy, College of Medical and Dental Science, University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Department of Infection and Tropical Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Chinese Academy of Medical Science (CAMS) Oxford Institute (COI), University of Oxford, Oxford, United Kingdom
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4
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Whitaker HJ, Tsang RSM, Byford R, Aspden C, Button E, Sebastian Pillai P, Jamie G, Kar D, Williams J, Sinnathamby M, Marsden G, Elson WH, Leston M, Anand S, Okusi C, Fan X, Linley E, Rowe C, DArcangelo S, Otter AD, Ellis J, Hobbs FDR, Tzortziou-Brown V, Zambon M, Ramsay M, Brown KE, Amirthalingam G, Andrews NJ, de Lusignan S, Lopez Bernal J. COVID-19 vaccine effectiveness against hospitalisation and death of people in clinical risk groups during the Delta variant period: English primary care network cohort study. J Infect 2023; 87:315-327. [PMID: 37579793 DOI: 10.1016/j.jinf.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND COVID-19 vaccines have been shown to be highly effective against hospitalisation and death following COVID-19 infection. COVID-19 vaccine effectiveness estimates against severe endpoints among individuals with clinical conditions that place them at increased risk of critical disease are limited. METHODS We used English primary care medical record data from the Oxford-Royal College of General Practitioners Research and Surveillance Centre sentinel network (N > 18 million). Data were linked to the National Immunisation Management Service database, Second Generation Surveillance System for virology test data, Hospital Episode Statistics, and death registry data. We estimated adjusted vaccine effectiveness (aVE) against COVID-19 infection followed by hospitalisation and death among individuals in specific clinical risk groups using a cohort design during the delta-dominant period. We also report mortality statistics and results from our antibody surveillance in this population. FINDINGS aVE against severe endpoints was high, 14-69d following a third dose aVE was 96.4% (95.1%-97.4%) and 97.9% (97.2%-98.4%) for clinically vulnerable people given a Vaxzevria and Comirnaty primary course respectively. Lower aVE was observed in the immunosuppressed group: 88.6% (79.1%-93.8%) and 91.9% (85.9%-95.4%) for Vaxzevria and Comirnaty respectively. Antibody levels were significantly lower among the immunosuppressed group than those not in this risk group across all vaccination types and doses. The standardised case fatality rate within 28 days of a positive test was 3.9/1000 in people not in risk groups, compared to 12.8/1000 in clinical risk groups. Waning aVE with time since 2nd dose was also demonstrated, for example, Comirnaty aVE against hospitalisation reduced from 96.0% (95.1-96.7%) 14-69days post-dose 2-82.9% (81.4-84.2%) 182days+ post-dose 2. INTERPRETATION In all clinical risk groups high levels of vaccine effectiveness against severe endpoints were seen. Reduced vaccine effectiveness was noted among the immunosuppressed group.
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Affiliation(s)
- Heather J Whitaker
- Statistics, Modelling and Economics Department, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Ruby S M Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Carole Aspden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Elizabeth Button
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | | | - Gavin Jamie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Debasish Kar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Mary Sinnathamby
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Gemma Marsden
- Royal College of General Practitioners Research and Surveillance Centre, Euston Square, London NW1 2FB, UK
| | - William H Elson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Meredith Leston
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Sneha Anand
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Cecilia Okusi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Xuejuan Fan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Ezra Linley
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester M13 9WL, UK
| | - Cathy Rowe
- Diagnostics and Genomics, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Silvia DArcangelo
- Diagnostics and Genomics, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Ashley D Otter
- Diagnostics and Genomics, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Joanna Ellis
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK; Virus Reference Laboratory, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Victoria Tzortziou-Brown
- Royal College of General Practitioners Research and Surveillance Centre, Euston Square, London NW1 2FB, UK
| | - Maria Zambon
- Virus Reference Laboratory, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Mary Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Kevin E Brown
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Nick J Andrews
- Statistics, Modelling and Economics Department, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK; Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; Royal College of General Practitioners Research and Surveillance Centre, Euston Square, London NW1 2FB, UK
| | - Jamie Lopez Bernal
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK.
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5
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Otter AD, Jones S, Hicks B, Bailey D, Callaby H, Houlihan C, Rampling T, Gordon NC, Selman H, Satheshkumar PS, Townsend M, Mehta R, Pond M, Jones R, Wright D, Oeser C, Tonge S, Linley E, Hemingway G, Coleman T, Millward S, Lloyd A, Damon I, Brooks T, Vipond R, Rowe C, Hallis B. Monkeypox virus-infected individuals mount comparable humoral immune responses as Smallpox-vaccinated individuals. Nat Commun 2023; 14:5948. [PMID: 37741831 PMCID: PMC10517934 DOI: 10.1038/s41467-023-41587-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023] Open
Abstract
In early 2022, a cluster of monkeypox virus (MPXV) infection (mpox) cases were identified within the UK with no prior travel history to MPXV-endemic regions. Subsequently, case numbers exceeding 80,000 were reported worldwide, primarily affecting gay, bisexual, and other men who have sex with men (GBMSM). Public health agencies worldwide have offered the IMVANEX Smallpox vaccination to these individuals at high-risk to provide protection and limit the spread of MPXV. We have developed a comprehensive array of ELISAs to study poxvirus-induced antibodies, utilising 24 MPXV and 3 Vaccinia virus (VACV) recombinant antigens. Panels of serum samples from individuals with differing Smallpox-vaccine doses and those with prior MPXV infection were tested on these assays, where we observed that one dose of Smallpox vaccination induces a low number of antibodies to a limited number of MPXV antigens but increasing with further vaccination doses. MPXV infection induced similar antibody responses to diverse poxvirus antigens observed in Smallpox-vaccinated individuals. We identify MPXV A27 as a serological marker of MPXV-infection, whilst MPXV M1 (VACV L1) is likely IMVANEX-specific. Here, we demonstrate analogous humoral antigen recognition between both MPXV-infected or Smallpox-vaccinated individuals, with binding to diverse yet core set of poxvirus antigens, providing opportunities for future vaccine (e.g., mRNA) and therapeutic (e.g., mAbs) design.
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Affiliation(s)
- Ashley D Otter
- Emerging Pathogen Serology group, UK Health Security Agency, Porton Down, Wiltshire, UK.
| | - Scott Jones
- Emerging Pathogen Serology group, UK Health Security Agency, Porton Down, Wiltshire, UK
| | - Bethany Hicks
- Emerging Pathogen Serology group, UK Health Security Agency, Porton Down, Wiltshire, UK
| | - Daniel Bailey
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Wiltshire, UK
| | - Helen Callaby
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Wiltshire, UK
| | - Catherine Houlihan
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Wiltshire, UK
- Department of Infection and Immunity, University College London, London, UK
| | - Tommy Rampling
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Wiltshire, UK
- The Hospital for Tropical Diseases, University College London Hospital, London, UK
- NIHR University College London Hospitals BRC, London, UK
| | - Nicola Claire Gordon
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Wiltshire, UK
| | - Hannah Selman
- Emerging Pathogen Serology group, UK Health Security Agency, Porton Down, Wiltshire, UK
| | | | - Michael Townsend
- Poxvirus and Rabies Branch, Centre for Disease Control and Prevention, Atlanta, GA, USA
| | - Ravi Mehta
- Imperial College Healthcare NHS Trust, London, UK
| | - Marcus Pond
- Imperial College Healthcare NHS Trust, London, UK
| | - Rachael Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Deborah Wright
- Research and Development, UK Health Security Agency, Porton Down, Wiltshire, UK
| | - Clarissa Oeser
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, Colindale, London, UK
| | - Simon Tonge
- Seroepidemiology Unit, UK Health Security Agency, Manchester, UK
| | - Ezra Linley
- Seroepidemiology Unit, UK Health Security Agency, Manchester, UK
| | - Georgia Hemingway
- Emerging Pathogen Serology group, UK Health Security Agency, Porton Down, Wiltshire, UK
| | - Tom Coleman
- Emerging Pathogen Serology group, UK Health Security Agency, Porton Down, Wiltshire, UK
| | - Sebastian Millward
- Emerging Pathogen Serology group, UK Health Security Agency, Porton Down, Wiltshire, UK
| | - Aaron Lloyd
- Emerging Pathogen Serology group, UK Health Security Agency, Porton Down, Wiltshire, UK
| | - Inger Damon
- Poxvirus and Rabies Branch, Centre for Disease Control and Prevention, Atlanta, GA, USA
| | - Tim Brooks
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Wiltshire, UK
| | - Richard Vipond
- Research and Development, UK Health Security Agency, Porton Down, Wiltshire, UK
| | - Cathy Rowe
- Emerging Pathogen Serology group, UK Health Security Agency, Porton Down, Wiltshire, UK
| | - Bassam Hallis
- Research and Development, UK Health Security Agency, Porton Down, Wiltshire, UK
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6
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Altmann DM, Reynolds CJ, Joy G, Otter AD, Gibbons JM, Pade C, Swadling L, Maini MK, Brooks T, Semper A, McKnight Á, Noursadeghi M, Manisty C, Treibel TA, Moon JC, Boyton RJ. Persistent symptoms after COVID-19 are not associated with differential SARS-CoV-2 antibody or T cell immunity. Nat Commun 2023; 14:5139. [PMID: 37612310 PMCID: PMC10447583 DOI: 10.1038/s41467-023-40460-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 07/27/2023] [Indexed: 08/25/2023] Open
Abstract
Among the unknowns in decoding the pathogenesis of SARS-CoV-2 persistent symptoms in Long Covid is whether there is a contributory role of abnormal immunity during acute infection. It has been proposed that Long Covid is a consequence of either an excessive or inadequate initial immune response. Here, we analyze SARS-CoV-2 humoral and cellular immunity in 86 healthcare workers with laboratory confirmed mild or asymptomatic SARS-CoV-2 infection during the first wave. Symptom questionnaires allow stratification into those with persistent symptoms and those without for comparison. During the period up to 18-weeks post-infection, we observe no difference in antibody responses to spike RBD or nucleoprotein, virus neutralization, or T cell responses. Also, there is no difference in the profile of antibody waning. Analysis at 1-year, after two vaccine doses, comparing those with persistent symptoms to those without, again shows similar SARS-CoV-2 immunity. Thus, quantitative differences in these measured parameters of SARS-CoV-2 adaptive immunity following mild or asymptomatic acute infection are unlikely to have contributed to Long Covid causality. ClinicalTrials.gov (NCT04318314).
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Affiliation(s)
- Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK.
| | | | - George Joy
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Joseph M Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Corinna Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Leo Swadling
- Division of Infection and Immunity, University College London, London, UK
| | - Mala K Maini
- Division of Infection and Immunity, University College London, London, UK
| | - Tim Brooks
- UK Health Security Agency, Porton Down, UK
| | | | - Áine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Charlotte Manisty
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Thomas A Treibel
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, London, UK.
- Lung Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Martin CA, Nazareth J, Jarkhi A, Pan D, Das M, Logan N, Scott S, Bryant L, Abeywickrama N, Adeoye O, Ahmed A, Asif A, Bandi S, George N, Gohar M, Gray LJ, Kaszuba R, Mangwani J, Martin M, Moorthy A, Renals V, Teece L, Vail D, Khunti K, Moss P, Tattersall A, Hallis B, Otter AD, Rowe C, Willett BJ, Haldar P, Cooper A, Pareek M. Ethnic differences in cellular and humoral immune responses to SARS-CoV-2 vaccination in UK healthcare workers: a cross-sectional analysis. EClinicalMedicine 2023; 58:101926. [PMID: 37034357 PMCID: PMC10071048 DOI: 10.1016/j.eclinm.2023.101926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 04/07/2023] Open
Abstract
Background Few studies have compared SARS-CoV-2 vaccine immunogenicity by ethnic group. We sought to establish whether cellular and humoral immune responses to SARS-CoV-2 vaccination differ according to ethnicity in UK Healthcare workers (HCWs). Methods In this cross-sectional analysis, we used baseline data from two immunological cohort studies conducted in HCWs in Leicester, UK. Blood samples were collected between March 3, and September 16, 2021. We excluded HCW who had not received two doses of SARS-CoV-2 vaccine at the time of sampling and those who had serological evidence of previous SARS-CoV-2 infection. Outcome measures were SARS-CoV-2 spike-specific total antibody titre, neutralising antibody titre and ELISpot count. We compared our outcome measures by ethnic group using univariable (t tests and rank-sum tests depending on distribution) and multivariable (linear regression for antibody titres and negative binomial regression for ELISpot counts) tests. Multivariable analyses were adjusted for age, sex, vaccine type, length of interval between vaccine doses and time between vaccine administration and sample collection and expressed as adjusted geometric mean ratios (aGMRs) or adjusted incidence rate ratios (aIRRs). To assess differences in the early immune response to vaccination we also conducted analyses in a subcohort who provided samples between 14 and 50 days after their second dose of vaccine. Findings The total number of HCWs in each analysis were 401 for anti-spike antibody titres, 345 for neutralising antibody titres and 191 for ELISpot. Overall, 25.4% (19.7% South Asian and 5.7% Black/Mixed/Other) were from ethnic minority groups. In analyses including the whole cohort, neutralising antibody titres were higher in South Asian HCWs than White HCWs (aGMR 1.47, 95% CI [1.06-2.06], P = 0.02) as were T cell responses to SARS-CoV-2 S1 peptides (aIRR 1.75, 95% CI [1.05-2.89], P = 0.03). In a subcohort sampled between 14 and 50 days after second vaccine dose, SARS-CoV-2 spike-specific antibody and neutralising antibody geometric mean titre (GMT) was higher in South Asian HCWs compared to White HCWs (9616 binding antibody units (BAU)/ml, 95% CI [7178-12,852] vs 5888 BAU/ml [5023-6902], P = 0.008 and 2851 95% CI [1811-4487] vs 1199 [984-1462], P < 0.001 respectively), increments which persisted after adjustment (aGMR 1.26, 95% CI [1.01-1.58], P = 0.04 and aGMR 2.01, 95% CI [1.34-3.01], P = 0.001). SARS-CoV-2 ELISpot responses to S1 and whole spike peptides (S1 + S2 response) were higher in HCWs from South Asian ethnic groups than those from White groups (S1: aIRR 2.33, 95% CI [1.09-4.94], P = 0.03; spike: aIRR, 2.04, 95% CI [1.02-4.08]). Interpretation This study provides evidence that, in an infection naïve cohort, humoral and cellular immune responses to SARS-CoV-2 vaccination are stronger in South Asian HCWs than White HCWs. These differences are most clearly seen in the early period following vaccination. Further research is required to understand the underlying mechanisms, whether differences persist with further exposure to vaccine or virus, and the potential impact on vaccine effectiveness. Funding DIRECT and BELIEVE have received funding from UK Research and Innovation (UKRI) through the COVID-19 National Core Studies Immunity (NCSi) programme (MC_PC_20060).
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Affiliation(s)
- Christopher A. Martin
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
- Leicester NIHR Biomedical Research Centre, Leicester, UK
| | - Joshua Nazareth
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
- Leicester NIHR Biomedical Research Centre, Leicester, UK
| | - Amar Jarkhi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
- Leicester NIHR Biomedical Research Centre, Leicester, UK
- Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, UK
| | - Mrinal Das
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Nicola Logan
- University of Glasgow Centre for Virus Research, University of Glasgow, Bearsden Road, Glasgow, UK
| | - Sam Scott
- University of Glasgow Centre for Virus Research, University of Glasgow, Bearsden Road, Glasgow, UK
| | - Luke Bryant
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Leicester NIHR Biomedical Research Centre, Leicester, UK
| | | | - Oluwatobi Adeoye
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Aleem Ahmed
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Aqua Asif
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Srini Bandi
- Department of Paediatrics, Leicester Royal Infirmary, Leicester, UK
| | - Nisha George
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Marjan Gohar
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Laura J. Gray
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Ross Kaszuba
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Jitendra Mangwani
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - Marianne Martin
- Children's Intensive Care Unit, Leicester Children's Hospital, Leicester, UK
| | - Arumugam Moorthy
- Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, UK
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Valerie Renals
- Research Space, University Hospitals of Leicester NHS Trust, UK
| | - Lucy Teece
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Denny Vail
- Research Space, University Hospitals of Leicester NHS Trust, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Bassam Hallis
- UK Health Security Agency, Porton Down, Salisbury, UK
| | | | - Cathy Rowe
- UK Health Security Agency, Porton Down, Salisbury, UK
| | - Brian J. Willett
- University of Glasgow Centre for Virus Research, University of Glasgow, Bearsden Road, Glasgow, UK
| | - Pranab Haldar
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Andrea Cooper
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Leicester NIHR Biomedical Research Centre, Leicester, UK
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
- Leicester NIHR Biomedical Research Centre, Leicester, UK
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8
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Atti A, Insalata F, Carr EJ, Otter AD, Castillo-Olivares J, Wu M, Harvey R, Howell M, Chan A, Lyall J, Temperton N, Cantoni D, da Costa K, Nadesalingam A, Taylor-Kerr A, Hettiarachchi N, Tranquillini C, Hewson J, Cole MJ, Foulkes S, Munro K, Monk EJM, Milligan ID, Linley E, Chand MA, Brown CS, Islam J, Semper A, Charlett A, Heeney JL, Beale R, Zambon M, Hopkins S, Brooks T, Hall V. Antibody correlates of protection from SARS-CoV-2 reinfection prior to vaccination: A nested case-control within the SIREN study. J Infect 2022; 85:545-556. [PMID: 36089104 PMCID: PMC9458758 DOI: 10.1016/j.jinf.2022.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/05/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To investigate serological differences between SARS-CoV-2 reinfection cases and contemporary controls, to identify antibody correlates of protection against reinfection. METHODS We performed a case-control study, comparing reinfection cases with singly infected individuals pre-vaccination, matched by gender, age, region and timing of first infection. Serum samples were tested for anti-SARS-CoV-2 spike (anti-S), anti-SARS-CoV-2 nucleocapsid (anti-N), live virus microneutralisation (LV-N) and pseudovirus microneutralisation (PV-N). Results were analysed using fixed effect linear regression and fitted into conditional logistic regression models. RESULTS We identified 23 cases and 92 controls. First infections occurred before November 2020; reinfections occurred before February 2021, pre-vaccination. Anti-S levels, LV-N and PV-N titres were significantly lower among cases; no difference was found for anti-N levels. Increasing anti-S levels were associated with reduced risk of reinfection (OR 0·63, CI 0·47-0·85), but no association for anti-N levels (OR 0·88, CI 0·73-1·05). Titres >40 were correlated with protection against reinfection for LV-N Wuhan (OR 0·02, CI 0·001-0·31) and LV-N Alpha (OR 0·07, CI 0·009-0·62). For PV-N, titres >100 were associated with protection against Wuhan (OR 0·14, CI 0·03-0·64) and Alpha (0·06, CI 0·008-0·40). CONCLUSIONS Before vaccination, protection against SARS-CoV-2 reinfection was directly correlated with anti-S levels, PV-N and LV-N titres, but not with anti-N levels. Detectable LV-N titres were sufficient for protection, whilst PV-N titres >100 were required for a protective effect. TRIAL REGISTRATION NUMBER ISRCTN11041050.
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Affiliation(s)
- Ana Atti
- UK Health Security Agency, Smith Square, London SW1P, UK.
| | | | - Edward J Carr
- The Francis Crick Institute, 1 Midland Rd, London NW1 1AT, UK
| | - Ashley D Otter
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Javier Castillo-Olivares
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge University, Madingley Road, Cambridge CB3 0ES, UK
| | - Mary Wu
- The Francis Crick Institute, 1 Midland Rd, London NW1 1AT, UK
| | - Ruth Harvey
- The Francis Crick Institute, 1 Midland Rd, London NW1 1AT, UK
| | - Michael Howell
- The Francis Crick Institute, 1 Midland Rd, London NW1 1AT, UK
| | - Andrew Chan
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge University, Madingley Road, Cambridge CB3 0ES, UK
| | - Jonathan Lyall
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge University, Madingley Road, Cambridge CB3 0ES, UK
| | - Nigel Temperton
- Viral Pseudotype Unit, Medway School of Pharmacy, Universities of Greenwich and Kent at Medway, Central Ave, Gillingham, Chatham ME4 4BF, UK
| | - Diego Cantoni
- Viral Pseudotype Unit, Medway School of Pharmacy, Universities of Greenwich and Kent at Medway, Central Ave, Gillingham, Chatham ME4 4BF, UK
| | - Kelly da Costa
- Viral Pseudotype Unit, Medway School of Pharmacy, Universities of Greenwich and Kent at Medway, Central Ave, Gillingham, Chatham ME4 4BF, UK
| | - Angalee Nadesalingam
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge University, Madingley Road, Cambridge CB3 0ES, UK
| | | | | | | | | | | | - Sarah Foulkes
- UK Health Security Agency, Smith Square, London SW1P, UK
| | - Katie Munro
- UK Health Security Agency, Smith Square, London SW1P, UK
| | | | | | - Ezra Linley
- Manchester Royal Infirmary, UK Health Security Agency, Oxford Road, Manchester M139WL, UK
| | - Meera A Chand
- UK Health Security Agency, Smith Square, London SW1P, UK
| | - Colin S Brown
- UK Health Security Agency, Smith Square, London SW1P, UK; The National Institute for Health Research Health Protection Research (NIHR) Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Old Road Campus, Headington, Oxford OX3 7BN, UK
| | - Jasmin Islam
- UK Health Security Agency, Smith Square, London SW1P, UK
| | - Amanda Semper
- UK Health Security Agency, Smith Square, London SW1P, UK
| | - Andre Charlett
- UK Health Security Agency, Smith Square, London SW1P, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol in partnership with Public Health England, Queens Road, Bristol BS8 1QU, UK; NIHR Health Protection Research Unit in Immunisation at the London School of Hygiene and Tropical Medicine in partnership with Public Health England, Keppel St, London WC1E 7HT, UK
| | | | - Rupert Beale
- The Francis Crick Institute, 1 Midland Rd, London NW1 1AT, UK
| | - Maria Zambon
- UK Health Security Agency, Smith Square, London SW1P, UK
| | - Susan Hopkins
- UK Health Security Agency, Smith Square, London SW1P, UK; The National Institute for Health Research Health Protection Research (NIHR) Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Old Road Campus, Headington, Oxford OX3 7BN, UK
| | - Tim Brooks
- UK Health Security Agency, Smith Square, London SW1P, UK
| | - Victoria Hall
- UK Health Security Agency, Smith Square, London SW1P, UK; The National Institute for Health Research Health Protection Research (NIHR) Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Old Road Campus, Headington, Oxford OX3 7BN, UK
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9
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Reynolds CJ, Pade C, Gibbons JM, Otter AD, Lin KM, Muñoz Sandoval D, Pieper FP, Butler DK, Liu S, Joy G, Forooghi N, Treibel TA, Manisty C, Moon JC, Semper A, Brooks T, McKnight Á, Altmann DM, Boyton RJ, Abbass H, Abiodun A, Alfarih M, Alldis Z, Altmann DM, Amin OE, Andiapen M, Artico J, Augusto JB, Baca GL, Bailey SNL, Bhuva AN, Boulter A, Bowles R, Boyton RJ, Bracken OV, O'Brien B, Brooks T, Bullock N, Butler DK, Captur G, Carr O, Champion N, Chan C, Chandran A, Coleman T, Couto de Sousa J, Couto-Parada X, Cross E, Cutino-Moguel T, D'Arcangelo S, Davies RH, Douglas B, Di Genova C, Dieobi-Anene K, Diniz MO, Ellis A, Feehan K, Finlay M, Fontana M, Forooghi N, Francis S, Gibbons JM, Gillespie D, Gilroy D, Hamblin M, Harker G, Hemingway G, Hewson J, Heywood W, Hickling LM, Hicks B, Hingorani AD, Howes L, Itua I, Jardim V, Lee WYJ, Jensen M, Jones J, Jones M, Joy G, Kapil V, Kelly C, Kurdi H, Lambourne J, Lin KM, Liu S, Lloyd A, Louth S, Maini MK, Mandadapu V, Manisty C, McKnight Á, Menacho K, Mfuko C, Mills K, Millward S, Mitchelmore O, Moon C, Moon J, Muñoz Sandoval D, Murray SM, Noursadeghi M, Otter A, Pade C, Palma S, Parker R, Patel K, Pawarova M, Petersen SE, Piniera B, Pieper FP, Rannigan L, Rapala A, Reynolds CJ, Richards A, Robathan M, Rosenheim J, Rowe C, Royds M, Sackville West J, Sambile G, Schmidt NM, Selman H, Semper A, Seraphim A, Simion M, Smit A, Sugimoto M, Swadling L, Taylor S, Temperton N, Thomas S, Thornton GD, Treibel TA, Tucker A, Varghese A, Veerapen J, Vijayakumar M, Warner T, Welch S, White H, Wodehouse T, Wynne L, Zahedi D, Chain B, Moon JC. Immune boosting by B.1.1.529 (Omicron) depends on previous SARS-CoV-2 exposure. Science 2022; 377:eabq1841. [PMID: 35699621 PMCID: PMC9210451 DOI: 10.1126/science.abq1841] [Citation(s) in RCA: 185] [Impact Index Per Article: 92.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/06/2022] [Indexed: 12/15/2022]
Abstract
The Omicron, or Pango lineage B.1.1.529, variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) carries multiple spike mutations with high transmissibility and partial neutralizing antibody (nAb) escape. Vaccinated individuals show protection against severe disease, often attributed to primed cellular immunity. We investigated T and B cell immunity against B.1.1.529 in triple BioNTech BNT162b2 messenger RNA-vaccinated health care workers (HCWs) with different SARS-CoV-2 infection histories. B and T cell immunity against previous variants of concern was enhanced in triple-vaccinated individuals, but the magnitude of T and B cell responses against B.1.1.529 spike protein was reduced. Immune imprinting by infection with the earlier B.1.1.7 (Alpha) variant resulted in less durable binding antibody against B.1.1.529. Previously infection-naïve HCWs who became infected during the B.1.1.529 wave showed enhanced immunity against earlier variants but reduced nAb potency and T cell responses against B.1.1.529 itself. Previous Wuhan Hu-1 infection abrogated T cell recognition and any enhanced cross-reactive neutralizing immunity on infection with B.1.1.529.
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Affiliation(s)
| | - Corinna Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Joseph M Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Kai-Min Lin
- Department of Infectious Disease, Imperial College London, London, UK
| | | | | | - David K Butler
- Department of Infectious Disease, Imperial College London, London, UK
| | - Siyi Liu
- Department of Infectious Disease, Imperial College London, London, UK
| | - George Joy
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Nasim Forooghi
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Thomas A Treibel
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Charlotte Manisty
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | | | | | | | - Tim Brooks
- UK Health Security Agency, Porton Down, UK
| | - Áine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, London, UK.,Lung Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
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10
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Hall V, Foulkes S, Insalata F, Kirwan P, Saei A, Atti A, Wellington E, Khawam J, Munro K, Cole M, Tranquillini C, Taylor-Kerr A, Hettiarachchi N, Calbraith D, Sajedi N, Milligan I, Themistocleous Y, Corrigan D, Cromey L, Price L, Stewart S, de Lacy E, Norman C, Linley E, Otter AD, Semper A, Hewson J, D'Arcangelo S, Chand M, Brown CS, Brooks T, Islam J, Charlett A, Hopkins S. Protection against SARS-CoV-2 after Covid-19 Vaccination and Previous Infection. N Engl J Med 2022; 386:1207-1220. [PMID: 35172051 PMCID: PMC8908850 DOI: 10.1056/nejmoa2118691] [Citation(s) in RCA: 362] [Impact Index Per Article: 181.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The duration and effectiveness of immunity from infection with and vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are relevant to pandemic policy interventions, including the timing of vaccine boosters. METHODS We investigated the duration and effectiveness of immunity in a prospective cohort of asymptomatic health care workers in the United Kingdom who underwent routine polymerase-chain-reaction (PCR) testing. Vaccine effectiveness (≤10 months after the first dose of vaccine) and infection-acquired immunity were assessed by comparing the time to PCR-confirmed infection in vaccinated persons with that in unvaccinated persons, stratified according to previous infection status. We used a Cox regression model with adjustment for previous SARS-CoV-2 infection status, vaccine type and dosing interval, demographic characteristics, and workplace exposure to SARS-CoV-2. RESULTS Of 35,768 participants, 27% (9488) had a previous SARS-CoV-2 infection. Vaccine coverage was high: 95% of the participants had received two doses (78% had received BNT162b2 vaccine [Pfizer-BioNTech] with a long interval between doses, 9% BNT162b2 vaccine with a short interval between doses, and 8% ChAdOx1 nCoV-19 vaccine [AstraZeneca]). Between December 7, 2020, and September 21, 2021, a total of 2747 primary infections and 210 reinfections were observed. Among previously uninfected participants who received long-interval BNT162b2 vaccine, adjusted vaccine effectiveness decreased from 85% (95% confidence interval [CI], 72 to 92) 14 to 73 days after the second dose to 51% (95% CI, 22 to 69) at a median of 201 days (interquartile range, 197 to 205) after the second dose; this effectiveness did not differ significantly between the long-interval and short-interval BNT162b2 vaccine recipients. At 14 to 73 days after the second dose, adjusted vaccine effectiveness among ChAdOx1 nCoV-19 vaccine recipients was 58% (95% CI, 23 to 77) - considerably lower than that among BNT162b2 vaccine recipients. Infection-acquired immunity waned after 1 year in unvaccinated participants but remained consistently higher than 90% in those who were subsequently vaccinated, even in persons infected more than 18 months previously. CONCLUSIONS Two doses of BNT162b2 vaccine were associated with high short-term protection against SARS-CoV-2 infection; this protection waned considerably after 6 months. Infection-acquired immunity boosted with vaccination remained high more than 1 year after infection. (Funded by the U.K. Health Security Agency and others; ISRCTN Registry number, ISRCTN11041050.).
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Affiliation(s)
- Victoria Hall
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Sarah Foulkes
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Ferdinando Insalata
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Peter Kirwan
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Ayoub Saei
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Ana Atti
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Edgar Wellington
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Jameel Khawam
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Katie Munro
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Michelle Cole
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Caio Tranquillini
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Andrew Taylor-Kerr
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Nipunadi Hettiarachchi
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Davina Calbraith
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Noshin Sajedi
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Iain Milligan
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Yrene Themistocleous
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Diane Corrigan
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Lisa Cromey
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Lesley Price
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Sally Stewart
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Elen de Lacy
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Chris Norman
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Ezra Linley
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Ashley D Otter
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Amanda Semper
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Jacqueline Hewson
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Silvia D'Arcangelo
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Meera Chand
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Colin S Brown
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Tim Brooks
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Jasmin Islam
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Andre Charlett
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
| | - Susan Hopkins
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy's and St. Thomas' NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, in partnership with Public Health England, Bristol (A.C.) - all in the United Kingdom
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11
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Reynolds CJ, Gibbons JM, Pade C, Lin KM, Sandoval DM, Pieper F, Butler DK, Liu S, Otter AD, Joy G, Menacho K, Fontana M, Smit A, Kele B, Cutino-Moguel T, Maini MK, Noursadeghi M, Brooks T, Semper A, Manisty C, Treibel TA, Moon JC, McKnight Á, Altmann DM, Boyton RJ. Heterologous infection and vaccination shapes immunity against SARS-CoV-2 variants. Science 2022; 375:183-192. [PMID: 34855510 PMCID: PMC10186585 DOI: 10.1126/science.abm0811] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/25/2021] [Indexed: 12/15/2022]
Abstract
The impact of the initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infecting strain on downstream immunity to heterologous variants of concern (VOCs) is unknown. Studying a longitudinal healthcare worker cohort, we found that after three antigen exposures (infection plus two vaccine doses), S1 antibody, memory B cells, and heterologous neutralization of B.1.351, P.1, and B.1.617.2 plateaued, whereas B.1.1.7 neutralization and spike T cell responses increased. Serology using the Wuhan Hu-1 spike receptor binding domain poorly predicted neutralizing immunity against VOCs. Neutralization potency against VOCs changed with heterologous virus encounter and number of antigen exposures. Neutralization potency fell differentially depending on targeted VOCs over the 5 months from the second vaccine dose. Heterologous combinations of spike encountered during infection and vaccination shape subsequent cross-protection against VOC, with implications for future-proof next-generation vaccines.
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Affiliation(s)
| | - Joseph M. Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Corinna Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kai-Min Lin
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - Franziska Pieper
- Department of Infectious Disease, Imperial College London, London, UK
| | - David K. Butler
- Department of Infectious Disease, Imperial College London, London, UK
| | - Siyi Liu
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - George Joy
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
| | - Katia Menacho
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
| | | | | | - Beatrix Kele
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
| | | | - Mala K. Maini
- Division of Infection and Immunity, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - COVIDsortium Immune Correlates Network‡
- Department of Infectious Disease, Imperial College London, London, UK
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- UK Health Security Agency, Porton Down, UK
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Royal Free London NHS Foundation Trust, London, UK
- Division of Infection and Immunity, University College London, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Immunology and Inflammation, Imperial College London, London, UK
- Lung Division, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Tim Brooks
- UK Health Security Agency, Porton Down, UK
| | | | - Charlotte Manisty
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Thomas A. Treibel
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - James C. Moon
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - COVIDsortium Investigators‡
- Department of Infectious Disease, Imperial College London, London, UK
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- UK Health Security Agency, Porton Down, UK
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Royal Free London NHS Foundation Trust, London, UK
- Division of Infection and Immunity, University College London, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Immunology and Inflammation, Imperial College London, London, UK
- Lung Division, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Áine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Daniel M. Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Rosemary J. Boyton
- Department of Infectious Disease, Imperial College London, London, UK
- Lung Division, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
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12
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Whitaker HJ, Tsang RS, Byford R, Andrews NJ, Sherlock J, Pillai PS, Williams J, Button E, Campbell H, Sinnathamby M, Victor W, Anand S, Linley E, Hewson J, DArchangelo S, Otter AD, Ellis J, Hobbs RF, Howsam G, Zambon M, Ramsay M, Brown KE, de Lusignan S, Amirthalingam G, Bernal JL. Pfizer-BioNTech and Oxford AstraZeneca COVID-19 vaccine effectiveness and immune response among individuals in clinical risk groups. J Infect 2022; 84:675-683. [PMID: 34990709 PMCID: PMC8720678 DOI: 10.1016/j.jinf.2021.12.044] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 01/30/2023]
Abstract
Background COVID-19 vaccines approved in the UK are highly effective in general population cohorts, however, data on effectiveness amongst individuals with clinical conditions that place them at increased risk of severe disease are limited. Methods We used GP electronic health record data, sentinel virology swabbing and antibody testing within a cohort of 712 general practices across England to estimate vaccine antibody response and vaccine effectiveness against medically attended COVID-19 amongst individuals in clinical risk groups using cohort and test-negative case control designs. Findings There was no reduction in S-antibody positivity in most clinical risk groups, however reduced S-antibody positivity and response was significant in the immunosuppressed group. Reduced vaccine effectiveness against clinical disease was also noted in the immunosuppressed group; after a second dose, effectiveness was moderate (Pfizer: 59.6%, 95%CI 18.0–80.1%; AstraZeneca 60.0%, 95%CI -63.6–90.2%). Interpretation In most clinical risk groups, immune response to primary vaccination was maintained and high levels of vaccine effectiveness were seen. Reduced antibody response and vaccine effectiveness were seen after 1 dose of vaccine amongst a broad immunosuppressed group, and second dose vaccine effectiveness was moderate. These findings support maximising coverage in immunosuppressed individuals and the policy of prioritisation of this group for third doses.
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Affiliation(s)
- Heather J Whitaker
- Statistics, Modelling and Economics Department, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Ruby Sm Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Nick J Andrews
- Statistics, Modelling and Economics Department, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK; Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Julian Sherlock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Praveen Sebastian Pillai
- Virus Reference Laboratory, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Elizabeth Button
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Helen Campbell
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Mary Sinnathamby
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - William Victor
- Royal College of General Practitioners Research and Surveillance Centre, Euston Square, London, NW1 2FB
| | - Sneha Anand
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Ezra Linley
- Vaccine Evaluation Unit, UK Health Security Agency (formerly Public Health England)), Manchester M13 9WL, UK
| | - Jacqueline Hewson
- Diagnostics and Genomics, UK Health Security Agency (formerly Public Health England), Porton Down, Salisbury SP4 0JG, UK
| | - Silvia DArchangelo
- Diagnostics and Genomics, UK Health Security Agency (formerly Public Health England), Porton Down, Salisbury SP4 0JG, UK
| | - Ashley D Otter
- Diagnostics and Genomics, UK Health Security Agency (formerly Public Health England), Porton Down, Salisbury SP4 0JG, UK
| | - Joanna Ellis
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK; Virus Reference Laboratory, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Richard Fd Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Gary Howsam
- Royal College of General Practitioners Research and Surveillance Centre, Euston Square, London, NW1 2FB
| | - Maria Zambon
- Virus Reference Laboratory, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Mary Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Kevin E Brown
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG; Royal College of General Practitioners Research and Surveillance Centre, Euston Square, London, NW1 2FB
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Jamie Lopez Bernal
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK.
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Castillo-Olivares J, Wells DA, Ferrari M, Chan ACY, Smith P, Nadesalingam A, Paloniemi M, Carnell GW, Ohlendorf L, Cantoni D, Mayora-Neto M, Palmer P, Tonks P, Temperton NJ, Peterhoff D, Neckermann P, Wagner R, Doffinger R, Kempster S, Otter AD, Semper A, Brooks T, Albecka A, James LC, Page M, Schwaeble W, Baxendale H, Heeney JL. Analysis of Serological Biomarkers of SARS-CoV-2 Infection in Convalescent Samples From Severe, Moderate and Mild COVID-19 Cases. Front Immunol 2021; 12:748291. [PMID: 34867975 PMCID: PMC8640495 DOI: 10.3389/fimmu.2021.748291] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/22/2021] [Indexed: 12/11/2022] Open
Abstract
Precision monitoring of antibody responses during the COVID-19 pandemic is increasingly important during large scale vaccine rollout and rise in prevalence of Severe Acute Respiratory Syndrome-related Coronavirus-2 (SARS-CoV-2) variants of concern (VOC). Equally important is defining Correlates of Protection (CoP) for SARS-CoV-2 infection and COVID-19 disease. Data from epidemiological studies and vaccine trials identified virus neutralising antibodies (Nab) and SARS-CoV-2 antigen-specific (notably RBD and S) binding antibodies as candidate CoP. In this study, we used the World Health Organisation (WHO) international standard to benchmark neutralising antibody responses and a large panel of binding antibody assays to compare convalescent sera obtained from: a) COVID-19 patients; b) SARS-CoV-2 seropositive healthcare workers (HCW) and c) seronegative HCW. The ultimate aim of this study is to identify biomarkers of humoral immunity that could be used to differentiate severe from mild or asymptomatic SARS-CoV-2 infections. Some of these biomarkers could be used to define CoP in further serological studies using samples from vaccination breakthrough and/or re-infection cases. Whenever suitable, the antibody levels of the samples studied were expressed in International Units (IU) for virus neutralisation assays or in Binding Antibody Units (BAU) for ELISA tests. In this work we used commercial and non-commercial antibody binding assays; a lateral flow test for detection of SARS-CoV-2-specific IgG/IgM; a high throughput multiplexed particle flow cytometry assay for SARS-CoV-2 Spike (S), Nucleocapsid (N) and Receptor Binding Domain (RBD) proteins); a multiplex antigen semi-automated immuno-blotting assay measuring IgM, IgA and IgG; a pseudotyped microneutralisation test (pMN) and an electroporation-dependent neutralisation assay (EDNA). Our results indicate that overall, severe COVID-19 patients showed statistically significantly higher levels of SARS-CoV-2-specific neutralising antibodies (average 1029 IU/ml) than those observed in seropositive HCW with mild or asymptomatic infections (379 IU/ml) and that clinical severity scoring, based on WHO guidelines was tightly correlated with neutralisation and RBD/S antibodies. In addition, there was a positive correlation between severity, N-antibody assays and intracellular virus neutralisation.
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Affiliation(s)
- Javier Castillo-Olivares
- Lab of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - David A. Wells
- Lab of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
- DIOSynVax, University of Cambridge, Cambridge, United Kingdom
| | - Matteo Ferrari
- Lab of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
- DIOSynVax, University of Cambridge, Cambridge, United Kingdom
| | - Andrew C. Y. Chan
- Lab of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Peter Smith
- Lab of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Angalee Nadesalingam
- Lab of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Minna Paloniemi
- Lab of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - George W. Carnell
- Lab of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Luis Ohlendorf
- Lab of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Diego Cantoni
- Viral Pseudotype Unit, Medway School of Pharmacy, University of Kent, Chatham, United Kingdom
| | - Martin Mayora-Neto
- Viral Pseudotype Unit, Medway School of Pharmacy, University of Kent, Chatham, United Kingdom
| | - Phil Palmer
- Lab of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Paul Tonks
- Lab of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Nigel J. Temperton
- Viral Pseudotype Unit, Medway School of Pharmacy, University of Kent, Chatham, United Kingdom
| | - David Peterhoff
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Patrick Neckermann
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Ralf Wagner
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Rainer Doffinger
- Department of Clinical Biochemistry and Immunology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Sarah Kempster
- Division of Virology, National Institute for Biological Standards and Control, Potters Bar, United Kingdom
| | | | - Amanda Semper
- UK Health Security Agency, Porton Down, United Kingdom
| | - Tim Brooks
- UK Health Security Agency, Porton Down, United Kingdom
| | - Anna Albecka
- MRC Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - Leo C. James
- MRC Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - Mark Page
- Division of Virology, National Institute for Biological Standards and Control, Potters Bar, United Kingdom
| | - Wilhelm Schwaeble
- Complement Laboratory, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Helen Baxendale
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Jonathan L. Heeney
- Lab of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
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14
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Keeton R, Richardson SI, Moyo-Gwete T, Hermanus T, Tincho MB, Benede N, Manamela NP, Baguma R, Makhado Z, Ngomti A, Motlou T, Mennen M, Chinhoyi L, Skelem S, Maboreke H, Doolabh D, Iranzadeh A, Otter AD, Brooks T, Noursadeghi M, Moon JC, Grifoni A, Weiskopf D, Sette A, Blackburn J, Hsiao NY, Williamson C, Riou C, Goga A, Garrett N, Bekker LG, Gray G, Ntusi NAB, Moore PL, Burgers WA. Prior infection with SARS-CoV-2 boosts and broadens Ad26.COV2.S immunogenicity in a variant-dependent manner. Cell Host Microbe 2021; 29:1611-1619.e5. [PMID: 34688376 PMCID: PMC8511649 DOI: 10.1016/j.chom.2021.10.003] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/10/2021] [Accepted: 10/07/2021] [Indexed: 01/02/2023]
Abstract
The Johnson and Johnson Ad26.COV2.S single-dose vaccine represents an attractive option for coronavirus disease 2019 (COVID-19) vaccination in countries with limited resources. We examined the effect of prior infection with different SARS-CoV-2 variants on Ad26.COV2.S immunogenicity. We compared participants who were SARS-CoV-2 naive with those either infected with the ancestral D614G virus or infected in the second wave when Beta predominated. Prior infection significantly boosts spike-binding antibodies, antibody-dependent cellular cytotoxicity, and neutralizing antibodies against D614G, Beta, and Delta; however, neutralization cross-reactivity varied by wave. Robust CD4 and CD8 T cell responses are induced after vaccination, regardless of prior infection. T cell recognition of variants is largely preserved, apart from some reduction in CD8 recognition of Delta. Thus, Ad26.COV2.S vaccination after infection could result in enhanced protection against COVID-19. The impact of the infecting variant on neutralization breadth after vaccination has implications for the design of second-generation vaccines based on variants of concern.
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Affiliation(s)
- Roanne Keeton
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Simone I Richardson
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa; MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Thandeka Moyo-Gwete
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa; MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Tandile Hermanus
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa; MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Marius B Tincho
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Ntombi Benede
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Nelia P Manamela
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa; MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard Baguma
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Zanele Makhado
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa; MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Amkele Ngomti
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Thopisang Motlou
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa; MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Mathilda Mennen
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, South Africa
| | - Lionel Chinhoyi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, South Africa
| | - Sango Skelem
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, South Africa
| | - Hazel Maboreke
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Chemical and Systems Biology, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
| | - Deelan Doolabh
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Arash Iranzadeh
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Ashley D Otter
- National Infection Service, Public Health England, Porton Down, UK
| | - Tim Brooks
- National Infection Service, Public Health England, Porton Down, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - James C Moon
- Institute of Cardiovascular Sciences, University College London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Alba Grifoni
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Daniela Weiskopf
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA, USA; Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Jonathan Blackburn
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Chemical and Systems Biology, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
| | - Nei-Yuan Hsiao
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa; NHLS Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Carolyn Williamson
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Catherine Riou
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Ameena Goga
- South African Medical Research Council, Cape Town, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa; Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Linda-Gail Bekker
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Desmond Tutu HIV Centre, Cape Town, South Africa
| | - Glenda Gray
- South African Medical Research Council, Cape Town, South Africa
| | - Ntobeko A B Ntusi
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, University of Cape Town and Groote Schuur Hospital, South Africa; Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Penny L Moore
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa; MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.
| | - Wendy A Burgers
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa.
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15
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Reynolds CJ, Pade C, Gibbons JM, Butler DK, Otter AD, Menacho K, Fontana M, Smit A, Sackville-West JE, Cutino-Moguel T, Maini MK, Chain B, Noursadeghi M, Brooks T, Semper A, Manisty C, Treibel TA, Moon JC, Valdes AM, McKnight Á, Altmann DM, Boyton R. Prior SARS-CoV-2 infection rescues B and T cell responses to variants after first vaccine dose. Science 2021; 372:eabh1282. [PMID: 33931567 PMCID: PMC8168614 DOI: 10.1126/science.abh1282] [Citation(s) in RCA: 209] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022]
Abstract
SARS-CoV-2 vaccine rollout has coincided with the spread of variants of concern. We investigated if single dose vaccination, with or without prior infection, confers cross protective immunity to variants. We analyzed T and B cell responses after first dose vaccination with the Pfizer/BioNTech mRNA vaccine BNT162b2 in healthcare workers (HCW) followed longitudinally, with or without prior Wuhan-Hu-1 SARS-CoV-2 infection. After one dose, individuals with prior infection showed enhanced T cell immunity, antibody secreting memory B cell response to spike and neutralizing antibodies effective against B.1.1.7 and B.1.351. By comparison, HCW receiving one vaccine dose without prior infection showed reduced immunity against variants. B.1.1.7 and B.1.351 spike mutations resulted in increased, abrogated or unchanged T cell responses depending on human leukocyte antigen (HLA) polymorphisms. Single dose vaccination with BNT162b2 in the context of prior infection with a heterologous variant substantially enhances neutralizing antibody responses against variants.
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Affiliation(s)
| | - Corinna Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Joseph M Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - David K Butler
- Department of Infectious Disease, Imperial College London, London, UK
| | - Ashley D Otter
- National Infection Service, Public Health England, Porton Down, UK
| | - Katia Menacho
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Marianna Fontana
- Royal Free London NHS Foundation Trust, London, UK
- Division of Medicine, University College London, London, UK
| | | | | | | | - Mala K Maini
- Division of Infection and Immunity, University College London, London, UK
| | - Benjamin Chain
- Division of Infection and Immunity, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Tim Brooks
- National Infection Service, Public Health England, Porton Down, UK
| | - Amanda Semper
- National Infection Service, Public Health England, Porton Down, UK
| | - Charlotte Manisty
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Thomas A Treibel
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Ana M Valdes
- Academic Rheumatology, Clinical Sciences, Nottingham City Hospital, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Áine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Rosemary Boyton
- Department of Infectious Disease, Imperial College London, London, UK.
- Lung Division, Royal Brompton and Harefield Hospitals, London, UK
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16
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Manisty C, Otter AD, Treibel TA, McKnight Á, Altmann DM, Brooks T, Noursadeghi M, Boyton RJ, Semper A, Moon JC. Antibody response to first BNT162b2 dose in previously SARS-CoV-2-infected individuals. Lancet 2021; 397:1057-1058. [PMID: 33640038 PMCID: PMC7972310 DOI: 10.1016/s0140-6736(21)00501-8] [Citation(s) in RCA: 277] [Impact Index Per Article: 92.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, UK; Department of Cardiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Ashley D Otter
- National Infection Service, Public Health England, Porton Down, UK
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, London, UK; Department of Cardiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Áine McKnight
- The Blizard Institute, Queen Mary University of London School of Medicine and Dentistry, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London W12 0NN, UK
| | - Timothy Brooks
- National Infection Service, Public Health England, Porton Down, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK; Lung Division, Royal Brompton and Harefield Hospitals, London, UK.
| | - Amanda Semper
- National Infection Service, Public Health England, Porton Down, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK; Department of Cardiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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