Vaccine-induced correlate of protection against fatal COVID-19 in older and frail adults during waves of neutralization-resistant variants of concern: an observational study.

Autor:	Vikström L; The Department of Clinical Microbiology, Umeå University, Umeå, Sweden., Fjällström P; The Department of Clinical Microbiology, Umeå University, Umeå, Sweden., Gwon YD; The Department of Clinical Microbiology, Umeå University, Umeå, Sweden., Sheward DJ; The Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Solna, Sweden., Wigren-Byström J; The Department of Clinical Microbiology, Umeå University, Umeå, Sweden., Evander M; The Department of Clinical Microbiology, Umeå University, Umeå, Sweden., Bladh O; The Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden., Widerström M; The Department of Clinical Microbiology, Umeå University, Umeå, Sweden., Molnar C; Familjeläkarna, Stockholm, Sweden., Rasmussen G; School of Medical Sciences, Örebro University, Örebro, Sweden., Bennet L; Department of Clinical Sciences, Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund University, Lund, Sweden., Åberg M; The Department of Medical Sciences, Clinical Chemistry and SciLifeLab, Uppsala University, Uppsala, Sweden., Björk J; The Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden., Tevell S; Faculty of Medicine and Health, The Department of Infectious Diseases, Karlstad Hospital and Centre for Clinical Research and Education, Region Värmland, Örebro University, Örebro, Sweden., Thålin C; The Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden., Blom K; The Swedish Public Health Agency, Stockholm, Sweden., Klingström J; The Department of Biomedical Clinical Sciences, Linköpings University, Linköping, Sweden., Murrell B; The Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Solna, Sweden., Ahlm C; The Department of Clinical Microbiology, Umeå University, Umeå, Sweden., Normark J; The Department of Clinical Microbiology, Umeå University, Umeå, Sweden., Johansson AF; The Department of Clinical Microbiology, Umeå University, Umeå, Sweden., Forsell MNE; The Department of Clinical Microbiology, Umeå University, Umeå, Sweden.
Jazyk:	angličtina
Zdroj:	The Lancet regional health. Europe [Lancet Reg Health Eur] 2023 May 06, pp. 100646. Date of Electronic Publication: 2023 May 06.
DOI:	10.1016/j.lanepe.2023.100646
Abstrakt:	Background: To inform future preventive measures including repeated vaccinations, we have searched for a clinically useful immune correlate of protection against fatal COVID-19 among nursing homes residents. Methods: We performed repeated capillary blood sampling with analysis of S-binding IgG in an open cohort of nursing home residents in Sweden. We analyzed immunological and registry data from 16 September 2021 to 31 August 2022 with follow-up of deaths to 30 September 2022. The study period included implementation of the 3rd and 4th mRNA monovalent vaccine doses and Omicron virus waves. Findings: A total of 3012 nursing home residents with median age 86 were enrolled. The 3rd mRNA dose elicited a 99-fold relative increase of S-binding IgG in blood and corresponding increase of neutralizing antibodies. The 4th mRNA vaccine dose boosted levels 3.8-fold. Half-life of S-binding IgG was 72 days. A total 528 residents acquired their first SARS-CoV-2 infection after the 3rd or the 4th vaccine dose and the associated 30-day mortality was 9.1%. We found no indication that levels of vaccine-induced antibodies protected against infection with Omicron VOCs. In contrast, the risk of death was inversely correlated to levels of S-directed IgG below the 20th percentile. The death risk plateaued at population average above the lower 35th percentile of S-binding IgG. Interpretation: In the absence of neutralizing antibodies that protect from infection, quantification of S-binding IgG post vaccination may be useful to identify the most vulnerable for fatal COVID-19 among the oldest and frailest. This information is of importance for future strategies to protect vulnerable populations against neutralization resistant variants of concern. Funding: Swedish Research Council, SciLifeLab via Knut and Alice Wallenberg Foundation, VINNOVA. Swedish Healthcare Regions, and Erling Persson Foundation. Competing Interests: All authors declare no competing interests. (© 2023 The Author(s).)
Databáze:	MEDLINE
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