Early Impact of Ontario’s COVID-19 Vaccine Rollout on Long-Term Care Home Residents and Health Care Workers

Brown, Kevin E.; Stall, Nathan M.; Vanniyasingam, Thuva; Buchan, Sarah A; Daneman, Nick; Hillmer, Michael; Hopkins, Jessica; Johnstone, Jennie; Maltsev, Antonina; McGeer, Allison; Sander, Beate; Savage, Rachel; Watts, Tania H.; Jüni, Peter; Rochon, Paula A.

doi:10.47326/ocsat.2021.02.13.1.0

Cited by 22 publications

(22 citation statements)

References 4 publications

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“…Residents in three homes received mRNA-1273, while those in the fourth received BNT162b2. 2 Immunosuppressed residents included those with diseases associated with immunosuppression, or those receiving immunosuppressive medications and include 3 residents with rheumatoid arthritis receiving methotrexate, 3 residents with myeloproliferative disease receiving hydroxyurea and 3 patients with bullous pemphigoid receiving prednisone 3 All homes had had cases of PCR-confirmed COVID-19 diagnosed in staff during the first 9 months of the pandemic; two (both of whose residents received mRNA-1273) had also had cases in residents. For those with PCR-confirmed COVID-19, the median time from diagnosis to first dose of vaccine was 100 days (range 52-282 days).…”

Section: Study Approvalmentioning

confidence: 99%

Neutralizing antibody responses to SARS-CoV-2 variants in vaccinated Ontario long-term care home residents and workers

Abe

Mozafarihashjin

et al. 2021

Preprint

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Prioritizing Ontario's long-term care home (LTCH) residents for vaccination against severe acute respiratory syndrome coronavirus 2 has drastically reduced their disease burden; however, recent LTCH outbreaks of variants of concern (VOCs) have raised questions regarding their immune responses. In 199 residents, mRNA vaccine dose 1 elicited partial spike and receptor binding domain antibody responses, while the second elicited a response at least equivalent to convalescent individuals in most residents. Residents administered mRNA-1273 (Moderna) mounted stronger total and neutralizing antibody responses than those administered BNT162b2 (Pfizer-BioNTech). Two to four weeks after dose 2, residents (n = 119, median age 88) produced 4.92-6.5-fold fewer neutralizing antibodies than staff (n = 78; median age 45) against wild-type (with D614G) pseudotyped lentivirus, and residents administered BNT162b2 produced 2.95-fold fewer neutralizing antibodies than those who received mRNA-1273. These effects were exacerbated upon serum challenge with pseudotyped VOC spike, with up to 6.64-fold reductions in B.1.351 (Beta) neutralization. Cumulatively, weaker vaccine stimulation, age/comorbidities, and the VOC produced an ~130-fold reduction in apparent neutralization titers in LTCH residents and 37.9% of BNT162b2-vaccinated residents had undetectable neutralizing antibodies to B.1.351. Continued immune response surveillance and additional vaccine doses may be required in this population with known vulnerabilities.

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Section: Study Approvalmentioning

confidence: 99%

Neutralizing antibody responses to SARS-CoV-2 variants in vaccinated Ontario long-term care home residents and workers

Abe

Mozafarihashjin

et al. 2021

Preprint

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“…Nursing home residents in Ontario, Canada, were prioritized for vaccination with mRNA vaccines from Moderna (mRNA-1273) or Pfizer (BNT163b2) in December 2020-January 2021, which significantly reduced the high morbidity and mortality due to COVID-19 1 . Yet nursing homes residents often fail to mount robust responses to vaccinations 2 and recent reports of breakthrough infections, particularly from variants of concern, raise questions about whether vaccination regimens elicit a sufficient humoral immune response or if booster doses are warranted.…”

Section: Introductionmentioning

confidence: 99%

Antibody Responses 3-5 Months Post-Vaccination with mRNA-1273 or BNT163b2 in Nursing Home Residents

Breznik

Zhang

Huynh

et al. 2021

Preprint

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Nursing homes residents often fail to mount robust responses to vaccinations and recent reports of breakthrough infections, particularly from variants of concern, raise questions about whether vaccination regimens elicit a sufficient humoral immune response or if booster doses are warranted. We examined SARS-CoV-2 antibody levels and neutralizing capacity in nursing home residents 3-5 months after 2 doses of mRNA-1273 or BNT163b2 vaccination as per recommended schedules. Nursing home residents were recruited from eight long-term care homes in Ontario, Canada, between March and July 2021. Antibody levels and neutralization capacity from a previously published convalescent cohort were used as a comparator.Serum SARS-CoV-2 IgA/G/M against spike (S) protein and its receptor-binding domain (RBD) were measured by validated ELISA, with assay cut-off at the mean and 3 standard deviations of a pre-COVID-19 population from the same geographic region. Antibody neutralization was measured against the wild-type strain of SARS-CoV-2 and the beta variant of concern (B.1.351). No neutralizing antibodies were detected in ~20% of residents to the wild-type virus (30/155; 19%) or beta variant (27/134; 20%). Residents that received BNT163b2 had a ~4-fold reduction in neutralization to the wild-type strain, and a ~2-fold reduction in neutralization to the beta variant relative to those who received mRNA-1273. Current mRNA SARS-CoV-2 vaccine regimens may not have equivalent efficacy in nursing home residents. Our findings imply that differences in the humoral immune response may contribute to breakthrough infections, and suggest that consideration of the type of vaccine administered to older adults will have a positive impact on the generation of protective immunity.

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“…Vaccination would not have impacted the results at peak in December 2020. 6 Our findings demonstrate that outside an outbreak or high-risk contact setting, the pretest probability of routine asymptomatic SARS-CoV-2 screen testing remains low, even in settings with high SARS-CoV-2 incidence. When pretest probability is low, the rate of false positives increases, further increasing the opportunity costs of such testing strategies (eg, unnecessary isolation of residents).…”

Section: Discussionmentioning

confidence: 65%

Low yield of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) asymptomatic routine screen testing, despite high community incidence

Kain

Stall

McGeer

et al. 2021

Infect. Control Hosp. Epidemiol.

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Early Impact of Ontario’s COVID-19 Vaccine Rollout on Long-Term Care Home Residents and Health Care Workers

Cited by 22 publications

References 4 publications

Neutralizing antibody responses to SARS-CoV-2 variants in vaccinated Ontario long-term care home residents and workers

Neutralizing antibody responses to SARS-CoV-2 variants in vaccinated Ontario long-term care home residents and workers

Antibody Responses 3-5 Months Post-Vaccination with mRNA-1273 or BNT163b2 in Nursing Home Residents

Low yield of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) asymptomatic routine screen testing, despite high community incidence

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