Natural and hybrid immunity following four COVID-19 waves: A prospective cohort study of mothers in South Africa

Zar, Heather J.; MacGinty, Rae; Workman, Lesley; Botha, Maresa; Johnson, Marina; Hunt, Adam; Burd, Tiffany; Nicol, Mark P.; Quilty, Billy J

doi:10.1016/j.eclinm.2022.101655

Cited by 27 publications

(21 citation statements)

References 33 publications

(64 reference statements)

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“…These trials had found similar effect sizes of around five-fold reduction in risk of Alpha infections at anti-S antibody levels of 600 IU/mL (Feng et al, 2021), and a halving of hazard by 10-fold increase in anti-S titers for ancestral strain infections (Gilbert et al, 2022). Moreover our results are in line with available studies on Omicron BA.1/BA.2 subvariants which have also found binding antibody levels to be correlates of protection against infection using in-house immunoassays (Hertz et al, 2022;Zar et al, 2022). On the other hand, we did not find differences in the hazard of having an Omicron BA.1/BA.2 infection with anti-S antibody levels below or above a certain threshold in the non-infected vaccinated group, as opposed to results reported for Delta infections (Wei et al, 2021).…”

Section: Discussionsupporting

confidence: 91%

“…Using the same immunoassay as in this study and a cell-free Spike trimer-ACE2 binding-based surrogate neutralization assay (Fenwick et al, 2021), we did not observe any significant correlation between anti-S binding and neutralizing antibody levels against Omicron subvariants in uninfected participants, as opposed to previously infected participants (Zaballa et al, 2022). These results can be linked to growing evidence that hybrid immunity (infection plus vaccination) provides the strongest protection against Omicron subvariant infections (Altarawneh et al 2022, Zar et al 2022, Golddblatt 2022. This infection history-specificity thus warrants care in the interpretation of binding antibodies as correlates of protection against Omicron sub-lineages, and could be immunoassay-dependent.…”

Section: Discussionsupporting

confidence: 53%

“…Binding antibody measurements have been found to correlate with neutralization capacity against the ancestral SARS-CoV-2 strain at different degrees depending on time post infection/vaccination, and on immuno-assay (Earle et al, 2021;Goldblatt et al, 2022;L'Huillier et al, 2021). Evidence for their more general use as correlate of protection is mounting both from population-level (Earle et al, 2021;Goldblatt et al, 2022), as well as individual-level studies in the context of vaccine trials (Dimeglio et al, 2022b;Feng et al, 2021;Gilbert et al, 2022;Wei et al, 2021). These studies suggest that higher antibody measurements after infection and/or vaccination tend to reduce subsequent infection risk (Osman et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…These studies suggest that higher antibody measurements after infection and/or vaccination tend to reduce subsequent infection risk (Osman et al, 2021). However, most of these studies focused on the ancestral SARS-CoV-2 strain and it is yet to be clarified whether these results robustly extend to the Omicron subvariants (Hertz et al, 2022;Zar et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

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Long term anti-SARS-CoV-2 antibody kinetics and correlate of protection against Omicron BA.1/BA.2 infection

Perez-Saez

Zaballa

Lamour

et al. 2022

Preprint

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Binding antibody levels against SARS-CoV-2 have shown to be correlates of protection against infection with pre-Omicron lineages. This has been challenged by the emergence of immune-evasive variants, notably the Omicron sublineages, in an evolving immune landscape with high levels of cumulative incidence and vaccination coverage. This in turn limits the use of commercially available high-throughput methods to quantify binding antibodies as a tool to monitor protection at the population-level. In this work, we leverage repeated serological measurements between April 2020 and December 2021 on 1'083 participants of a population-based cohort in Geneva, Switzerland, to evaluate anti-Spike RBD antibody levels as a correlate of protection against Omicron BA.1/BA.2 infections during the December 2021-March 2022 epidemic wave. We do so by first modeling antibody dynamics in time with kinetic models. We then use these models to predict antibody trajectories into the time period where Omicron BA.1/BA.2 were the predominant circulating sub-lineages and use survival analyses to compare the hazard of having a positive SARS-CoV-2 test by antibody level, vaccination status and infection history. We find that antibody kinetics in our sample are mainly determined by infection and vaccination history, and to a lesser extent by demographics. After controlling for age and previous infections (based on anti-nucleocapsid serology), survival analyses show reveal a significant reduction in the hazard of having a documented positive SARS-CoV-2 infection during the Omicron BA.1/BA.2 wave with increasing antibody levels, reaching up to a three-fold reduction for anti-S antibody levels above 800 IU/mL (HR 0.30, 95% CI 0.22-0.41). However, we did not detect a reduction in hazard among uninfected participants. Taken together these results indicate that anti-Spike RBD antibody levels, as quantified by the immunoassay used in this study, are an indirect correlate of protection against Omicron BA.1/BA.2 for individuals with a history of previous SARS-CoV-2 infection. Despite the uncertainty in what SARS-COV-2 variant will come next, these results provide reassuring insights into the continued interpretation of SARS-CoV-2 binding antibody measurements as an independent marker of protection at both the individual and population levels.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Long term anti-SARS-CoV-2 antibody kinetics and correlate of protection against Omicron BA.1/BA.2 infection

Perez-Saez

Zaballa

Lamour

et al. 2022

Preprint

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“…For now, current evidence supports strong protection against severe COVID-19 from prior infection, 34,35 which is even better with hybrid immunity (prior infection plus vaccination). 36,37 The SARS-CoV-2 seroprevalence was generally high across all the seven districts surveyed in the current study, with higher seroprevalence in urban compared to rural areas, as reported in our blood donor serosurvey 10 and in other sub-Saharan African settings. 38 This is consistent with national COVID-19 data at the time of the study that reported 51% of confirmed cases in the country were from the cities of Blantyre and Lilongwe, 17 with a caveat that rural areas had relatively fewer SARS-CoV-2 testing sites.…”

Section: Discussionsupporting

confidence: 76%

Omicron B.1.1.529 variant infections associated with severe disease are uncommon in a COVID-19 under-vaccinated, high SARS-CoV-2 seroprevalence population in Malawi

et al. 2023

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Evaluation of Waning of SARS-CoV-2 Vaccine–Induced Immunity

et al. 2023

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ImportanceEstimates of the rate of waning of vaccine effectiveness (VE) against COVID-19 are key to assess population levels of protection and future needs for booster doses to face the resurgence of epidemic waves.ObjectiveTo quantify the progressive waning of VE associated with the Delta and Omicron variants of SARS-CoV-2 by number of received doses.Data SourcesPubMed and Web of Science were searched from the databases’ inception to October 19, 2022, as well as reference lists of eligible articles. Preprints were included.Study SelectionSelected studies for this systematic review and meta-analysis were original articles reporting estimates of VE over time against laboratory-confirmed SARS-CoV-2 infection and symptomatic disease.Data Extraction and SynthesisEstimates of VE at different time points from vaccination were retrieved from original studies. A secondary data analysis was performed to project VE at any time from last dose administration, improving the comparability across different studies and between the 2 considered variants. Pooled estimates were obtained from random-effects meta-analysis.Main Outcomes and MeasuresOutcomes were VE against laboratory-confirmed Omicron or Delta infection and symptomatic disease and half-life and waning rate associated with vaccine-induced protection.ResultsA total of 799 original articles and 149 reviews published in peer-reviewed journals and 35 preprints were identified. Of these, 40 studies were included in the analysis. Pooled estimates of VE of a primary vaccination cycle against laboratory-confirmed Omicron infection and symptomatic disease were both lower than 20% at 6 months from last dose administration. Booster doses restored VE to levels comparable to those acquired soon after the administration of the primary cycle. However, 9 months after booster administration, VE against Omicron was lower than 30% against laboratory-confirmed infection and symptomatic disease. The half-life of VE against symptomatic infection was estimated to be 87 days (95% CI, 67-129 days) for Omicron compared with 316 days (95% CI, 240-470 days) for Delta. Similar waning rates of VE were found for different age segments of the population.Conclusions and RelevanceThese findings suggest that the effectiveness of COVID-19 vaccines against laboratory-confirmed Omicron or Delta infection and symptomatic disease rapidly wanes over time after the primary vaccination cycle and booster dose. These results can inform the design of appropriate targets and timing for future vaccination programs.

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Natural and hybrid immunity following four COVID-19 waves: A prospective cohort study of mothers in South Africa

Cited by 27 publications

References 33 publications

Long term anti-SARS-CoV-2 antibody kinetics and correlate of protection against Omicron BA.1/BA.2 infection

Long term anti-SARS-CoV-2 antibody kinetics and correlate of protection against Omicron BA.1/BA.2 infection

Omicron B.1.1.529 variant infections associated with severe disease are uncommon in a COVID-19 under-vaccinated, high SARS-CoV-2 seroprevalence population in Malawi

Evaluation of Waning of SARS-CoV-2 Vaccine–Induced Immunity

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