Durability of immunity and clinical protection in nursing home residents following bivalent SARS-CoV-2 vaccination.

Antibodies COVID-19 Effectiveness Long-term care Vaccine

Journal

EBioMedicine
ISSN: 2352-3964
Titre abrégé: EBioMedicine
Pays: Netherlands
ID NLM: 101647039

Informations de publication

Date de publication:
10 Jun 2024
Historique:
received: 02 08 2023
revised: 12 05 2024
accepted: 17 05 2024
medline: 12 6 2024
pubmed: 12 6 2024
entrez: 11 6 2024
Statut: aheadofprint

Résumé

Bivalent SARS-CoV-2 vaccines were developed to counter increasing susceptibility to emerging SARS-CoV-2 variants. We evaluated the durability of immunity and protection following first bivalent vaccination among nursing home residents. We evaluated anti-spike and neutralization titers from blood in 653 community nursing home residents before and after each monovalent booster, and a bivalent vaccine. Concurrent clinical outcomes were evaluated using electronic health record data from a separate cohort of 3783 residents of Veterans Affairs (VA) nursing homes who had received at least the primary series monovalent vaccination. Using target trial emulation, we compared VA residents who did and did not receive the bivalent vaccine to measure vaccine effectiveness against infection, hospitalization, and death. In the community cohort, Omicron BA.5 neutralization activity rose after each monovalent and bivalent booster vaccination regardless of prior infection history. Titers declined over time but six months post-bivalent vaccination, BA.5 neutralization persisted at detectable levels in 75% of infection-naive and 98% of prior-infected individuals. In the VA nursing home cohort, bivalent vaccine added effectiveness to monovalent booster vaccination by 18.5% for infection (95% confidence interval (CI) -5.6, 34.0%), and 29.2% for hospitalization or death (95% CI -14.2, 56.2%) over five months. The level of protection declined after bivalent vaccination over a 6 month period and may open a window of added vulnerability before the next updated vaccine becomes available, suggesting a subset of nursing home residents may benefit from an additional vaccination booster. CDC, NIH, VHA.

Sections du résumé

BACKGROUND BACKGROUND
Bivalent SARS-CoV-2 vaccines were developed to counter increasing susceptibility to emerging SARS-CoV-2 variants. We evaluated the durability of immunity and protection following first bivalent vaccination among nursing home residents.
METHODS METHODS
We evaluated anti-spike and neutralization titers from blood in 653 community nursing home residents before and after each monovalent booster, and a bivalent vaccine. Concurrent clinical outcomes were evaluated using electronic health record data from a separate cohort of 3783 residents of Veterans Affairs (VA) nursing homes who had received at least the primary series monovalent vaccination. Using target trial emulation, we compared VA residents who did and did not receive the bivalent vaccine to measure vaccine effectiveness against infection, hospitalization, and death.
FINDINGS RESULTS
In the community cohort, Omicron BA.5 neutralization activity rose after each monovalent and bivalent booster vaccination regardless of prior infection history. Titers declined over time but six months post-bivalent vaccination, BA.5 neutralization persisted at detectable levels in 75% of infection-naive and 98% of prior-infected individuals. In the VA nursing home cohort, bivalent vaccine added effectiveness to monovalent booster vaccination by 18.5% for infection (95% confidence interval (CI) -5.6, 34.0%), and 29.2% for hospitalization or death (95% CI -14.2, 56.2%) over five months.
INTERPRETATION CONCLUSIONS
The level of protection declined after bivalent vaccination over a 6 month period and may open a window of added vulnerability before the next updated vaccine becomes available, suggesting a subset of nursing home residents may benefit from an additional vaccination booster.
FUNDING BACKGROUND
CDC, NIH, VHA.

Identifiants

DOI: 10.1016/j.ebiom.2024.105180 PMID: 38861869
pubmed: 38861869
pii: S2352-3964(24)00215-9
doi: 10.1016/j.ebiom.2024.105180
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

105180

Informations de copyright

Published by Elsevier B.V.

Déclaration de conflit d'intérêts

Declaration of interests Stefan Gravenstein (S. G.) and David H. Canaday (D. H. C.) are recipients of investigator-initiated grants to their universities from Pfizer to study pneumococcal vaccines, Moderna to study respiratory infections, and Sanofi Pasteur and Seqirus to study influenza vaccines, and S.G. from Genentech on influenza antivirals. S. G. also receives consulting fees from GlaxoSmithKline, Icosavax, Janssen, Merck, Moderna, Novavax, Pfizer, Reviral, Sanofi, Seqirus, and Vaxart, and has received fees for speaking for Janssen, Pfizer, Moderna, GlaxoSmithKline, Sanofi, and Seqirus. KWM Investigator initiated research support from Seqirus pharmaceuticals, Sanofi-Pasteur, Genentech and Pfizer.

Auteurs

Stefan Gravenstein (S)

Warren Alpert Medical School, Brown University, Providence, RI, USA; Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Veterans Administration (VA) Medical Center, Providence, RI, USA. Electronic address: stefan_gravenstein@brown.edu.

Frank DeVone (F)

Center of Innovation in Long-Term Services and Supports, Veterans Administration (VA) Medical Center, Providence, RI, USA.

Oladayo A Oyebanji (OA)

Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Yasin Abul (Y)

Warren Alpert Medical School, Brown University, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Veterans Administration (VA) Medical Center, Providence, RI, USA.

Yi Cao (Y)

Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA.

Philip A Chan (PA)

Warren Alpert Medical School, Brown University, Providence, RI, USA; Rhode Island Department of Health, Providence, RI, USA.

Christopher W Halladay (CW)

Center of Innovation in Long-Term Services and Supports, Veterans Administration (VA) Medical Center, Providence, RI, USA.

James L Rudolph (JL)

Warren Alpert Medical School, Brown University, Providence, RI, USA; Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Veterans Administration (VA) Medical Center, Providence, RI, USA.

Clare Nugent (C)

Warren Alpert Medical School, Brown University, Providence, RI, USA.

Jürgen Bosch (J)

Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Christopher L King (CL)

Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Brigid M Wilson (BM)

Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.

Alejandro B Balazs (AB)

Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA.

Elizabeth M White (EM)

Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, RI, USA.

David H Canaday (DH)

Case Western Reserve University School of Medicine, Cleveland, OH, USA; Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA. Electronic address: dxc44@case.edu.

Kevin W McConeghy (KW)

Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Veterans Administration (VA) Medical Center, Providence, RI, USA. Electronic address: kevin_mcconeghy@brown.edu.

Classifications MeSH