tetano
Editor, Senior Moderator
J Am Med Dir Assoc
. 2022 Mar;23(3):434-439.
doi: 10.1016/j.jamda.2021.12.001. Epub 2022 Jan 11.
Previous SARS-CoV-2 Infection, Age, and Frailty Are Associated With 6-Month Vaccine-Induced Anti-Spike Antibody Titer in Nursing Home Residents
Adam H Dyer[SUP] 1 [/SUP], Claire Noonan[SUP] 2 [/SUP], Matt McElheron[SUP] 3 [/SUP], Isabella Batten[SUP] 3 [/SUP], Conor Reddy[SUP] 3 [/SUP], Emma Connolly[SUP] 3 [/SUP], Rachel Pierpoint[SUP] 2 [/SUP], Caroline Murray[SUP] 4 [/SUP], Ann Leonard[SUP] 5 [/SUP], Catriona Higgins[SUP] 4 [/SUP], Phyllis Reilly[SUP] 4 [/SUP], Gerard Boran[SUP] 5 [/SUP], Thomas Phelan[SUP] 6 [/SUP], William McCormack[SUP] 6 [/SUP], Desmond O'Neill[SUP] 7 [/SUP], Aoife Fallon[SUP] 2 [/SUP], Gareth Brady[SUP] 6 [/SUP], Cliona O'Farrelly[SUP] 8 [/SUP], Nollaig M Bourke[SUP] 3 [/SUP], Sean P Kennelly[SUP] 9 [/SUP]
Affiliations
Abstract
Objectives: Older nursing home residents make up the population at greatest risk of morbidity and mortality from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. No studies have examined the determinants of long-term antibody responses post vaccination in this group.
Design: Longitudinal cohort study.
Setting and participants: Residents from 5 nursing homes assessed before vaccination, and 5 weeks and 6 months post vaccination, with the BNT162b2 messenger RNA SARS-CoV-2 vaccine.
Methods: Comprehensive clinical assessment was performed, including assessment for comorbidity, frailty, and SARS-CoV-2 infection history. Serum nucleocapsid and anti-spike receptor binding domain (RBD) antibodies were analyzed at all timepoints. An in vitro angiotensin-converting enzyme (ACE2) receptor-spike RBD neutralization assay assessed serum neutralization capacity.
Results: Of 86 participants (81.1 ± 10.8 years; 65% female), just under half (45.4%; 39 of 86) had evidence of previous SARS-CoV-2 infection. All participants demonstrated a significant antibody response to vaccination at 5 weeks and a significant decline in this response by 6 months. SARS-CoV-2 infection history was the strongest predictor of antibody titer (log-transformed) at both 5 weeks [β: 3.00; 95% confidence interval (CI): 2.32-3.70; P < .001] and 6 months (β: 3.59; 95% CI: 2.89-4.28; P < .001). Independent of SARS-CoV-2 infection history, both age in years (β: -0.05; 95% CI: -0.08 to -0.02; P < .001) and frailty (β: -0.22; 95% CI: -0.33 to -0.11; P < .001) were associated with a significantly lower antibody titer at 6 months. Anti-spike antibody titers at both 5 weeks and 6 months significantly correlated with in vitro neutralization capacity.
Conclusions and implications: In older nursing home residents, SARS-CoV-2 infection history was the strongest predictor of anti-spike antibody titers at 6 months, whereas age and frailty were independently associated with lower titers at 6 months. Antibody titers significantly correlated with in vitro neutralization capacity. Although older SARS-CoV-2 naïve nursing home residents may be particularly vulnerable to breakthrough SARS-CoV-2 infection, the relationship between antibody titers, SARS-CoV-2 infection, and clinical outcomes remains to be fully elucidated in this vulnerable population.
Keywords: COVID-19; Nursing homes; SARS-CoV-2.0; antibody; long-term care; vaccine.
. 2022 Mar;23(3):434-439.
doi: 10.1016/j.jamda.2021.12.001. Epub 2022 Jan 11.
Previous SARS-CoV-2 Infection, Age, and Frailty Are Associated With 6-Month Vaccine-Induced Anti-Spike Antibody Titer in Nursing Home Residents
Adam H Dyer[SUP] 1 [/SUP], Claire Noonan[SUP] 2 [/SUP], Matt McElheron[SUP] 3 [/SUP], Isabella Batten[SUP] 3 [/SUP], Conor Reddy[SUP] 3 [/SUP], Emma Connolly[SUP] 3 [/SUP], Rachel Pierpoint[SUP] 2 [/SUP], Caroline Murray[SUP] 4 [/SUP], Ann Leonard[SUP] 5 [/SUP], Catriona Higgins[SUP] 4 [/SUP], Phyllis Reilly[SUP] 4 [/SUP], Gerard Boran[SUP] 5 [/SUP], Thomas Phelan[SUP] 6 [/SUP], William McCormack[SUP] 6 [/SUP], Desmond O'Neill[SUP] 7 [/SUP], Aoife Fallon[SUP] 2 [/SUP], Gareth Brady[SUP] 6 [/SUP], Cliona O'Farrelly[SUP] 8 [/SUP], Nollaig M Bourke[SUP] 3 [/SUP], Sean P Kennelly[SUP] 9 [/SUP]
Affiliations
- PMID: 35219507
- DOI: 10.1016/j.jamda.2021.12.001
Abstract
Objectives: Older nursing home residents make up the population at greatest risk of morbidity and mortality from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. No studies have examined the determinants of long-term antibody responses post vaccination in this group.
Design: Longitudinal cohort study.
Setting and participants: Residents from 5 nursing homes assessed before vaccination, and 5 weeks and 6 months post vaccination, with the BNT162b2 messenger RNA SARS-CoV-2 vaccine.
Methods: Comprehensive clinical assessment was performed, including assessment for comorbidity, frailty, and SARS-CoV-2 infection history. Serum nucleocapsid and anti-spike receptor binding domain (RBD) antibodies were analyzed at all timepoints. An in vitro angiotensin-converting enzyme (ACE2) receptor-spike RBD neutralization assay assessed serum neutralization capacity.
Results: Of 86 participants (81.1 ± 10.8 years; 65% female), just under half (45.4%; 39 of 86) had evidence of previous SARS-CoV-2 infection. All participants demonstrated a significant antibody response to vaccination at 5 weeks and a significant decline in this response by 6 months. SARS-CoV-2 infection history was the strongest predictor of antibody titer (log-transformed) at both 5 weeks [β: 3.00; 95% confidence interval (CI): 2.32-3.70; P < .001] and 6 months (β: 3.59; 95% CI: 2.89-4.28; P < .001). Independent of SARS-CoV-2 infection history, both age in years (β: -0.05; 95% CI: -0.08 to -0.02; P < .001) and frailty (β: -0.22; 95% CI: -0.33 to -0.11; P < .001) were associated with a significantly lower antibody titer at 6 months. Anti-spike antibody titers at both 5 weeks and 6 months significantly correlated with in vitro neutralization capacity.
Conclusions and implications: In older nursing home residents, SARS-CoV-2 infection history was the strongest predictor of anti-spike antibody titers at 6 months, whereas age and frailty were independently associated with lower titers at 6 months. Antibody titers significantly correlated with in vitro neutralization capacity. Although older SARS-CoV-2 naïve nursing home residents may be particularly vulnerable to breakthrough SARS-CoV-2 infection, the relationship between antibody titers, SARS-CoV-2 infection, and clinical outcomes remains to be fully elucidated in this vulnerable population.
Keywords: COVID-19; Nursing homes; SARS-CoV-2.0; antibody; long-term care; vaccine.