理解“混合免疫”：对严重急性呼吸综合征冠状病毒 2 感染（SARS-CoV-2）和 2019 年冠状病毒病（COVID-19）疫苗的体液免疫反应的比较和预测因素。

Understanding "Hybrid Immunity": Comparison and Predictors of Humoral Immune Responses to Severe Acute Respiratory Syndrome Coronavirus 2 Infection (SARS-CoV-2) and Coronavirus Disease 2019 (COVID-19) Vaccines.

机构信息

Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.

Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA.

出版信息

Clin Infect Dis. 2023 Feb 8;76(3):e439-e449. doi: 10.1093/cid/ciac392.

DOI:10.1093/cid/ciac392

PMID:35608504

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9213853/

Abstract

BACKGROUND

Comparison of humoral responses in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinees, those with SARS-CoV-2 infection, or combinations of vaccine/ infection ("hybrid immunity") may clarify predictors of vaccine immunogenicity.

METHODS

We studied 2660 US Military Health System beneficiaries with a history of SARS-CoV-2 infection-alone (n = 705), vaccination-alone (n = 932), vaccine-after-infection (n = 869), and vaccine-breakthrough-infection (n = 154). Peak anti-spike-immunoglobulin G (IgG) responses through 183 days were compared, with adjustment for vaccine product, demography, and comorbidities. We excluded those with evidence of clinical or subclinical SARS-CoV-2 reinfection from all groups.

RESULTS

Multivariable regression results indicated that vaccine-after-infection anti-spike-IgG responses were higher than infection-alone (P < .01), regardless of prior infection severity. An increased time between infection and vaccination was associated with greater post-vaccination IgG response (P < .01). Vaccination-alone elicited a greater IgG response but more rapid waning of IgG (P < .01) compared with infection-alone (P < .01). BNT162b2 and mRNA-1273 vaccine-receipt was associated with greater IgG responses compared with JNJ-78436735 vaccine-receipt (P < .01), regardless of infection history. Those with vaccine-after-infection or vaccine-breakthrough-infection had a more durable anti-spike-IgG response compared to infection-alone (P < .01).

CONCLUSIONS

Vaccine-receipt elicited higher anti-spike-IgG responses than infection-alone, although IgG levels waned faster in those vaccinated (compared to infection-alone). Vaccine-after-infection elicits a greater humoral response compared with vaccine or infection alone; and the timing, but not disease severity, of prior infection predicted these post-vaccination IgG responses. While differences between groups were small in magnitude, these results offer insights into vaccine immunogenicity variations that may help inform vaccination timing strategies.

摘要

背景

比较严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）疫苗接种者、SARS-CoV-2 感染者或疫苗/感染组合（“混合免疫”）的体液反应，可能有助于阐明疫苗免疫原性的预测因素。

方法

我们研究了 2660 名美国军事医疗系统的受益人，他们有 SARS-CoV-2 感染史（n=705）、疫苗接种史（n=932）、疫苗接种后感染史（n=869）和疫苗突破性感染史（n=154）。通过 183 天比较了峰值抗刺突免疫球蛋白 G（IgG）反应，并根据疫苗产品、人口统计学和合并症进行了调整。我们排除了所有组中具有临床或亚临床 SARS-CoV-2 再感染证据的个体。

结果

多变量回归结果表明，疫苗接种后感染的抗刺突-IgG 反应高于单独感染（P<.01），而与先前感染的严重程度无关。感染与接种疫苗之间的时间间隔增加与接种后 IgG 反应增加有关（P<.01）。与单独感染相比（P<.01），单独接种疫苗会引起更大的 IgG 反应，但 IgG 衰减更快（P<.01）。与接受 JNJ-78436735 疫苗接种相比，接种 BNT162b2 和 mRNA-1273 疫苗与更大的 IgG 反应相关（P<.01），而与感染史无关。与单独感染相比，疫苗接种后感染或疫苗突破性感染的个体具有更持久的抗刺突-IgG 反应（P<.01）。

结论

与单独感染相比，接种疫苗会引起更高的抗刺突-IgG 反应，尽管接种疫苗的个体 IgG 水平衰减更快（与单独感染相比）。与单独接种疫苗或感染相比，疫苗接种后感染可引起更大的体液反应；并且，先前感染的时间，但不是疾病严重程度，预测了这些接种后 IgG 反应。虽然组间差异的幅度较小，但这些结果提供了对疫苗免疫原性变化的深入了解，这可能有助于为接种时间策略提供信息。