Abstract
Background: Natural and vaccine-induced immunity will play a key role in controlling the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. SARS-CoV-2 variants have the potential to evade natural and vaccine-induced immunity.
Methods: In a longitudinal cohort study of healthcare workers (HCWs) in Oxfordshire, United Kingdom, we investigated the protection from symptomatic and asymptomatic polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection conferred by vaccination (Pfizer-BioNTech BNT162b2, Oxford-AstraZeneca ChAdOx1 nCOV-19) and prior infection (determined using anti-spike antibody status), using Poisson regression adjusted for age, sex, temporal changes in incidence and role. We estimated protection conferred after 1 versus 2 vaccinations and from infections with the B.1.1.7 variant identified using whole genome sequencing.
Results: In total, 13 109 HCWs participated; 8285 received the Pfizer-BioNTech vaccine (1407 two doses), and 2738 the Oxford-AstraZeneca vaccine (49 two doses). Compared to unvaccinated seronegative HCWs, natural immunity and 2 vaccination doses provided similar protection against symptomatic infection: no HCW vaccinated twice had symptomatic infection, and incidence was 98% lower in seropositive HCWs (adjusted incidence rate ratio 0.02 [95% confidence interval {CI} < .01-.18]). Two vaccine doses or seropositivity reduced the incidence of any PCR-positive result with or without symptoms by 90% (0.10 [95% CI .02-.38]) and 85% (0.15 [95% CI .08-.26]), respectively. Single-dose vaccination reduced the incidence of symptomatic infection by 67% (0.33 [95% CI .21-.52]) and any PCR-positive result by 64% (0.36 [95% CI .26-.50]). There was no evidence of differences in immunity induced by natural infection and vaccination for infections with S-gene target failure and B.1.1.7.
Conclusions: Natural infection resulting in detectable anti-spike antibodies and 2 vaccine doses both provide robust protection against SARS-CoV-2 infection, including against the B.1.1.7 variant.
| Original language | English |
|---|---|
| Pages (from-to) | 1208-1219 |
| Number of pages | 12 |
| Journal | Clinical Infectious Diseases |
| Volume | 74 |
| Issue number | 7 |
| Early online date | 3 Jul 2021 |
| DOIs | |
| Publication status | Published - 9 Apr 2022 |
Bibliographical note
Funding Information: This work was supported by the UK Government’s Department of Health and Social Care. This work was also supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Oxford University in partnership with Public Health England (PHE) (grant number NIHR200915), the NIHR Biomedical Research Centre, Oxford, and benefactions from the Huo Family Foundation and Andrew Spokes. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health or Public Health England. This study is affiliated with Public Health England’s SARS-CoV-2 Immunity & Reinfection EvaluatioN (SIREN) study.D. W. E. is a Robertson Foundation Fellow and an NIHR Oxford BRC Senior Fellow. S. F. L. is a Wellcome Trust Clinical Research Fellow. D. I. S. is supported by the Medical Research Council (grant number MR/N00065X/1). P. C. M. holds a Wellcome Intermediate Fellowship (grant number 110110/Z/15/Z). B. D. M. is supported by the SGC, a registered charity (grant number 1097737) that receives funds from AbbVie, Bayer Pharma AG, Boehringer Ingelheim, Canada Foundation for Innovation, Eshelman Institute for Innovation, Genome Canada through Ontario Genomics Institute (grant number OGI-055), Innovative Medicines Initiative (EU/EFPIA) (ULTRA-DD grant number 115766), Janssen, Merck KGaA, Darmstadt, Germany, MSD, Novartis Pharma AG, Pfizer, Sao Paulo Research Foundation-FAPESP, Takeda, and Wellcome. B. D. M. is also supported by the Kennedy Trust for Rheumatology Research.
G. S. is a Wellcome Trust Senior Investigator and acknowledges funding from the Schmidt Foundation. T. M. W. is a Wellcome Trust Clinical Career Development Fellow (grant number 214560/Z/18/Z). A. S. W. is an NIHR Senior Investigator.
D. W. E. declares lecture fees from Gilead, outside the submitted work. R. J. C. is a founder, shareholder, and consultant to MIROBio, outside the submitted work. All other authors report no potential conflicts.
All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Open Access: This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted
reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Publisher Copyright: © The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.
Citation: Sheila F Lumley, Gillian Rodger, Bede Constantinides, Nicholas Sanderson, Kevin K Chau, Teresa L Street, Denise O’Donnell, Alison Howarth, Stephanie B Hatch, Brian D Marsden, Stuart Cox, Tim James, Fiona Warren, Liam J Peck, Thomas G Ritter, Zoe de Toledo, Laura Warren, David Axten, Richard J Cornall, E Yvonne Jones, David I Stuart, Gavin Screaton, Daniel Ebner, Sarah Hoosdally, Meera Chand, Derrick W Crook, Anne-Marie O’Donnell, Christopher P Conlon, Koen B Pouwels, A Sarah Walker, Tim E A Peto, Susan Hopkins, Timothy M Walker, Nicole E Stoesser, Philippa C Matthews, Katie Jeffery, David W Eyre, Oxford University Hospitals Staff Testing Group, An Observational Cohort Study on the Incidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection and B.1.1.7 Variant Infection in Healthcare Workers by Antibody and Vaccination Status, Clinical Infectious Diseases, Volume 74, Issue 7, 1 April 2022, Pages 1208–1219.
DOI: https://doi.org/10.1093/cid/ciab608
Keywords
- SARS-CoV-2
- antibody
- healthcare worker
- immunity
- vaccine
