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. 2023 Jun 15;11(3):e0516322.
doi: 10.1128/spectrum.05163-22. Epub 2023 Apr 26.

Vaccination and Omicron BA.1/BA.2 Convalescence Enhance Systemic but Not Mucosal Immunity against BA.4/5

Affiliations

Vaccination and Omicron BA.1/BA.2 Convalescence Enhance Systemic but Not Mucosal Immunity against BA.4/5

Gabriel Diem et al. Microbiol Spectr. .

Abstract

Rising breakthrough infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron BA.4/5 led to the performance of various studies investigating systemic immunity and neutralizing antibodies in sera, but mucosal immunity remains understudied. In this cohort study, the humoral immune responses, including immunoglobulin levels and the presence of virus-neutralizing antibodies, of 92 vaccinated and/or BA.1/BA.2 convalescent individuals were investigated. Cohorts received two doses of ChAdOx1, BNT162b2, or mRNA-1273 and subsequent booster vaccination with either BNT162b2 or mRNA-1273, following BA.1/BA.2 infection. In addition, vaccinated and nonconvalescent or unvaccinated and BA.1 convalescent individuals were studied. Serum and saliva samples were used to determine SARS-CoV-2 spike-specific IgG and IgA titers and neutralizing activity against replication-competent SARS-CoV-2 wild-type virus and the Omicron BA.4/5 variant. Vaccinated/convalescent cohorts demonstrated strongest neutralization against BA.4/5, with 50% neutralization titer (NT50) values reaching 174.2; however, neutralization was reduced up to 11-fold, compared to wild-type virus. Both BA.1 convalescent and vaccinated nonconvalescent cohorts displayed the weakest neutralization against BA.4/5, with NT50 values being reduced to 4.6, accompanied by lower numbers of positive neutralizers. Additionally, salivary neutralization against wild-type virus was strongest in vaccinated and BA.2 convalescent subjects, but this elevated neutralization efficiency was lost when challenged with BA.4/5. Our data support the contention that current coronavirus disease 2019 (COVID-19) vaccines efficiently induce humoral immunity. However, antiviral effectiveness in serum and saliva is greatly reduced against novel variants of concern. These results suggest an adjustment of current vaccine strategies to an adapted or alternative vaccine delivery, such as mucosal booster vaccinations, which might establish enhanced or even sterilizing immunity against novel SARS-CoV-2 variants. IMPORTANCE Rising incidences of breakthrough infections caused by SARS-CoV-2 Omicron BA.4/5 have been observed. Although various studies were conducted investigating neutralizing antibodies in sera, mucosal immunity was barely evaluated. Here, we investigated mucosal immunity, since the presence of neutralizing antibodies at mucosal entry sites plays a fundamental role in disease limitation. We found strong induction of serum IgG/IgA, salivary IgA, and neutralization against SARS-CoV-2 wild-type virus in vaccinated/convalescent subjects but detected 10-fold reduced (albeit positive) serum neutralization against BA.4/5. Interestingly, vaccinated and BA.2 convalescent patients demonstrated the greatest serum neutralization against BA.4/5, but this advantageous neutralizing effect was not observed in the saliva. Our data support the contention that current COVID-19 vaccines are very efficient against severe/critical disease progression. Moreover, these results suggest an adjustment of the current vaccine strategy to adapted and alternative vaccine delivery, such as mucosal booster vaccinations, to establish robust sterilizing immunity against novel SARS-CoV-2 variants.

Keywords: COVID-19 vaccines; Omicron BA.4/5; SARS-CoV-2; adaptive immunity; neutralizing antibodies; systemic/mucosal immunity.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIG 1
FIG 1
Analyses of SARS-CoV-2-specific antibodies in sera and saliva from vaccinated and/or convalescent individuals. (Upper) Serum was tested for SARS-CoV-2 RBD-specific IgG (A) and S1-specific IgA (B). Additionally, the presence of S1-specific IgA was determined in saliva (C). IgG and IgA titers from three times vaccinated and BA.1 (Vac/BA.1) (blue) or BA.2 (Vac/BA.2) (red) convalescent individuals, as well as three times vaccinated but nonconvalescent individuals (Vac) (orange) and nonvaccinated but BA.1 convalescent individuals (BA.1-conv) (green), are shown. Red lines indicate positive titer thresholds, and yellow lines indicate borderline levels. (Lower) Percentages of individuals with positive, borderline, and negative IgG or IgA titers are shown. Thresholds for IgG and IgA were set according the manufacturer’s instructions (WT IgG against RBD, positive is >7.1 BAU/mL; WT IgA against S1, positive ratio is >1.1 and borderline ratio is 0.9 to 1.1). Data are shown as geometric means ± 95% confidence intervals (CIs), and statistical significances were determined via the Mann-Whitney test. *, P < 0.05; **, P < 0.01; ***, P < 0.001; ****, P < 0.0001.
FIG 2
FIG 2
Analyses of neutralization capacity using sera and saliva from vaccinated and/or convalescent individuals. (Upper) Graphs illustrate serum neutralization against the WT virus (A) and the BA.4/5 variant (B) and salivary neutralization against the WT virus (C) and the BA.4/5 variant (D). Data for three times vaccinated and BA.1 (Vac/BA.1) (blue) or BA.2 (Vac/BA.2) (red) convalescent individuals, three times vaccinated but nonconvalescent individuals (Vac) (orange), and nonvaccinated but BA.1 convalescent individuals (BA.1-conv) (green) are shown. Red lines indicate the defined neutralization threshold, and yellow lines indicate borderline levels. (Lower) Percentages of individuals in each group with positive, borderline, and negative neutralization are presented. Thresholds for sera were defined as positive for NT50 values of >32 and as borderline for NT50 values between 16 and 32. For saliva, NT50 thresholds were set as positive for NT50 values of >1. Data are shown as geometric means ± 95% CIs, and statistical significances were determined via the Mann-Whitney test. *, P < 0.05; **, P < 0.01; ***, P < 0.001; ****, P < 0.0001.

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