Reduced BNT162b2 mRNA vaccine response in SARS-CoV-2-naive nursing home residents

AbstractThe SARS-CoV-2 pandemic impact on nursing home (NH) residents prompted their prioritization for early vaccination. To fill the data gap for vaccine immunogenicity in NH residents, we examined antibody levels after BNT162b2 mRNA vaccine to spike, receptor binding domain (RBD) and for virus neutralization in 149 NH residents and 111 health care worker controls. SARS-CoV-2-naive NH residents mount antibody responses with nearly 4-fold lower median neutralization titers and half the anti-spike level compared to SARS-CoV-2-naive healthcare workers. By contrast, SARS-CoV-2-recovered vaccinated NH residents had neutralization, anti-spike and anti-RBD titers similar to SARS-CoV-2-recovered vaccinated healthcare workers. NH residents’ blunted antibody responses have important implications regarding the quality and durability of protection afforded by neoantigen vaccines. We urgently need better longitudinal evidence on vaccine effectiveness specific to NH resident populations to inform best practices for NH infection control measures, outbreak prevention and potential indication for a vaccine boost.

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Significant reduction in humoral immunity among healthcare workers and nursing home residents 6 months after COVID-19 BNT162b2 mRNA vaccination

10.1101/2021.08.15.21262067 ◽

2021 ◽

Cited By ~ 1

Author(s):

David H. Canaday ◽

Oladayo A. Oyebanji ◽

Debbie Keresztesy ◽

Michael Payne ◽

Dennis Wilk ◽

...

Keyword(s):

Nursing Home ◽

Humoral Immunity ◽

Healthcare Workers ◽

Limit Of Detection ◽

Nursing Home Residents ◽

Good Health ◽

Neutralization Assay ◽

Vaccine Response ◽

Post Vaccination ◽

Antibody Levels

AbstractHigh COVID-19 mortality among nursing home (NH) residents led to their prioritization for SARS-CoV-2 vaccination; most NH residents received BNT162b2 mRNA vaccination under the Emergency Use Authorization due to first to market and its availability. With NH residents’ poor initial vaccine response, the rise of NH breakthrough infections and outbreaks, characterization of the durability of immunity to inform public health policy on the need for boosting is needed. We report on humoral immunity from 2 weeks to 6-months post-vaccination in 120 NH residents and 92 ambulatory healthcare worker controls with and without pre-vaccination SARS-CoV-2 infection. Anti-spike and anti-receptor binding domain (RBD) IgG, and serum neutralization titers, were assessed using a bead-based ELISA method and pseudovirus neutralization assay. Anti-spike, anti-RBD and neutralization levels dropped more than 84% over 6 months’ time in all groups irrespective of prior SARS-CoV-2 infection. At 6 months post-vaccine, 70% of the infection-naive NH residents had neutralization titers at or below the lower limit of detection compared to 16% at 2 weeks after full vaccination. These data demonstrate a significant reduction in levels of antibody in all groups. In particular, those infection-naive NH residents had lower initial post-vaccination humoral immunity immediately and exhibited the greatest declines 6 months later. Healthcare workers, given their younger age and relative good-health, achieved higher initial antibody levels and better maintained them, yet also experienced significant declines in humoral immunity. Based on the rapid spread of the delta variant and reports of vaccine breakthrough in NH and among younger community populations, boosting NH residents may be warranted.

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Does a lack of vaccine side effects correlate with reduced BNT162b2 mRNA vaccine response among healthcare workers and nursing home residents?

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01987-9 ◽

2021 ◽

Author(s):

Oladayo A. Oyebanji ◽

Brigid Wilson ◽

Debbie Keresztesy ◽

Lenore Carias ◽

Dennis Wilk ◽

...

Keyword(s):

Nursing Home ◽

Side Effects ◽

Healthcare Workers ◽

Nursing Home Residents ◽

Community Dwelling ◽

Vaccine Response ◽

Term Care ◽

Post Vaccination ◽

Dichotomous Variable ◽

Antibody Levels

Abstract Background The BNT162b2 SARS-CoV-2 mRNA vaccination has mitigated the burden of COVID-19 among residents of long-term care facilities considerably, despite being excluded from the vaccine trials. Data on reactogenicity (vaccine side effects) in this population are limited. Aims To assess reactogenicity among nursing home (NH) residents. To provide a plausible proxy for predicting vaccine response among this population. Methods We enrolled and sampled NH residents and community-dwelling healthcare workers who received the BNT162b2 mRNA vaccine, to assess local or systemic reactogenicity and antibody levels (immunogenicity). Results NH residents reported reactions at a much lower frequency and lesser severity than the community-dwelling healthcare workers. These reactions were mild and transient with all subjects experiencing more local than systemic reactions. Based on our reactogenicity and immunogenicity data, we developed a linear regression model predicting log-transformed anti-spike, anti-receptor-binding domain (RBD), and neutralizing titers, with a dichotomous variable indicating the presence or absence of reported reactions which revealed a statistically significant effect, with estimated shifts in log-transformed titers ranging from 0.32 to 0.37 (all p < 0.01) indicating greater immunogenicity in subjects with one or more reported reactions of varying severity. Discussion With a significantly lower incidence of post-vaccination reactions among NH residents as reported in this study, the BNT162b2 mRNA vaccine appears to be well-tolerated among this vulnerable population. If validated in larger populations, absence of reactogenicity could help guide clinicians in prioritizing vaccine boosters. Conclusions Reactogenicity is significantly mild among nursing home residents and overall, subjects who reported post-vaccination reactions developed higher antibody titers.

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Zanamivir Use During Transmission of Amantadine-Resistant Influenza A in a Nursing Home

Infection Control and Hospital Epidemiology ◽

10.1086/501727 ◽

2000 ◽

Vol 21 (11) ◽

pp. 700-704 ◽

Cited By ~ 42

Author(s):

Christine Lee ◽

Mark Loeb ◽

Anne Phillips ◽

Judy Nesbitt ◽

Karen Smith ◽

...

Keyword(s):

Nursing Home ◽

Influenza A ◽

Nursing Home Residents ◽

Care Facility ◽

Respiratory Illness ◽

The Elderly ◽

Control Measures ◽

Term Care ◽

Long Term Care Facility ◽

Infection Control Measures

AbstractObjective:To describe the use of zanamivir during an influenza A outbreak.Population:Residents of a 176-bed long-term-care facility for the elderly in Newmarket, Ontario, Canada, 90% of whom received influenza vaccine in the fall of 1998.Outbreak:When respiratory illness due to influenza A was confirmed, infection control measures and amantadine prophylaxis were initiated. Despite these measures, transmission of influenza A continued.Intervention:Zanamivir inhalations, 10 mg daily for prophylaxis and 10 mg twice daily for treatment of influenza.Results:There were 13 definite and 66 probable outbreak-associated cases of influenza A. Twelve (15%) cases developed pneumonia, 7 (9%) were hospitalized, and 2 (2.6%) died. All 12 culture-positive cases yielded influenza A/Sydney/H3N2/05/97-like virus, a 1998/99 vaccine component. The three isolates obtained prior to the initiation of amantadine were amantadine-susceptible; all nine obtained after prophylaxis was instituted were amantadine-resistant. One hundred twenty-nine (92%) of 140 residents who were offered zanamivir accepted it and were able to attempt inhalations. Of these 129, 78% (100) had no difficulty in complying with inhalations. Difficulty with inhalations was associated with decreased functional and mental status. Fifteen (58%) of 26 residents fully dependent in activities of daily living had difficulty compared to 14 (14%) of 100 others (P<.001). Twenty-two (45%) of 49 residents not oriented to person, place, or time had difficulty compared to 7 (10%) of 77 others (P<001). In the 2 weeks after zanamivir prophylaxis, only 2 new cases of respiratory illness occurred, neither confirmed as influenza. No side effects were identified in 128 zanamivir-treated residents.Conclusion:A minority of nursing home residents have difficulty following instructions for zanamivir inhalations. Zanamivir was well tolerated, and its use was temporally associated with termination of an outbreak that amantadine had failed to control.

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Antibody Response to Influenza Vaccination in Nursing Home Residents and Healthcare Workers During Four Successive Seasons in Niigata, Japan

Infection Control and Hospital Epidemiology ◽

10.1086/502509 ◽

2005 ◽

Vol 26 (11) ◽

pp. 859-866 ◽

Cited By ~ 14

Author(s):

Mizuho Sato ◽

Reiko Saito ◽

Naohito Tanabe ◽

Makoto Nishikawa ◽

Asami Sasaki ◽

...

Keyword(s):

Multivariate Analysis ◽

Nursing Home ◽

Antibody Response ◽

Healthcare Workers ◽

Geometric Mean ◽

Nursing Home Residents ◽

Antibody Responses ◽

Fourfold Increase ◽

Almost All ◽

Underlying Diseases

AbstractObjective:To evaluate the antibody response to influenza vaccines in nursing home residents and healthcare workers (HCWs) and its relation to residents' functional and chronic disease status during four successive seasons.Design:Before-after study.Setting:Nine nursing homes during the 1998-1999 season and two during the 1999-2000, 2000-2001, and 2001-2002 seasons.Participants:Two hundred fifty-nine residents and 79 HCWs during the 1998-1999 season; 180 and 71, respectively, during the 1999-2000 season; 162 and 71, respectively, during the 2000-2001 season; and 153 and 79, respectively, during the 2001-2002 season.Results:Multivariate analysis indicated that the mean fold increase in the geometric mean titers (GMTs) of hemagglutination inhibition (HI) antibodies and the response rate (the proportion of vaccinées resulting in a significant, at least fourfold increase in antibody titer) were good and no significant differences occurred for almost all strains in both residents and HCWs. The GMTs of HI antibodies and the protection rate (the proportion of participants with HI antibody titers & 40) were increased in both residents and HCWs, but were significantly lower for almost all strains in residents than in HCWs. Furthermore, multivariate analysis indicated that subdivision of residents into three groups by level of daily activities and into four groups according to underlying diseases revealed only minor differences in immune responses.Conclusions:Antibody responses to the influenza vaccine were lower in residents than in HCWs. However, residents showed similar antibody responses regardless of their level of daily activity or underlying diseases.

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Preventing SARS-CoV-2 transmission in the emergency department by implementing a separate pathway for patients with respiratory conditions

Journal of Complementary and Integrative Medicine ◽

10.1515/jcim-2020-0422 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Fulwah Alqahtani ◽

Marzouqah Alanazi ◽

Wajdan Alassaf ◽

Fadilah Sfouq Aleanizy ◽

Muna Aljahany ◽

...

Keyword(s):

Emergency Department ◽

Longitudinal Study ◽

Healthcare Workers ◽

Respiratory Symptoms ◽

Control Measures ◽

University Hospital ◽

Respiratory Pathway ◽

Infection Control Measures ◽

Separate Pathway ◽

Respiratory Conditions

Abstract Objectives This study aimed to describe the development and implementation of a separated pathway to check and treat patients with a suspected/confirmed coronavirus disease 2019 (COVID-19) in the emergency department (ED) at King Abdullah bin Abdulaziz University Hospital in Riyadh. Methods We conducted a retrospective, descriptive longitudinal study from March to July 2020 by analyzing data of all confirmed cases of COVID-19 among ED visitors and healthcare workers in King Abdullah bin Abdulaziz University Hospital. Results During the study period, a total of 1,182 swab samples were collected for testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), of which 285 (24.1%) tested positive. Of the 285 cases of confirmed SARS-CoV-2 infection, 18 were healthcare workers and 267 were patients. As a result of using the respiratory pathway for COVID-19 patients, the hospital managed to limit transmission of SARS-CoV-2 not only between patients but also between patients and healthcare workers, while also containing the pandemic. There were no cases of nosocomial SARS-CoV-2 infection recorded among the patients who visited the ED or the flu clinic. All confirmed cases were community acquired and patients were cared for under constrained measures. Conclusions Implementing infection control measures and restricting those with respiratory symptoms to the ED pathway prevented nosocomial spread of SARS-CoV-2 infection in the ED.

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Dynamics of the seroprevalence of SARS-CoV-2 antibodies among healthcare workers at a COVID-19 referral hospital in Milan, Italy

Occupational and Environmental Medicine ◽

10.1136/oemed-2020-107060 ◽

2021 ◽

pp. oemed-2020-107060

Author(s):

Laura Milazzo ◽

Alessia Lai ◽

Laura Pezzati ◽

Letizia Oreni ◽

Annalisa Bergna ◽

...

Keyword(s):

Healthcare Workers ◽

Referral Hospital ◽

Control Measures ◽

Referral Centre ◽

Single Centre ◽

Factors Associated ◽

Infection Control Measures ◽

Professional Exposure ◽

First Time ◽

Time Point

ObjectivesHealthcare workers (HCWs) are at high risk of developing SARS-CoV-2 infection. The aim of this single-centre prospective study was to evaluate the trend of SARS-CoV-2 seroprevalence in HCWs working at the primary referral centre for infectious diseases and bioemergencies (eg, COVID-19) in Northern Italy and investigate the factors associated with seroconversion.MethodsSix hundred and seventy-nine HCW volunteers were tested for anti-SARS-CoV-2 antibodies three times between 4 March and 27 May 2020 and completed a questionnaire covering COVID-19 exposure, symptoms and personal protective equipment (PPE) training and confidence at each time.ResultsSARS-CoV-2 seroprevalence rose from 3/679 to 26/608 (adjusted prevalence: 0.5%, 95% CI 0.1 to 1.7% and 5.4%, 95% CI 3.6 to 7.9, respectively) between the first two time points and then stabilised, in line with the curve of the COVID-19 epidemic in Milan. From the first time point, 61.6% of the HCWs had received training in the use of PPE and 17 (61.5%) of those who proved to be seropositive reported symptoms compatible with SARS-CoV-2 infection. Contacts with ill relatives or friends and self-reported symptoms were independently associated with an increased likelihood of seroconversion (p<0.0001 for both), whereas there was no significant association with professional exposure.ConclusionThe seroprevalence of SARS-CoV-2 among the HCWs at our COVID-19 referral hospital was low at the time of the peak of the epidemic. The seroconversions were mainly attributable to extrahospital contacts, probably because the hospital readily adopted effective infection control measures. The relatively high number of asymptomatic seropositive HCWs highlights the need to promptly identify and isolate potentially infectious HCWs.

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Rapid decline of neutralizing antibodies against SARS-CoV-2 among infected healthcare workers

Nature Communications ◽

10.1038/s41467-021-21111-9 ◽

2021 ◽

Vol 12 (1) ◽

Cited By ~ 16

Author(s):

Stéphane Marot ◽

◽

Isabelle Malet ◽

Valentin Leducq ◽

Karen Zafilaza ◽

...

Keyword(s):

Neutralizing Antibodies ◽

Healthcare Workers ◽

Disease Onset ◽

Control Measures ◽

Infection Prevention And Control ◽

Rapid Decline ◽

Prevention And Control Measures ◽

Few Data ◽

Antibody Levels ◽

And Control

AbstractThere are only few data concerning persistence of neutralizing antibodies (NAbs) among SARS-CoV-2-infected healthcare workers (HCW). These individuals are particularly exposed to SARS-CoV-2 infection and at potential risk of reinfection. We followed 26 HCW with mild COVID-19 three weeks (D21), two months (M2) and three months (M3) after the onset of symptoms. All the HCW had anti-receptor binding domain (RBD) IgA at D21, decreasing to 38.5% at M3 (p < 0.0001). Concomitantly a significant decrease in NAb titers was observed between D21 and M2 (p = 0.03) and between D21 and M3 (p < 0.0001). Here, we report that SARS-CoV-2 can elicit a NAb response correlated with anti-RBD antibody levels. However, this neutralizing activity declines, and may even be lost, in association with a decrease in systemic IgA antibody levels, from two months after disease onset. This short-lasting humoral protection supports strong recommendations to maintain infection prevention and control measures in HCW, and suggests that periodic boosts of SARS-CoV-2 vaccination may be required.

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Determinants of Protection Against Measles Infection in a Vaccinated Healthcare Worker

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.722 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s185-s185

Author(s):

Annie St-Pierre ◽

Anne-Marie Charron ◽

Pamela Doyon-Plourde ◽

Caroline Quach

Keyword(s):

Vaccination Status ◽

Secondary Case ◽

Enzyme Linked Immunosorbent Assay ◽

Demographic Information ◽

Vaccine Response ◽

Vaccine Responses ◽

Equivocal Result ◽

Commercial Enzyme Immunoassay ◽

Antibody Levels ◽

Care Worker

Background: In 2019, a measles community outbreak resulted in a secondary case in a health care worker (HCW) working in a pediatric hospital in Montral, Canada. Following the event, HCWs were screened to identify individuals susceptible to measles infection based on serology results. Objective: Our aim was to assess measles seroprotection rates and to evaluate vaccine responses of susceptible HCWs using commercial enzyme immunoassay (EIA) or enzyme linked immunosorbent assay (ELISA). Methods: Emergency department (ED) employees, including doctors, were screened for measles susceptibility as part of a postoutbreak measure by the hospital occupational health service. Demographic information was collected. Measles history and vaccination information were collected using a personal vaccination booklet, employee vaccination profile, or the Qubec vaccination registry. According to the Quebec Immunization Protocol (PIQ), individuals born before 1970, or who have received 2 doses of a measles-containing vaccines are considered protected. Individuals with undetectable or equivocal antibody levels were considered at risk of measles infection. These individuals were offered vaccination and were tested for vaccine response 4 weeks after vaccination. Results: Anti-IgG measles antibody results, demographic information, and vaccination information were obtained for 257 employees. The results are currently available for 233 HCWs: 224 HCWs (96%) were seropositive, 7 (3%) were seronegative, and 2 were equivocal. Among seronegative individuals, 6 (85.7%) were born after 1980 and 3 (42.9%) had received 2 doses of a measles-containing vaccine. Of those with an equivocal result, 1 (50%) had received 2 doses and 1 (50%), born after 1970, did not confirm vaccination status. Finally, 9 (4%) of seropositive individuals were not vaccinated; of whom 8 (88.9%) were born before 1970. Conclusions: Our preliminary results suggest that the 95% immunity threshold that is usually required to prevent secondary transmission of measles has been reached in our ED HCW cohort. Even years after the second MMR dose, HCWs remain well protected. Relying on documented vaccination status is thus acceptable.Funding: NoneDisclosures: None

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Healthcare Workers Infection Rate in the Era of Coronavirus Disease 2019 - in Tertiary Teaching Hospital

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6584 ◽

2021 ◽

Vol 9 (A) ◽

pp. 651-658

Author(s):

Mona Mohiedden ◽

Aml M. Said ◽

Ahmed M. Ali ◽

Mohammed M. Abdel Razik ◽

Maha Ali Gad

Keyword(s):

Healthcare Workers ◽

Statistical Significance ◽

Descriptive Analysis ◽

Control Measures ◽

University Hospitals ◽

Cross Sectional ◽

Infection Control Measures ◽

Increased Risk ◽

Tertiary Teaching ◽

Potential Risk Factors

BACKGROUND: Healthcare workers (HCWs) are at the frontline defense against coronavirus disease 2019 (COVID-19) pandemic. AIM: The study aimed to describe the characteristics and appraise potential risk factors of COVID-19 transmission among HCWs who tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in one of Cairo University Hospitals. METHOD: Cross-sectional descriptive analysis of confirmed polymerase chain reaction (PCR) positive versus negative cases for COVID-19. RESULTS: Through March–June 2020, (145/846; 17%) suspected HCWs were tested for COVID-19 by PCR; out of them (70/145; 48.3%) were confirmed as positive, these positive cases represented (70/846; 8.3%) of all HCWs of the hospital. About 33% of confirmed COVID-19 positive HCWs acquired the infection from the healthcare while only (13/70; 19%) from community settings, and no clear exposure data were identified in (34/70; 48%) of cases. Most of symptomatic cases showed a positive PCR test for SARS-CoV-2 versus asymptomatic cases, p < 0.001. There was no statistical significance regarding gender, age, presence of comorbidity, workload or the type of acquisition. CONCLUSION: HCWs are at an increased risk of COVID-19 infection at the workplace. Strict implementation of infection control measures is of crucial role in preventing transmission of COVID-19 infection in health-care settings.

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