Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 153 No. 12 (2023)

Long-term course of neutralising antibodies against SARS-CoV-2 in vaccinated and unvaccinated staff and residents in a Swiss nursing home: a cohort study 2021–2022

  • Lisa Perrig
  • Irene A. Abela
  • Nicolas Banholzer
  • Annette Audigé
  • Selina Epp
  • Catrina Mugglin
  • Kathrin Zürcher
  • Matthias Egger
  • Alexandra Trkola
  • Lukas Fenner
DOI
https://doi.org/10.57187/s.3502
Cite this as:
Swiss Med Wkly. 2023;153:3502
Published
22.12.2023

Summary

BACKGROUND: Given their high-risk resident population, nursing homes were critical institutions in the COVID-19 pandemic, calling for continued monitoring and vaccine administration to healthcare workers and residents. Here, we studied long-term severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunity in vaccinated and unvaccinated healthcare workers and residents of a nursing home in Switzerland between February 2021 and June 2022.

METHODS: Our study comprised 45 participants, of which 39 were healthcare workers and six were residents. All participants were offered a maximum of three mRNA vaccine doses (Pfizer/BioNTech, BNT162b2) in December 2020, January 2021, and November/December 2021. Thirty-five participants received three vaccinations, seven either one or two, and three remained unvaccinated. We collected four blood samples: one in March 2021 and three during follow-ups in November 2021, February 2022, and June 2022. We performed a multifactorial serological SARS-CoV-2 assay (ABCORA) for immunoglobulin G, A, and M responses to spike (receptor-binding domain, S1, and S2) and nucleocapsid (N) proteins. Furthermore, we assessed predicted neutralisation activity based on signal over cutoff in ABCORA. We collected epidemiological data from participants via a standardised questionnaire.

RESULTS: Thirty-two (71%) of the 45 participants showed hybrid immunity from combined vaccination and previous infection; 10 (22%) had only vaccine-induced immunity; and three (7%) had only post-infection immunity. Participants with hybrid immunity showed the highest predicted neutralisation activity at the end of the study period (median Sum S1 = 273), and unvaccinated participants showed the lowest (median Sum S1 = 41). Amongst participants who reported a SARS-CoV-2 infection, median Sum S1 levels increased with the number of vaccinations (p = 0.077). The healthcare worker group showed a significant time-dependent decrease in median Sum S1 after base immunisation (93% decrease, p = 0.0005) and the booster dose (26% decrease, p = 0.010). Predicted neutralisation activity was lower amongst residents (adjusted ratio of means [AM] = 0.7, 95% confidence interval [CI] = 0.3–1.0) and amongst smokers (AM = 0.5, 95% CI 0.3–0.8). Activity increased with the number of vaccinations (booster: AM = 3.6, 95% CI 1.5–8.8; no booster: AM = 2.3, 95% CI 0.9–2.5). Positive SARS-CoV-2 infection status tended to confer higher predicted neutralisation levels (AM = 1.5, 95% CI 0.9–2.5).

CONCLUSIONS: Our study of the long-term serological course of SARS-CoV-2 in a nursing home showed that the first SARS-CoV-2 booster vaccine was essential for maintaining antiviral antibody levels. Hybrid immunity sustained SARS-CoV-2 immunity at the highest level. In critical settings such as nursing homes, monitoring the SARS-CoV-2 immune status may guide booster vaccinations.

References

  1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al.; China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020 Feb;382(8):727–33. 10.1056/NEJMoa2001017 DOI: https://doi.org/10.1056/NEJMoa2001017
  2. Federal Office of Public Health (FOPH). COVID -⁠19 Switzerland. 2021 [cited 2023 February 6 2023]; Available from: https://www.covid19.admin.ch/en/overview
  3. Swissmedic. Swissmedic grants authorisation for the first COVID-19 vaccine in Switzerland. 2021 [cited 2023 February 2023]; Available from: https://www.swissmedic.ch/swissmedic/en/home/news/coronavirus-covid-19/covid-19-impfstoff_erstzulassung.html
  4. Swissmedic. Swissmedic grants authorisation for the COVID-19 vaccine from Moderna: Second COVID-19 vaccine authorised in Switzerland. 2021 [cited 2021 January]; Available from: https://www.swissmedic.ch/swissmedic/en/home/news/coronavirus-covid-19/zulassung-covid-19-impfstoff-moderna.html
  5. Zürcher K, Mugglin C, Egger M, Müller S, Fluri M, Bolick L, et al. Vaccination willingness for COVID-19 among healthcare workers: a cross-sectional survey in a Swiss canton. Swiss Med Wkly. 2021 Sep;151(3738):w30061. 10.4414/SMW.2021.w30061 DOI: https://doi.org/10.4414/SMW.2021.w30061
  6. Haas EJ, Angulo FJ, McLaughlin JM, Anis E, Singer SR, Khan F, et al. Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national surveillance data. Lancet. 2021 May;397(10287):1819–29. 10.1016/S0140-6736(21)00947-8 DOI: https://doi.org/10.1016/S0140-6736(21)00947-8
  7. Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al.; C4591001 Clinical Trial Group. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020 Dec;383(27):2603–15. 10.1056/NEJMoa2034577 DOI: https://doi.org/10.1056/NEJMoa2034577
  8. Goldberg Y, Mandel M, Bar-On YM, Bodenheimer O, Freedman L, Haas EJ, et al. Waning Immunity after the BNT162b2 Vaccine in Israel. N Engl J Med. 2021 Dec;385(24):e85. 10.1056/NEJMoa2114228 DOI: https://doi.org/10.1056/NEJMoa2114228
  9. Federal Office of Public Health (FOPH). Impfempfehlung für mRNA-Impfstoffe gegen Covid-19 (Stand 09.11.21). Federal office of public health 2021.
  10. Carazo S, Skowronski DM, Brisson M, Barkati S, Sauvageau C, Brousseau N, et al. Protection against omicron (B.1.1.529) BA.2 reinfection conferred by primary omicron BA.1 or pre-omicron SARS-CoV-2 infection among health-care workers with and without mRNA vaccination: a test-negative case-control study. Lancet Infect Dis. 2023 Jan;23(1):45–55. 10.1016/S1473-3099(22)00578-3 DOI: https://doi.org/10.1016/S1473-3099(22)00578-3
  11. Altarawneh HN, Chemaitelly H, Ayoub HH, Tang P, Hasan MR, Yassine HM, et al. Effects of Previous Infection and Vaccination on Symptomatic Omicron Infections. N Engl J Med. 2022 Jul;387(1):21–34. 10.1056/NEJMoa2203965 DOI: https://doi.org/10.1056/NEJMoa2203965
  12. Bobrovitz N, Ware H, Ma X, Li Z, Hosseini R, Cao C, et al. Protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against the omicron variant and severe disease: a systematic review and meta-regression. Lancet Infect Dis. 2023 May;23(5):556–67. 10.1016/S1473-3099(22)00801-5 DOI: https://doi.org/10.1016/S1473-3099(22)00801-5
  13. Bruel T, Pinaud L, Tondeur L, Planas D, Staropoli I, Porrot F, et al. Neutralising antibody responses to SARS-CoV-2 omicron among elderly nursing home residents following a booster dose of BNT162b2 vaccine: A community-based, prospective, longitudinal cohort study. EClinicalMedicine. 2022 Jul;51:101576. 10.1016/j.eclinm.2022.101576 DOI: https://doi.org/10.1016/j.eclinm.2022.101576
  14. Menni C, May A, Polidori L, Louca P, Wolf J, Capdevila J, et al. COVID-19 vaccine waning and effectiveness and side-effects of boosters: a prospective community study from the ZOE COVID Study. Lancet Infect Dis. 2022 Jul;22(7):1002–10. 10.1016/S1473-3099(22)00146-3 DOI: https://doi.org/10.1016/S1473-3099(22)00146-3
  15. Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, et al.; SHEA; APIC. SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008. Infect Control Hosp Epidemiol. 2008 Sep;29(9):785–814. 10.1086/592416 DOI: https://doi.org/10.1086/592416
  16. Gómez-Ochoa SA, Franco OH, Rojas LZ, Raguindin PF, Roa-Díaz ZM, Wyssmann BM, et al. COVID-19 in Health-Care Workers: A Living Systematic Review and Meta-Analysis of Prevalence, Risk Factors, Clinical Characteristics, and Outcomes. Am J Epidemiol. 2021 Jan;190(1):161–75. 10.1093/aje/kwaa191 DOI: https://doi.org/10.1093/aje/kwaa191
  17. Zurcher K, et al. Alpha variant coronavirus outbreak in a nursing home despite high vaccination coverage: molecular, epidemiological and immunological studies. Clin Infect Dis. 2022;•••: 10.1093/cid/ciab1005 DOI: https://doi.org/10.1093/cid/ciab1005
  18. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al.; REDCap Consortium. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019 Jul;95:103208. 10.1016/j.jbi.2019.103208 DOI: https://doi.org/10.1016/j.jbi.2019.103208
  19. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009 Apr;42(2):377–81. 10.1016/j.jbi.2008.08.010 DOI: https://doi.org/10.1016/j.jbi.2008.08.010
  20. Chammartin F, Kusejko K, Pasin C, Trkola A, Briel M, Amico P, et al.; and the Swiss HIV Cohort Study. Determinants of antibody response to severe acute respiratory syndrome coronavirus 2 mRNA vaccines in people with HIV. AIDS. 2022 Aug;36(10):1465–8. 10.1097/QAD.0000000000003246 DOI: https://doi.org/10.1097/QAD.0000000000003246
  21. Abela IA, Pasin C, Schwarzmüller M, Epp S, Sickmann ME, Schanz MM, et al. Multifactorial seroprofiling dissects the contribution of pre-existing human coronaviruses responses to SARS-CoV-2 immunity. Nat Commun. 2021 Nov;12(1):6703. 10.1038/s41467-021-27040-x DOI: https://doi.org/10.1038/s41467-021-27040-x
  22. Barda N, Dagan N, Cohen C, Hernán MA, Lipsitch M, Kohane IS, et al. Effectiveness of a third dose of the BNT162b2 mRNA COVID-19 vaccine for preventing severe outcomes in Israel: an observational study. Lancet. 2021 Dec;398(10316):2093–100. 10.1016/S0140-6736(21)02249-2 DOI: https://doi.org/10.1016/S0140-6736(21)02249-2
  23. Team RC (Computing S, editor). R: A language and environment for statistical computing, R.F.f. Vienna, Austria; 2021.
  24. Hussein K, Dabaja-Younis H, Szwarcwort-Cohen M, Almog R, Leiba R, Weissman A, et al. Third BNT162b2 Vaccine Booster Dose against SARS-CoV-2-Induced Antibody Response among Healthcare Workers. Vaccines (Basel). 2022 Oct;10(10):1741. 10.3390/vaccines10101741 DOI: https://doi.org/10.3390/vaccines10101741
  25. Crooke, S.N., et al., Immunosenescence and human vaccine immune responses. Immunity & ageing : I & A, 2019. 16: p. 25-25. 10.1186/s12979-019-0164-9 DOI: https://doi.org/10.1186/s12979-019-0164-9
  26. Weinberger B, Herndler-Brandstetter D, Schwanninger A, Weiskopf D, Grubeck-Loebenstein B. Biology of immune responses to vaccines in elderly persons. Clin Infect Dis. 2008 Apr;46(7):1078–84. 10.1086/529197 DOI: https://doi.org/10.1086/529197
  27. Goodwin K, Viboud C, Simonsen L. Antibody response to influenza vaccination in the elderly: a quantitative review. Vaccine. 2006 Feb;24(8):1159–69. 10.1016/j.vaccine.2005.08.105 DOI: https://doi.org/10.1016/j.vaccine.2005.08.105
  28. Lelic A, Verschoor CP, Lau VW, Parsons R, Evelegh C, Bowdish DM, et al. Immunogenicity of Varicella Vaccine and Immunologic Predictors of Response in a Cohort of Elderly Nursing Home Residents. J Infect Dis. 2016 Dec;214(12):1905–10. 10.1093/infdis/jiw462 DOI: https://doi.org/10.1093/infdis/jiw462
  29. Mori Y, Tanaka M, Kozai H, Hotta K, Aoyama Y, Shigeno Y, et al. Antibody response of smokers to the COVID-19 vaccination: evaluation based on cigarette dependence. Drug Discov Ther. 2022 May;16(2):78–84. 10.5582/ddt.2022.01022 DOI: https://doi.org/10.5582/ddt.2022.01022
  30. Ferrara P, Ponticelli D, Agüero F, Caci G, Vitale A, Borrelli M, et al. Does smoking have an impact on the immunological response to COVID-19 vaccines? Evidence from the VASCO study and need for further studies. Public Health. 2022 Feb;203:97–9. 10.1016/j.puhe.2021.12.013 DOI: https://doi.org/10.1016/j.puhe.2021.12.013

Most read articles by the same author(s)

1 2 > >>