Paucity and discordance of neutralising antibody responses to SARS-CoV-2 VOCs in vaccinated immunodeficient patients and health-care workers in the UK.
Paucity and discordance of neutralising antibody responses to SARS-CoV-2 VOCs in vaccinated immunodeficient patients and health-care workers in the UK.
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DOI：
10.1016/s2666-5247(21)00157-9
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发表时间：
2021-09
期刊：
影响因子：
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通讯作者：
HICC consortium
中科院分区：
文献类型：
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作者：
Nadesalingam A;Cantoni D;Wells DA;Aguinam ET;Ferrari M;Smith P;Chan A;Carnell G;Ohlendorf L;Einhauser S;George C;Wagner R;Temperton N;Castillo-Olivares J;Baxendale H;Heeney JL;HICC consortium
截至2021年6月，英国人口只接种了部分新冠肺炎疫苗，许多人只接种了一剂疫苗(BNT162b2[辉瑞-生物技术])或ChAdOx1nCoV-19[AZD1222；牛津-阿斯利康])。跟踪SARS-CoV-2致病变种(VOCs)的传播对于了解疫苗诱导免疫水平和识别疫苗逃逸变种的出现仍然很重要。在两剂疫苗接种后的第三阶段临床试验中，建立了对SARS-CoV-2和新冠肺炎的保护作用的免疫相关性是在VOCs出现之前，研究组中SARS-CoV-2的中和抗体(NAB)滴度。1疫苗接种方案正在使接种疫苗人群的疾病严重程度和死亡率有希望地降低。然而，社区内持续传播的情况，包括在一些疫苗接受者中传播的情况，以及新出现的VOCs，继续对公共卫生和这些疫苗的效力构成严重威胁。截至2021年1月11日，在英国，第一针和第二针疫苗接种的间隔延长到12周。这一延期通过为尽可能多的个人接种疫苗来预防疾病和住院，从而实现了最大限度地扩大人口覆盖面的目标。令人鼓舞的是，越来越多的研究报告称，英国出现中重度临床症状的患者数量显著减少，住院治疗的新冠肺炎患者数量大幅下降，这突显了这一策略的成功。2、3许多国家在疫苗接种运动的早期和后期阶段，都面临着新的VOCs感染病例，这些VOCs获得了有助于增加传播和逃避先前存在的免疫的突变。这些VOCs可能会导致发病率和死亡率的增加。4-6 B.1.1。7(又称阿尔法)挥发性有机化合物已在114多个国家报告，B.1.351(又称贝塔)挥发性有机化合物在68多个国家报告，而P.1(又称伽马)挥发性有机化合物在37多个国家报告，世界范围内不断有新病例报告。其他VOC，如B.1.617。2，很可能继续出现并威胁我们正在进行的新冠肺炎疫苗接种计划。2021年的早期报告表明，单剂和双剂疫苗接种方案在保护方面都存在差距。7、8在南非，ChAdOx1nCoV-19疫苗的两剂方案在感染B.1.351变种后对轻到中度新冠肺炎没有显示出保护作用。9此外，卡塔尔一份关于接种BNT162b2疫苗的人的报告发现，对B.162b2 VOC的疫苗效力比B.1.1低14.9%。7个VOC，并表明有相当数量的突破性感染。以色列的一项病例队列研究也注意到了10个类似的问题，该研究发现，与未接种疫苗的人相比，完全接种疫苗的人的B.1.351感染率高得不成比例。11这些发现表明，尽管实施了积极的免疫接种计划，但流通中的VOCs的存在严重关切疫苗逃逸变异的出现，这些变异要么比疫苗毒株更具传播性或毒性，要么两者兼而有之，或者能够逃脱疫苗诱导的中和抗体。了解特定风险群体和普通人群在持续传播期间对VOCs的保护性免疫阈值水平，对于提供信息和重新确定免疫战略的重点非常重要。需要提供有关临床脆弱群体保护的免疫相关数据，以告知…
As of June, 2021, the UK population is only partly vaccinated against COVID-19, with many people having received just one vaccination dose (either BNT162b2 [Pfizer–BioNTech]) or ChAdOx1 nCoV-19 [AZD1222; Oxford–AstraZeneca]). Tracking the spread of SARS-CoV-2 Variants of Concern (VOCs) remains important for understanding the levels of vaccineinduced immunity and for identifying the emergence of vaccine escape variants. The immune correlates of protection to SARS-CoV-2 and COVID-19 established in phase 3 clinical trials following two doses of vaccine was the titre of neutralising antibodies (NAbs) to SARS-CoV-2 in study groups, before the VOCs emerged. 1 Vaccination programmes are leading to promising reductions in disease severity and mortality in vaccinated populations. However, the combined situation of ongoing transmission within communities, including in some vaccine recipients, alongside newly arising VOCs, continues to pose a serious threat to public health and the efficacy of these vaccines. As of Jan 11, 2021, in the UK, the interval between the first and second dose of vaccination was extended to 12 weeks. This extension achieved the aim of maximising population coverage by immunising the greatest possible number of individuals to prevent disease and hospital admissions. Encouragingly, a growing number of studies have reported a marked reduction in the number of individuals with moderate-to-severe clinical symptoms and a substantial decline in the number of hospitalised patients with COVID-19 in the UK, underscoring the success of this strategy. 2, 3 Many countries, both in the early and advanced stages of their vaccination campaigns, are facing new cases of infection with VOCs that have acquired mutations facilitating increased transmission and evasion of preexisting immunity. These VOCs might cause increased morbidity and mortality. 4–6 The B. 1.1. 7 (also known as Alpha) VOC has been reported in more than 114 countries, the B. 1.351 (also known as Beta) VOC in more than 68 countries, and the P. 1 (also known as Gamma) VOC in more than 37 countries, and new cases continue to be reported worldwide. Additional VOCs, such as B. 1.617. 2, are likelyto continue to emerge and threaten our ongoing COVID-19 vaccination programmes. Early reports in 2021, suggest that both single-dose and two-dose vaccination regimens are showing gaps in protection. 7, 8 In South Africa, a two-dose regimen of the ChAdOx1 nCoV-19 vaccine did not show protection against mild-to-moderate COVID-19 after infection with the B. 1.351 variant. 9 Additionally, a report of individuals immunised with BNT162b2 in Qatar found that vaccine effectiveness was 14· 9% lower against the B. 1.351 VOC than the B. 1.1. 7 VOC, and indicated a notable number of breakthrough infections. 10 Similar concerns were also noted in a case-cohort study in Israel, which found disproportionately high infection rates with B. 1.351 in fully vaccinated comparedwith unvaccinated individuals. 11 These findings suggest that, despite aggressive immunisation programmes, the presence of circulating VOCs represent a serious concern for the emergence of vaccine escape variants that are either more transmissable or virulent, or both, than the vaccine strain or are able to escape vaccine-induced neutralising antibodies. Understanding the threshold levels of protective immunity against VOCs in specific risk groups and in the general population during ongoing transmission is important for informing and refocusing immunisation strategies. Providing data on the immune correlates of protection in clinically vulnerable groups is needed to inform the …