Demographic and clinical characteristics associated with variations in antibody response to BNT162b2 COVID-19 vaccination among healthcare workers at an academic medical centre: a longitudinal cohort analysis
Brian Claggett,
Sonia Sharma,
Min Wu,
Peter Chen,
Gil Y Melmed,
Nancy Sun,
Susan Cheng,
Joseph E Ebinger,
Matthew Driver,
Dermot P B McGovern,
Kimia Sobhani,
Mohit Jain,
Sandy Joung,
Yunxian Liu,
Brittany Weber,
Patrick G Botting,
Yu Hung Kao,
Briana Khuu,
Timothy Wynter,
Trevor-Trung Nguyen,
Mona Alotaibi,
John C Prostko,
Edwin C Frias,
James L Stewart,
Helen S Goodridge,
Stanley C Jordan,
Justyna Fert-Bober,
Jennifer E Van Eyk,
Margo B Minissian,
Moshe Arditi,
Jonathan G Braun
Affiliations
Brian Claggett
2 Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Sonia Sharma
8 La Jolla Institute for Allergy and Immunology, La Jolla, California, USA
Min Wu
1The First Hospital of Jilin University, Jilin, China
Peter Chen
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
Gil Y Melmed
1 F. Widjaja Inflammatory Bowel Disease Institute, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
Nancy Sun
1 Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Susan Cheng
1 Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Joseph E Ebinger
3 Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Matthew Driver
1 Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Dermot P B McGovern
12 F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Kimia Sobhani
13 Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
Mohit Jain
7 Department of Medicine, School of Medicine, University of California, San Diego, San Diego, California, USA
Sandy Joung
Smidt Heart Institute, Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
Yunxian Liu
1 Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Brittany Weber
2 Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Patrick G Botting
1 Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Yu Hung Kao
1 Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Briana Khuu
1 Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Timothy Wynter
1 Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Trevor-Trung Nguyen
1 Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Mona Alotaibi
3 Division of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, California, USA
John C Prostko
4 Applied Research and Technology, Abbott Laboratories, Abbott Park, Illinois, USA
Edwin C Frias
4 Applied Research and Technology, Abbott Laboratories, Abbott Park, Illinois, USA
James L Stewart
4 Applied Research and Technology, Abbott Laboratories, Abbott Park, Illinois, USA
Helen S Goodridge
5 Department of Biomedical Sciences, Research Division of Immunology, Cedars-Sinai Medical Center, Los Angeles, California, USA
Stanley C Jordan
6 Transplant Immunology Laboratory and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
Justyna Fert-Bober
1 Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Jennifer E Van Eyk
1 Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Margo B Minissian
1 Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Moshe Arditi
11 Smidt Heart Institute; Department of Pediatrics, Division of Infectious Diseases and Immunology; Infectious and Immunologic Diseases Research Center (IIDRC); Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
Jonathan G Braun
12 F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Objectives We sought to understand the demographic and clinical factors associated with variations in longitudinal antibody response following completion of two-dose regiment of BNT162b2 vaccination.Design This study is a 10-month longitudinal cohort study of healthcare workers and serially measured anti-spike protein IgG (IgG-S) antibody levels using mixed linear models to examine their associations with participant characteristics.Setting A large, multisite academic medical centre in Southern California, USA.Participants A total of 843 healthcare workers met inclusion criteria including completion of an initial two-dose course of BNT162b2 vaccination, complete clinical history and at least two blood samples for analysis. Patients had an average age of 45±13 years, were 70% female and 7% with prior SARS-CoV-2 infection.Results Vaccine-induced IgG-S levels remained in the positive range for 99.6% of individuals up to 10 months after initial two-dose vaccination. Prior SARS-CoV-2 infection was the primary correlate of sustained higher postvaccination IgG-S levels (partial R2=0.133), with a 1.74±0.11 SD higher IgG-S response (p<0.001). Female sex (beta 0.27±0.06, p<0.001), younger age (0.01±0.00, p<0.001) and absence of hypertension (0.17±0.08, p=0.003) were also associated with persistently higher IgG-S responses. Notably, prior SARS-CoV-2 infection augmented the associations of sex (−0.42 for male sex, p=0.08) and modified the associations of hypertension (1.17, p=0.001), such that infection-naïve individuals with hypertension had persistently lower IgG-S levels whereas prior infected individuals with hypertension exhibited higher IgG-S levels that remained augmented over time.Conclusions While the IgG-S antibody response remains in the positive range for up to 10 months following initial mRNA vaccination in most adults, determinants of sustained higher antibody levels include prior SARS-CoV-2 infection, female sex, younger age and absence of hypertension. Certain determinants of the longitudinal antibody response appear significantly modified by prior infection status. These findings offer insights regarding factors that may influence the ‘hybrid’ immunity conferred by natural infection combined with vaccination.
