Durability of immunity and clinical protection in nursing home residents following bivalent SARS-CoV-2 vaccinationResearch in context
Stefan Gravenstein,
Frank DeVone,
Oladayo A. Oyebanji,
Yasin Abul,
Yi Cao,
Philip A. Chan,
Christopher W. Halladay,
James L. Rudolph,
Clare Nugent,
Jürgen Bosch,
Christopher L. King,
Brigid M. Wilson,
Alejandro B. Balazs,
Elizabeth M. White,
David H. Canaday,
Kevin W. McConeghy
Affiliations
Stefan Gravenstein
Warren Alpert Medical School, Brown University, Providence, RI, USA; Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Veterans Administration (VA) Medical Center, Providence, RI, USA; Corresponding author. Warren Alpert Medical School, Brown University, Providence, RI, USA.
Frank DeVone
Center of Innovation in Long-Term Services and Supports, Veterans Administration (VA) Medical Center, Providence, RI, USA
Oladayo A. Oyebanji
Case Western Reserve University School of Medicine, Cleveland, OH, USA
Yasin Abul
Warren Alpert Medical School, Brown University, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Veterans Administration (VA) Medical Center, Providence, RI, USA
Yi Cao
Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
Philip A. Chan
Warren Alpert Medical School, Brown University, Providence, RI, USA; Rhode Island Department of Health, Providence, RI, USA
Christopher W. Halladay
Center of Innovation in Long-Term Services and Supports, Veterans Administration (VA) Medical Center, Providence, RI, USA
James L. Rudolph
Warren Alpert Medical School, Brown University, Providence, RI, USA; Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Veterans Administration (VA) Medical Center, Providence, RI, USA
Clare Nugent
Warren Alpert Medical School, Brown University, Providence, RI, USA
Jürgen Bosch
Case Western Reserve University School of Medicine, Cleveland, OH, USA
Christopher L. King
Case Western Reserve University School of Medicine, Cleveland, OH, USA
Brigid M. Wilson
Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
Alejandro B. Balazs
Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
Elizabeth M. White
Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, RI, USA
David H. Canaday
Case Western Reserve University School of Medicine, Cleveland, OH, USA; Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA; Corresponding author. Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Kevin W. McConeghy
Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Veterans Administration (VA) Medical Center, Providence, RI, USA; Corresponding author. Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, RI, USA.
Summary: Background: Bivalent SARS-CoV-2 vaccines were developed to counter increasing susceptibility to emerging SARS-CoV-2 variants. We evaluated the durability of immunity and protection following first bivalent vaccination among nursing home residents. Methods: We evaluated anti-spike and neutralization titers from blood in 653 community nursing home residents before and after each monovalent booster, and a bivalent vaccine. Concurrent clinical outcomes were evaluated using electronic health record data from a separate cohort of 3783 residents of Veterans Affairs (VA) nursing homes who had received at least the primary series monovalent vaccination. Using target trial emulation, we compared VA residents who did and did not receive the bivalent vaccine to measure vaccine effectiveness against infection, hospitalization, and death. Findings: In the community cohort, Omicron BA.5 neutralization activity rose after each monovalent and bivalent booster vaccination regardless of prior infection history. Titers declined over time but six months post-bivalent vaccination, BA.5 neutralization persisted at detectable levels in 75% of infection-naive and 98% of prior-infected individuals. In the VA nursing home cohort, bivalent vaccine added effectiveness to monovalent booster vaccination by 18.5% for infection (95% confidence interval (CI) −5.6, 34.0%), and 29.2% for hospitalization or death (95% CI −14.2, 56.2%) over five months. Interpretation: The level of protection declined after bivalent vaccination over a 6 month period and may open a window of added vulnerability before the next updated vaccine becomes available, suggesting a subset of nursing home residents may benefit from an additional vaccination booster. Funding: CDC, NIH, VHA.
