BACKGROUND AND PURPOSE: Waning immunity and the surge of SARS-CoV-2 variants are responsible for breakthrough infections, i.e., infections in fully vaccinated individuals. Although the majority of vaccinated infected subjects report mild or no symptoms, some others require hospitalization. The clinical and immunological features of vaccinated hospitalized COVID-19 patients are currently unknown. METHODS: Twenty-nine unvaccinated and 36 vaccinated hospitalized COVID-19 patients were prospectively enrolled and clinical and laboratory data were gathered. Immunophenotyping of leukocytes' subsets, T and B cell SARS-CoV-2-specific responses were evaluated via flow cytometry. Anti-IFN-α autoantibodies were measured via ELISA. RESULTS: Despite vaccinated patients were older and with more comorbidities, unvaccinated subjects showed higher levels of pro-inflammatory markers, more severe disease, and increased mortality rate. Accordingly, they presented significant alterations in the circulating leukocyte composition, typical of severe COVID-19. Vaccinated patients displayed higher levels of anti-Spike IgGs and Spike-specific B cells. Of all participants, survivors showed higher levels of anti-Spike IgGs and Spike-specific CD4+ T cells than non-survivors. At hospital admission, 6 out of 65 patients (9.2%) displayed high serum concentrations of autoantibodies targeting IFN-α. Remarkably, 3 were unvaccinated and eventually died, while the other 3 were vaccinated and survived. CONCLUSION: Despite more severe pre-existing clinical conditions, vaccinated patients have good outcome. A rapid activation of anti-SARS-CoV-2-specific immunity is fundamental for the resolution of the infection. Therefore, prior immunization through vaccination provides a significant contribution to prevention of disease worsening and can even overcome the presence of high-risk factors (i.e., older age, comorbidities, anti-IFN-α autoantibodies).
BACKGROUND AND PURPOSE: Waning immunity and the surge of SARS-CoV-2 variants are responsible for breakthrough infections, i.e., infections in fully vaccinated individuals. Although the majority of vaccinated infected subjects report mild or no symptoms, some others require hospitalization. The clinical and immunological features of vaccinated hospitalized COVID-19 patients are currently unknown. METHODS: Twenty-nine unvaccinated and 36 vaccinated hospitalized COVID-19 patients were prospectively enrolled and clinical and laboratory data were gathered. Immunophenotyping of leukocytes' subsets, T and B cell SARS-CoV-2-specific responses were evaluated via flow cytometry. Anti-IFN-α autoantibodies were measured via ELISA. RESULTS: Despite vaccinated patients were older and with more comorbidities, unvaccinated subjects showed higher levels of pro-inflammatory markers, more severe disease, and increased mortality rate. Accordingly, they presented significant alterations in the circulating leukocyte composition, typical of severe COVID-19. Vaccinated patients displayed higher levels of anti-Spike IgGs and Spike-specific B cells. Of all participants, survivors showed higher levels of anti-Spike IgGs and Spike-specific CD4+ T cells than non-survivors. At hospital admission, 6 out of 65 patients (9.2%) displayed high serum concentrations of autoantibodies targeting IFN-α. Remarkably, 3 were unvaccinated and eventually died, while the other 3 were vaccinated and survived. CONCLUSION: Despite more severe pre-existing clinical conditions, vaccinated patients have good outcome. A rapid activation of anti-SARS-CoV-2-specific immunity is fundamental for the resolution of the infection. Therefore, prior immunization through vaccination provides a significant contribution to prevention of disease worsening and can even overcome the presence of high-risk factors (i.e., older age, comorbidities, anti-IFN-α autoantibodies).
Authors: Mark M Painter; Divij Mathew; Rishi R Goel; Sokratis A Apostolidis; Ajinkya Pattekar; Oliva Kuthuru; Amy E Baxter; Ramin S Herati; Derek A Oldridge; Sigrid Gouma; Philip Hicks; Sarah Dysinger; Kendall A Lundgreen; Leticia Kuri-Cervantes; Sharon Adamski; Amanda Hicks; Scott Korte; Josephine R Giles; Madison E Weirick; Christopher M McAllister; Jeanette Dougherty; Sherea Long; Kurt D'Andrea; Jacob T Hamilton; Michael R Betts; Paul Bates; Scott E Hensley; Alba Grifoni; Daniela Weiskopf; Alessandro Sette; Allison R Greenplate; E John Wherry Journal: Immunity Date: 2021-08-13 Impact factor: 43.474
Authors: Alison Tarke; Camila H Coelho; Zeli Zhang; Jennifer M Dan; Esther Dawen Yu; Nils Methot; Nathaniel I Bloom; Benjamin Goodwin; Elizabeth Phillips; Simon Mallal; John Sidney; Gilberto Filaci; Daniela Weiskopf; Ricardo da Silva Antunes; Shane Crotty; Alba Grifoni; Alessandro Sette Journal: Cell Date: 2022-01-24 Impact factor: 41.582
Authors: Paul Naaber; Liina Tserel; Kadri Kangro; Epp Sepp; Virge Jürjenson; Ainika Adamson; Liis Haljasmägi; Anna Pauliina Rumm; Regina Maruste; Jaanika Kärner; Joachim M Gerhold; Anu Planken; Mart Ustav; Kai Kisand; Pärt Peterson Journal: Lancet Reg Health Eur Date: 2021-09-06
Authors: Timothy A Bates; Savannah K McBride; Hans C Leier; Gaelen Guzman; Zoe L Lyski; Devin Schoen; Bradie Winders; Joon-Yong Lee; David Xthona Lee; William B Messer; Marcel E Curlin; Fikadu G Tafesse Journal: Sci Immunol Date: 2022-02-18
Authors: Prerak V Juthani; Akash Gupta; Kelly A Borges; Christina C Price; Alfred I Lee; Christine H Won; Hyung J Chun Journal: Lancet Infect Dis Date: 2021-09-07 Impact factor: 25.071