10 ms·

Antibody levels highly predictive of immune protection from symptomatic Covid

101 points by georgecmu 5y ago

xiphias2 5y ago
My father tested negative for spike specific antibodies 2 weeks after the 2nd Pfizer vaccine (he's not the only one), and as I didn't find any data on people who test negative (and I know that the vaccine has 94% efficiency preventing COVID), he's still mostly not leaving his apartment. He'll have a test against the viruses themselves next week, but he'll need to wait 2 weeks for the result for that test.
- tdeck 5y ago
  How did he happen to get that antibody test?
  - xiphias2 5y ago
    A nurse came to his apartment to take the test (I payed for it)
    - tdeck 5y ago
      That's cool! I had no idea those were available to the general public.
  - tgsovlerkhgsel 5y ago
    (not the person you asked) I opted to have one done (out of pocket) when I was doing an unrelated blood test, since I had gotten sick around the time COVID started to be an issue in my area. It's just a matter of checking an additional checkbox on the lab request (if you have the blood taken at a lab) or asking your doctor "hey, can you please also check box X" if the sample is taken at a doctor. Would have definitely stuck to the bare minimum of government-mandated precautions if it had been positive.
- rgbbtc4life 5y ago
  If the vaccine is truly 95% effective in preventing infection, how did 9 fully vaccinated Yankees players all contract the virus?
  - verdverm 5y ago
    1. It was a single player, the rest were other staff 2. Vaccines don't prevent infection, they reduce severity by training the body's immune system. Natural exposure works the same way. This it is not surprising that 8/9 Yankees which tested positive were asymptomatic
    - atty 5y ago
      This is incorrect - from population studies, we now know that both the mRNA vaccines reduce infection rates and reduce severity of symptoms for those who do get infected. In fact, they both show about 90% efficacy at preventing infection at all. That number is probably trending down a bit with all the new strains, but it is still very high.
      - verdverm 5y ago
        I suppose that depends on how infection is defined. Nothing prevents the virus from entering the body and triggering a positive test result, especially when the tests are run with longer cycle times
      - _coveredInBees 5y ago
        The Yankee players all had J&J vaccines, so not the mRNA variety.
        verdverm 5y ago
        https://www.cnn.com/2021/05/20/health/yankees-covid-19-breakthrough-infections/index.html https://www.cnn.com/2021/05/20/health/yankees-covid-19-break... The Yankees are reported to be using the J&J vaccine, which is a viral vector product.
    - 5y ago
- yosito 5y ago
  I wonder if an expert could chime in on this. If someone tests negative for antibodies a few weeks after a vaccine, should that person get vaccinated again? Maybe with a different vaccine?
- azinman2 5y ago
  That doesn’t mean he doesn’t have protection. The antibody tests only look For one thing, but the body has many mechanisms of protection from the vaccine. That is one of the reasons why they’re not suggested to be used for the general population.
  - xiphias2 5y ago
    I know that it doesn't mean that he isn't protected, but I didn't find data on the protection against severe covid disease with the conditional probability of spike specific antibody test being negative after being properly vaccinated. Instead of just guidance I would like to see data. Anyways that's why there are specific, slower test that can test his protection against specific virus mutations.
- inter_netuser 5y ago
  Has he been tested for immune deficiencies? What is his age? Have a contact that's an NIH immunologist, want to get his opinion. tia
mikem170 5y ago
From the article, a section called "Prediction of the potential for long term protection" at the bottom of the Results: > The estimated neutralization level for protection from severe infection is approximately sixfold lower than the level required to protect from any symptomatic infection. Thus, a higher level of protection against severe infection is expected for any given level of vaccine efficacy against mild SARS-CoV-2 infection. Assuming that this relationship remains constant over time, it appears probable that immunity to severe infection may be much more durable than overall immunity to any infection. Long-term studies of antibody responses to vaccinia, measles, mumps or rubella suggest that these responses generally stabilize with half-lives of >10 years. We therefore projected beyond the reported decay of SARS-CoV-2 responses (out to 8 months after infection5), assuming that after 8 months following the infection the decay rate will slow down. We modeled the decay rate of the neutralization titer, assuming that it slowed linearly to a 10-year half-life over 1, 1.5 or 2 years (details in Methods). This analysis predicts that even without immune boosting, a significant proportion of individuals may maintain long-term protection from severe infection by an antigenically similar strain, even though they may become susceptible to mild infection (Fig. 3b,c). Sounds like good news. This study appears to be saying that the vaccines do a 6x better job of preventing severe covid infection than the known 94% efficacy preventing even mild symptoms from appearing, and that long term immunity [0] might be expected to last decades, similar to other vaccines. [0], EDIT: "long term protection against severe sickness", as opposed to "immunity", as pointed out by PeterHolzwarth in comment below
- PeterHolzwarth 5y ago
  I believe the paper indicates otherwise, in regards to immunity. To help make sense of the paper, I read this Science Daily article that reviews it, and contains some comments from the paper's authors. https://www.sciencedaily.com/releases/2021/05/210517105727.htm https://www.sciencedaily.com/releases/2021/05/210517105727.h... Here, one of the people associated with the paper mentions: "Vaccination works very well to prevent both symptoms and severe disease in the short to medium term, but efficacy is predicted to decline over the first few months for most of these vaccines," "However, it is very important to understand the difference between immunity against infection and protection from developing severe disease. Our study found that a 6-fold lower level of antibodies is required to protect against severe disease. So even though our analysis predicts that we will start losing immunity to mild infection in the first year after vaccination, protection from severe infection should be longer lived," says Dr Khoury. Key is that distinction between immunity and protection against severe sickness.
rgbbtc4life 5y ago
The people achieving immunity through vaccination are at a huge disadvantage compared to those with natural immunity. As shown in research from the other day, natural antibodies target several proteins and more of the spike protein than Pfizer immunity does. Additionally, natural immunity stimulates both the innate immune response and killer T cell response. I wouldn't be surprised if we start seeing ADE among vaccinated individuals - there's a good chance their antibodies will be non neutralizing when challenged with live virus a year from now. Also, it appears governments are motivated to hide information about the vaccine. It's come out the CDC is performing PCR testing for vaccinated individuals with a lower cycle count than for the unvaccinated. There's no reason to trust anything coming out of the CDC with regards to vaccination.
- grej 5y ago
  I don’t believe this is clear at all. So far, it actually seems the mRNA vaccines as well as the viral vector vaccines greatly attenuate the severity of COVID among those who do catch a variant.
  - rgbbtc4life 5y ago
    There is only one study to estimate the effectiveness of the mrna vaccines. It was quite small, and performed only on those who received pristine mrna injections. It's come out that the mass produced vaccine has significant mrna degradation. It's unclear how many people's vaccines were even effective. Additionally you have 9 Yankees players who were fully vaccinated contracting the virus, so its not 95% effective in preventing infection and there's a very real risk of Merek's disease as a result. Furthermore, Pfizer is on record as saying a 3rd dose will be needed. Meanwhile, natural immunity has been shown to be robust and long lasting.
    - t-writescode 5y ago
      The Yankees were given the J&J vaccine, not an mRNA vaccine. https://edition.cnn.com/2021/05/13/sport/yankees-test-positive-covid/index.html https://edition.cnn.com/2021/05/13/sport/yankees-test-positi... Are you scared? Or intentionally spreading misinformation?
AlexCoventry 5y ago
I'm a little surprised this is in nature... Isn't that exactly what you'd expect?
- dEnigma 5y ago
  But not everything turns out as you'd expect, so it's important to actually test and provide evidence.
  - AlexCoventry 5y ago
    Yeah, it just seems unusual for Nature to publish such a confirmatory outcome.
- noodlenotes 5y ago
  The headline might be what you expect, but the article contains mathematical details about the relationship between antibody levels from the vaccines and neutralization. It also models antibody levels over time to see what immune protection we'll have in the future. Did we know the expected efficacy of the vaccine against severe Covid 750 days post-vaccine before?
The_rationalist 5y ago
I wonder whether bromantane can help with the covid response
dunnevens 5y ago
My partner is the recipient of an organ transplant and is on anti-rejection meds. She's already had both shots of Pfizer. So we're following the research closely. Researchers are beginning to look at how the vaccine works in the immunosuppressed. The initial results aren't great. In one study[1], 46% didn't have any antibodies after both shots. 39% had antibodies only after the second shot. Only 15% received antibodies after the first shot. I know this research is still in early stages and the initial sample size was relatively small. And T-cell responses were not measured. There's a decent chance the situation isn't as bad as it initially seems. But it's still discouraging. [1] Antibody Response to 2-Dose SARS-CoV-2 mRNA Vaccine Series in Solid Organ Transplant Recipients https://jamanetwork.com/journals/jama/fullarticle/2779852 https://jamanetwork.com/journals/jama/fullarticle/2779852
- meepmorp 5y ago
  I'm assuming the J&J/other viral vaccines are a no-go with the immunosupressants. Hopefully, additional mRNA boosters can improve the immune response.
ralusek 5y ago
I hope a consequence of this is that we'll begin to treat antibody levels as an alternative proof of immunity to vaccine documentation. Vaccines are a means to an end, not an end themselves. If someone has the requisite antibody immunity from having had the virus, we shouldn't necessarily be vaccinating those people. For one, there are people all around the world waiting for vaccines. If the antibody levels can be used as a general stand in for immunity, there are people that need the vaccines more than those who have the requisite antibodies. Secondly, intentionally triggering an immune response isn't exactly good for you. The assumption is that a vaccine arrives at an immune response in a less harmful way than getting the infection itself...but for those who have had the infection (and demonstrated a sufficiently high antibody count), retriggering an immune response is subjecting a person to a needless secondary immune response.
- Dma54rhs 5y ago
  At least in EU that will be the case.
timka 5y ago
In the 80s they achieved antibodies while working on a HIV vaccine. The vaccine still doesn't exist.
- dragonwriter 5y ago
  > In the 80s they achieved antibodies while working on a HIV vaccine. The I in HIV and the ID in the name of the associated disease mean something important here.
  - timka 5y ago
    Exactly! You're on the right track. It also has something to do with what A means in ADE. To make long story short next questions you should ask are: * what antibody classification systems exists, which one is used and why? * what's the difference between non-cyclic (natural smallpox, plague, measles) and cyclic (HIV, T-cell leukemia, serum hepatitis, herpes)? * what does ID have to do with the IFNγR1 gene? https://doi.org/10.35825/2587-5728-2020-4-3-338-373 https://doi.org/10.35825/2587-5728-2020-4-3-338-373

101 points by georgecmu 5y ago

My father tested negative for spike specific antibodies 2 weeks after the 2nd Pfizer vaccine (he's not the only one), and as I didn't find any data on people who test negative (and I know that the vaccine has 94% efficiency preventing COVID), he's still mostly not leaving his apartment. He'll have a test against the viruses themselves next week, but he'll need to wait 2 weeks for the result for that test.

tdeck 5y ago
How did he happen to get that antibody test?
- xiphias2 5y ago
  A nurse came to his apartment to take the test (I payed for it)
  - tdeck 5y ago
    That's cool! I had no idea those were available to the general public.
- tgsovlerkhgsel 5y ago
  (not the person you asked) I opted to have one done (out of pocket) when I was doing an unrelated blood test, since I had gotten sick around the time COVID started to be an issue in my area. It's just a matter of checking an additional checkbox on the lab request (if you have the blood taken at a lab) or asking your doctor "hey, can you please also check box X" if the sample is taken at a doctor. Would have definitely stuck to the bare minimum of government-mandated precautions if it had been positive.
rgbbtc4life 5y ago
If the vaccine is truly 95% effective in preventing infection, how did 9 fully vaccinated Yankees players all contract the virus?
- verdverm 5y ago
  1. It was a single player, the rest were other staff 2. Vaccines don't prevent infection, they reduce severity by training the body's immune system. Natural exposure works the same way. This it is not surprising that 8/9 Yankees which tested positive were asymptomatic
  - atty 5y ago
    This is incorrect - from population studies, we now know that both the mRNA vaccines reduce infection rates and reduce severity of symptoms for those who do get infected. In fact, they both show about 90% efficacy at preventing infection at all. That number is probably trending down a bit with all the new strains, but it is still very high.
    - verdverm 5y ago
      I suppose that depends on how infection is defined. Nothing prevents the virus from entering the body and triggering a positive test result, especially when the tests are run with longer cycle times
    - _coveredInBees 5y ago
      The Yankee players all had J&J vaccines, so not the mRNA variety.
      - verdverm 5y ago
        https://www.cnn.com/2021/05/20/health/yankees-covid-19-breakthrough-infections/index.html https://www.cnn.com/2021/05/20/health/yankees-covid-19-break... The Yankees are reported to be using the J&J vaccine, which is a viral vector product.
  - 5y ago
yosito 5y ago
I wonder if an expert could chime in on this. If someone tests negative for antibodies a few weeks after a vaccine, should that person get vaccinated again? Maybe with a different vaccine?
azinman2 5y ago
That doesn’t mean he doesn’t have protection. The antibody tests only look For one thing, but the body has many mechanisms of protection from the vaccine. That is one of the reasons why they’re not suggested to be used for the general population.
- xiphias2 5y ago
  I know that it doesn't mean that he isn't protected, but I didn't find data on the protection against severe covid disease with the conditional probability of spike specific antibody test being negative after being properly vaccinated. Instead of just guidance I would like to see data. Anyways that's why there are specific, slower test that can test his protection against specific virus mutations.
inter_netuser 5y ago
Has he been tested for immune deficiencies? What is his age? Have a contact that's an NIH immunologist, want to get his opinion. tia

mikem170 5y ago

From the article, a section called "Prediction of the potential for long term protection" at the bottom of the Results: > The estimated neutralization level for protection from severe infection is approximately sixfold lower than the level required to protect from any symptomatic infection. Thus, a higher level of protection against severe infection is expected for any given level of vaccine efficacy against mild SARS-CoV-2 infection. Assuming that this relationship remains constant over time, it appears probable that immunity to severe infection may be much more durable than overall immunity to any infection. Long-term studies of antibody responses to vaccinia, measles, mumps or rubella suggest that these responses generally stabilize with half-lives of >10 years. We therefore projected beyond the reported decay of SARS-CoV-2 responses (out to 8 months after infection5), assuming that after 8 months following the infection the decay rate will slow down. We modeled the decay rate of the neutralization titer, assuming that it slowed linearly to a 10-year half-life over 1, 1.5 or 2 years (details in Methods). This analysis predicts that even without immune boosting, a significant proportion of individuals may maintain long-term protection from severe infection by an antigenically similar strain, even though they may become susceptible to mild infection (Fig. 3b,c). Sounds like good news. This study appears to be saying that the vaccines do a 6x better job of preventing severe covid infection than the known 94% efficacy preventing even mild symptoms from appearing, and that long term immunity [0] might be expected to last decades, similar to other vaccines. [0], EDIT: "long term protection against severe sickness", as opposed to "immunity", as pointed out by PeterHolzwarth in comment below

PeterHolzwarth 5y ago
I believe the paper indicates otherwise, in regards to immunity. To help make sense of the paper, I read this Science Daily article that reviews it, and contains some comments from the paper's authors. https://www.sciencedaily.com/releases/2021/05/210517105727.htm https://www.sciencedaily.com/releases/2021/05/210517105727.h... Here, one of the people associated with the paper mentions: "Vaccination works very well to prevent both symptoms and severe disease in the short to medium term, but efficacy is predicted to decline over the first few months for most of these vaccines," "However, it is very important to understand the difference between immunity against infection and protection from developing severe disease. Our study found that a 6-fold lower level of antibodies is required to protect against severe disease. So even though our analysis predicts that we will start losing immunity to mild infection in the first year after vaccination, protection from severe infection should be longer lived," says Dr Khoury. Key is that distinction between immunity and protection against severe sickness.

rgbbtc4life 5y ago

The people achieving immunity through vaccination are at a huge disadvantage compared to those with natural immunity. As shown in research from the other day, natural antibodies target several proteins and more of the spike protein than Pfizer immunity does. Additionally, natural immunity stimulates both the innate immune response and killer T cell response. I wouldn't be surprised if we start seeing ADE among vaccinated individuals - there's a good chance their antibodies will be non neutralizing when challenged with live virus a year from now. Also, it appears governments are motivated to hide information about the vaccine. It's come out the CDC is performing PCR testing for vaccinated individuals with a lower cycle count than for the unvaccinated. There's no reason to trust anything coming out of the CDC with regards to vaccination.

grej 5y ago
I don’t believe this is clear at all. So far, it actually seems the mRNA vaccines as well as the viral vector vaccines greatly attenuate the severity of COVID among those who do catch a variant.
- rgbbtc4life 5y ago
  There is only one study to estimate the effectiveness of the mrna vaccines. It was quite small, and performed only on those who received pristine mrna injections. It's come out that the mass produced vaccine has significant mrna degradation. It's unclear how many people's vaccines were even effective. Additionally you have 9 Yankees players who were fully vaccinated contracting the virus, so its not 95% effective in preventing infection and there's a very real risk of Merek's disease as a result. Furthermore, Pfizer is on record as saying a 3rd dose will be needed. Meanwhile, natural immunity has been shown to be robust and long lasting.
  - t-writescode 5y ago
    The Yankees were given the J&J vaccine, not an mRNA vaccine. https://edition.cnn.com/2021/05/13/sport/yankees-test-positive-covid/index.html https://edition.cnn.com/2021/05/13/sport/yankees-test-positi... Are you scared? Or intentionally spreading misinformation?

AlexCoventry 5y ago

I'm a little surprised this is in nature... Isn't that exactly what you'd expect?

dEnigma 5y ago
But not everything turns out as you'd expect, so it's important to actually test and provide evidence.
- AlexCoventry 5y ago
  Yeah, it just seems unusual for Nature to publish such a confirmatory outcome.
noodlenotes 5y ago
The headline might be what you expect, but the article contains mathematical details about the relationship between antibody levels from the vaccines and neutralization. It also models antibody levels over time to see what immune protection we'll have in the future. Did we know the expected efficacy of the vaccine against severe Covid 750 days post-vaccine before?

The_rationalist 5y ago

I wonder whether bromantane can help with the covid response

dunnevens 5y ago

My partner is the recipient of an organ transplant and is on anti-rejection meds. She's already had both shots of Pfizer. So we're following the research closely. Researchers are beginning to look at how the vaccine works in the immunosuppressed. The initial results aren't great. In one study[1], 46% didn't have any antibodies after both shots. 39% had antibodies only after the second shot. Only 15% received antibodies after the first shot. I know this research is still in early stages and the initial sample size was relatively small. And T-cell responses were not measured. There's a decent chance the situation isn't as bad as it initially seems. But it's still discouraging. [1] Antibody Response to 2-Dose SARS-CoV-2 mRNA Vaccine Series in Solid Organ Transplant Recipients https://jamanetwork.com/journals/jama/fullarticle/2779852 https://jamanetwork.com/journals/jama/fullarticle/2779852

meepmorp 5y ago
I'm assuming the J&J/other viral vaccines are a no-go with the immunosupressants. Hopefully, additional mRNA boosters can improve the immune response.

ralusek 5y ago

I hope a consequence of this is that we'll begin to treat antibody levels as an alternative proof of immunity to vaccine documentation. Vaccines are a means to an end, not an end themselves. If someone has the requisite antibody immunity from having had the virus, we shouldn't necessarily be vaccinating those people. For one, there are people all around the world waiting for vaccines. If the antibody levels can be used as a general stand in for immunity, there are people that need the vaccines more than those who have the requisite antibodies. Secondly, intentionally triggering an immune response isn't exactly good for you. The assumption is that a vaccine arrives at an immune response in a less harmful way than getting the infection itself...but for those who have had the infection (and demonstrated a sufficiently high antibody count), retriggering an immune response is subjecting a person to a needless secondary immune response.

Dma54rhs 5y ago
At least in EU that will be the case.

timka 5y ago

In the 80s they achieved antibodies while working on a HIV vaccine. The vaccine still doesn't exist.

dragonwriter 5y ago
> In the 80s they achieved antibodies while working on a HIV vaccine. The I in HIV and the ID in the name of the associated disease mean something important here.
- timka 5y ago
  Exactly! You're on the right track. It also has something to do with what A means in ADE. To make long story short next questions you should ask are: * what antibody classification systems exists, which one is used and why? * what's the difference between non-cyclic (natural smallpox, plague, measles) and cyclic (HIV, T-cell leukemia, serum hepatitis, herpes)? * what does ID have to do with the IFNγR1 gene? https://doi.org/10.35825/2587-5728-2020-4-3-338-373 https://doi.org/10.35825/2587-5728-2020-4-3-338-373