The effects of hybrid immunity on humoral immune response following COVID-19 mRNA vaccination in a cohort of essential and frontline workers
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The effects of hybrid immunity on humoral immune response following COVID-19 mRNA vaccination in a cohort of essential and frontline workers

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In a recent study published in Clinical Infectious Diseases, researchers longitudinally evaluated humoral immune responses to the second and third (booster) doses of coronavirus disease 2019 (COVID-19) mRNA (messenger ribonucleic acid) vaccines among individuals with and without prior history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections.

Study: SARS-CoV-2 infection history and antibody response to three COVID-19 mRNA vaccine doses. Image Credit: chatuphot/Shutterstock

Background

Studies have documented the generation of adaptive immune responses to SARS-CoV-2 infections and vaccinations, boosted by third-dose administration, to protect against COVID-19 severity outcomes. However, data on the synergistic hybrid immune protection conferred by SARS-CoV-2 infection and COVID-19 vaccination, among individuals with and without prior SARS-CoV-2 exposure, booster dose timing, and the effect of hybrid immunity on the waning of humoral immunity are limited.

About the study

In the present prospective cohort study, researchers evaluated the impact of hybrid immune responses conferred by SARS-CoV-2 mRNA vaccines and prior COVID-19 history on humoral immunity.

The sample population comprised healthcare workers (76%), initial responders (five percent), and other frontline workers (20%) across six US states, i.e., Arizona, Florida, Minnesota, Oregon, Texas, and Utah. Serum samples were obtained from the participants at recruitment and after intervals of 11 weeks to 13 weeks. In addition, participants submitted serum samples within 21.0 days to 60.0 days after reverse transcription-polymerase chain reaction (RT-PCR)-confirmed COVID-19, and 14.0 days to 60.0 days post-every COVID-19 vaccination.

The decline of antibodies against SARS-CoV-2 Wuhan/Hu-1/2019 strain spike protein subunit 2 (S2) and RBD (receptor-binding domain) was evaluated till 9.0 months post-second vaccination using ELISA (enzyme-linked immunosorbent assay) and documented as AUC (area under the serial dilution curve) values.

The team compared pre- and post-booster dose serological antibody titers among individuals belonging to either of the three groups- (i) vaccination only (no infection, n=224); (ii) infection before vaccination (previous infection, n=123); and (iii) infection after the second dose and before booster dose (breakthrough infection, n=41).

In addition, individuals self-obtained middle turbinate nasal swabs every week and at the beginning of CLI (COVID-19-like illness) symptoms such as chills, fever, breathlessness, cough, diarrhea, sore throat, muscular ache, and altered taste or smell. The swabs were subjected to RT-RCR analysis to detect SARS-CoV-2. Furthermore, the participants filled out online surveys to provide data on illness duration, fever absence/presence, and medical consultations.

The team compared AUC value changes as fold changes by linear mixed modeling adjusted for homologous mRNA-1273 or BNT162b2 vaccinations. Prior COVID-19 history was recorded based on self-report, antigen test or RT-RCR test reports, or the reports of serological tests performed at study enrollment.

SARS-CoV-2 vaccination status was either self-documented or self-confirmed by vaccination cards. Additionally, areas in Oregon, Minnesota, Utah, and Texas reviewed electronic health records, state registries, and occupational health reports.

The team included 338 essential and frontline workers who were administered three mRNA vaccine doses in the pre-Omicron variant period between July 2020 and November 2021. Individuals infected with SARS-CoV-2 between the first and second vaccine doses or after two weeks of the second vaccination were excluded from the analysis.

Results

Most participants were women (69.0%), aged between 18.0 years and 39.0 years (58.0%). The interval between the second and third doses was eight months. Among the participants, 88% and 10% were homologous BNT162b2 vaccinees and mRNA-1273 vaccinees, respectively. Among vaccination-only individuals, after the second dose, geometric mean ratio (GMR) values comparing anti-S2 and anti-RBD titers were 1.8 and 2.6, respectively.

The corresponding titers were reduced by 32% and 55%, respectively, within 200 days after the second vaccine dose. After the booster dose, GMR values for the corresponding antibodies increased by 2.9-fold and 2.6-fold, respectively. Individuals infected within 3.0 months prior to booster vaccination showed no significant increase in antibody titers post-booster dose.

Among individuals with prior COVID-19 history, after the first dose, GMR values for anti-S2 and anti-RBD antibody titers in comparison to post-SARS-CoV-2 infection titers were 1.6 and 3.2, respectively. After the second dose, the corresponding GMR values compared to the first dose were 1.0 and 1.1, respectively.

Post-second vaccination, previously infected individuals showed consistently greater antibody titers over time than those vaccinated only till greater than or equal to 200.0 days after the second dose, significantly boosted by the third dose.

Of note, among recently infected individuals, the final antibody titers before the vaccine booster were comparable to antibody titers post-COVID-19 vaccination without any significant changes in anti-RBD or anti-S2 titers from pre- to post-booster vaccination.

Contrastingly, among individuals with breakthrough SARS-CoV-2 infections >90 days prior to the booster vaccination, anti-S2 and anti-RBD titers were 1.7-fold and 2.3-fold greater after the booster dose in comparison to the pre-booster dose end-titers.

Conclusion

Overall, the study findings showed that the booster dose of SARS-CoV-2 mRNA vaccines induced robust humoral immunological responses among prime-vaccinated individuals irrespective of whether the individuals had been infected >3.0 months earlier. However, there was no significant humoral immune boost by the third vaccine dose in individuals infected with SARS-CoV-2 <3.0 months before booster vaccination. The findings indicated a minimum 3.0-month interval post-SARS-CoV-2 infection and booster vaccination for maximal humoral benefit.

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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