Antibody Responses After mRNA-Based COVID-19 Vaccination in Residential Older Adults: Implications for Reopening

Abstract

Objective COVID-19 disproportionately impacts residents in long-term care facilities. Our objective was to quantify the presence and magnitude of antibody response in vaccinated, older adult residents at assisted living, personal care, and independent living communities. Design A cross-sectional quality improvement study was conducted March 15 – April 1, 2021 in the greater Pittsburgh region. Setting and Population: Participants were older adult residents at assisted living, personal care, and independent living communities, who received mRNA-based COVID-19 vaccine. Conditions that impair immune responses were exclusionary criteria. Methods Sera were collected to measure IgG anti-SARS-CoV-2 antibody level with reflex to total anti-SARS-CoV-2 immunoglobulin levels, and blinded evaluation of SARS-CoV-2 pseudovirus neutralization titers. Descriptive statistics, Pearson correlation coefficients, and multiple linear regression analysis evaluated relationships between factors potentially associated with antibody levels. Spearman correlations were calculated between antibody levels and neutralization titers. Results All participants (N = 70) had received two rounds of vaccination and were found to have antibodies with wide variation in relative levels. Antibody levels trended lower in males, advanced age, current use of steroids, and longer length of time from vaccination. Pseudovirus neutralization titer levels were strongly correlated ( P < .001) with Beckman Coulter antibody levels (D614 G NT50, r s = 0.91; B.1.1.7 [UK] NT50, r s = 0.91). Conclusions and Implications Higher functioning, healthier, residential older adults mounted detectable antibody responses when vaccinated with mRNA-based COVID-19 vaccines. Data suggests some degree of immunity is present during the immediate period following vaccination. However, protective effects remain to be determined in larger studies as clinical protection is afforded by ongoing adaptive immunity, which is known to be decreased in older adults. This study provides important preliminary results on level of population risk in older adult residents at assisted living, personal care, and independent living communities to inform reopening strategies, but are not likely to be translatable for residents in nursing homes.

Antibody Responses 3-5 Months Post-Vaccination with mRNA-1273 or BNT163b2 in Nursing Home Residents

“…These data align with recent observations of decreased antibody production and/or neutralization after BNT162b2 vaccination in nursing home residents compared with healthy young individuals. 4 , 5 , 6 In addition, we found that vaccination against SARS-CoV-2 with mRNA-1273 elicited a stronger humoral response compared with BNT162b2, with greater circulating IgG and neutralization antibody titers ∼3 months after vaccination. The mRNA-1273 vaccine contains a higher dose of mRNA, which may imply that a higher dose is beneficial to generate protective immunity in nursing home residents.…”

Effects of Short-Term Corticosteroid Use on Reactogenicity and Immunogenicity of the First Dose of ChAdOx1 nCoV-19 Vaccine

“…The potential effect of corticosteroid use on the immunogenicity of COVID-19 vaccines has not been thoroughly investigated. There was a report that the antibody level was lower in a low-dose steroid user in an older adult cohort who received two doses of mRNA vaccine, but the sample size was small and statistical significance was not achieved (24). It also was reported that the immunogenicity of COVID-19 vaccines in solid organ transplant recipients was poor, but they took T-cell suppressive agents in addition to corticosteroids (9,25).…”

Immunogenicity of the BNT162b2 mRNA COVID-19 vaccine in older residents of a long-term care facility: relation with age, frailty and prior infection status

“…Rapid and robust IgG response may suggest that S protein, used in the BNT162B2 vaccine, is highly immunogenic. Effective immunogenicity was observed in LTCF residents also in other COVID-19 vaccines (Nace et al 2021 ). Another argument for a vaccination of COVID-19 recovered individuals are observations that a single dose of mRNA vaccine boosted neutralising titers also against other variants of the virus (Stamatatos et al 2021 ).…”