Monica Gandhi MD, MPH Profile picture
Mar 7, 2021 19 tweets 6 min read Read on X
How long will immunity from COVID-19 vaccine last? Let's remember from papers tweeted before, immunity from natural infection & vaccinations across viruses lasts long. Remember: survivors of 1918 flu: memory B cells can stimulate Abs to fight same strain
nature.com/articles/natur…
Then immunity from pertussis, measles vaccinations lasts long long time - look at those T-cells (CD4 and CD8) from measles vaccination continue strong, measured out to 34 years after vaccination
ncbi.nlm.nih.gov/pmc/articles/P…
Then let's turn to the RNA viruses that are coronaviruses (influenza, measles both RNA viruses too). There are coronaviruses that cause colds (229E, NL63, OC43, HKU1) for instance & coronaviruses (SARS-CoV-1, MERS) that - like SARS-CoV-2 cause more severe symptoms. Behooves us to
compare durability of SARS-CoV-2 to its dangerous cousins that caused SARS and MERS epidemics, respectively. Before that, I have to convince you that adaptive immunity comprises two types of responses - antibodies & T cells and latter more enduring after vaccination (or natural) Image
EXCELLENT review on this from December 2020. Mark following words when we talk of yellow fever vax later: "Data from coronavirus infections in animals and humans emphasize the generation of a high-quality T cell response in protective immunity"
sciencedirect.com/science/articl…
"Yellow Fever and smallpox vaccines are excellent benchmarks for primary immune response to viral vaccination and induce long-lived virus-reactive CD8 T-cells, which are present and measurable within 1–4 months of vaccination".
sciencedirect.com/science/articl…
Okay, so when scientists say MERS pandemic in 2011 and were looking to develop vaccine, they looked back to SARS-CoV (initial SARS) pandemic 2002-2003 and saw that cytotoxic and other T-cell responses after natural infection to SARS lasted long (>10 years)
sciencedirect.com/science/articl…
So, let's turn to SARS-CoV-2 and remember that we have plenty of evidence now that T-cell immunity induced by both natural infection (see below figure) and by the vaccines (see that table I tweet out on what T-cell responses were measured in the clinical trials of vaccines) Image
Now, let's turn to this paper to answer - but okay, how long? How long will immunity from natural infection & vaccines last? Let's remember yellow fever vaccination as a one-time vaccine usually over a lifetime as we answer.
science.sciencemag.org/content/371/65…
My favorite paper of pandemic above assessed immune memory of all 3 branches of adaptive immunity among 188 (80 male; 108 female) patients recovered from COVID-19 (93% mild; 7% hospitalized) over 8 months. Longitudinal samples assessed circulating antibodies, memory B cells,
CD8+ T cells, and CD4+ T cells specific for SARS-CoV-2 over 8 months. Happily, memory B cells specific for the spike protein or receptor binding domain (RBD) were detected in almost all COVID-19 cases, with NO apparent half-life (didn't decrease) at 5 to 8 months post-infection.
Memory T cell half-lives also long, observed over 6 months in this cohort (~125-225 days for CD8+ and ~94-153 days for CD4+ T cells), comparable to the 123 days half-life observed for memory CD8+ T cells after yellow fever immunization (a vaccine usually given once a lifetime).
Antibodies against spike protein and RBD also durable x 8 months, with modest declines over time. Conclusion: This longitudinal & comprehensive analysis of memory T and B cell responses to COVID-19 after infection was heartening in term of the likely durability of immune memory
after either natural infection or vaccination for COVID. If we can believe the B cell & T cell half-life data (and why wouldn't we? This group has been doing careful work since beginning), vaccine-induced immunity may last a lifetime or at least (initial SARS-CoV data)>10 years
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See you all in 3 days after CROI!
Another intriguing article to add on to why immunity likely to be long-lived with #covid19 vaccines. Remember long-lived memory B & T cells are stored in germinal centers (like lymph nodes) in our body & generate responses to fight the virus if see again
researchsquare.com/article/rs-310…
32 individuals who received 2 doses of Pfizer vaccine. Antibodies peaked and declined. But you store your long-term memory cells in "germinal centers" and they biopsied those centers (lymph nodes) & found GC B cells that bind spike protein in all participants sampled after vax.
Extremely high frequencies of spike protein binding GC B cells were maintained in draining lymph nodes for up to seven weeks after first vaccine shot, with a substantial fraction of the plasmablast pool class switched to IgA (which protects us against nasal mucosal colonization)
Wanted to keep adding to thread of "how long will immunity last to COVID vaccine" as find more articles. This one shows us that T cells against the nucleocapsid protein with SARS-CoV (SARS epidemic 2002-03) strong at 17 years, immunity to COVID likely long
nature.com/articles/s4158…

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More from @MonicaGandhi9

Aug 30, 2023
HOW LONG DOES IMMUNITY LAST? To COVID vaccines or infection? We do not really know but there have been some really nice papers lately that give us more information. Please remember immunity divided into antibodies (which can come down & not work as well against variants)
IgA is one in the nose & mouth ("mucosa") that is raised by shots (vaccines) to certain extent but rise higher after natural infection; IgG is the one that is "humoral" or in the bloodstream. Many threads on here about cellular-mediated immunity: B & T cells cover all variants
This recent preprint is really important and summarized by @florian_krammer below in depth. Main take-aways: Breakthrough infections induce IgA (we knew) but protection from vaccine long-lasting even against former variants to severe disease/mortality
Read 8 tweets
May 3, 2023
RSV VACCINE FOR OLDER ADULTS: Respiratory syncytial virus (RSV) respiratory virus (most common after flu pre-COVID). 2 subtypes, A&B (1 dominates/season). Droplet; Recurrent infections. Most severe in neonates & adults >65; FDA approves 1st RSV vax today
msn.com/en-us/news/us/…
RSV vaccine 3 trials of new RSV vaccine, all published in the @NEJM recently so just to keep them straight- here is the vaccine which just got approved May 3 by the FDA for older adults. Remember our T/B cells so protection against severe disease higher!
nejm.org/doi/full/10.10…
A single dose of the RSVPreF3 OA vaccine had an acceptable safety profile and prevented RSV-related severe respiratory illness by 94% in adults>=60 years (71% against RSV infection, likely to fall with time as antibodies fall but severe disease protection will remain)
Read 4 tweets
Mar 21, 2023
NASAL VACCINES: To explain nasal vaccines, we have to explain the immune system first.
IgA is an antibody that helps attack the pathogen and exists in mucosal surfaces (like nose/mouth)
IgG is an antibody that is in the bloodstream
bbc.com/news/world-asi…
Cellular immunity is fantastic, redundant (so even if one cell line down in immunocompromised, have other), generated by either vaccine or infection; Comprised of
T cells- so in breadth from vax - works even across spike protein with its mutations
And the 2nd type of cell produced by vaccines or infection -B cell- amazing thing about B cells is that - if see omicron or one of its subvariants in future- they make antibodies adapted to that variant or subvariant (aided by T cells); adaptive immunity
Read 15 tweets
Mar 15, 2023
PUBLIC HEALTH POLICY: Seem to be at reckoning phase of COVID response- what worked, what didn't. Which interventions will be used in future pandemic responses? Interventions asked of public need good medical evidence for them (e.g. RCTs preferably, systematic reviews) to impose
In our field, Cochrane reviews represent best way to sum up the medical evidence to date by performing meta-analyses or systemic reviews of currently-available data; here is Cochrane on masks & other interventions for respiratory viruses including COVID
cochranelibrary.com/cdsr/doi/10.10…
Many asked past 3 years how CDC developed policies on masks (& age to mask), distancing (feet), ventilation, schools-> all non-pharmaceutical interventions. Originally theory-based. Now 3 years in, have data (RCTs highest level) to form policies from both US and other countries
Read 4 tweets
Mar 6, 2023
VACCINE DISCRIMINATION: We need to stop vaccine requirements for US entry like almost every other country. Am finishing COVID chapter for our ID "bible" & vaccines prevented transmission early on with alpha, but not enough now with current variants to justify such discrimination
Moreover, shame, stigma, blame (remember COVIDiots?), coercion, discrimination not good public health tools. When used for HIV, public health & ID physicians decried them but tactics used a lot in COVID. This book tries to explore & correct that for future
barnesandnoble.com/w/endemic-moni…
Concept of #harmreduction in pandemic responses means watching carefully if vulnerable people (like students, older people, low-income populations, migrants, sex workers, prisoners, those with disabilities, refugees, minorities) harmed more by response
nature.com/articles/s4146…
Read 4 tweets
Feb 8, 2023
FEAR: Some media & public health officials concerned Americans aren't fearful of COVID now. But the vaccines & therapeutics DO WORK. If we can't celebrate biomedical advances & imbibe their effectiveness (we have better tools for COVID than flu), what is point of developing?
In HIV medicine, when therapies came out, we didn't say to people- stay fearful; make this the controlling principle of your life. The book #Endemic I wrote (coming out July 11, 2023) hails these biomedical advances & the age we are in to fight pandemics to reassure the world
This is a rather brilliant summary of the issue from @benryanwriter
Read 4 tweets

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