Antibody titre 115 AU/ml for Covishield and 51 for covaxin.
27 breakthrough infections occurred (4.9%) after both doses: 25 were mild, 2 were moderate, no deaths.
Risk of breakthrough infection:
5.5% with covishield
2.2% with covaxin
2/5
Listing some facts which will help understand the context of the study:
1. Anti Spike antibody is not the same as neutralising antibody. Its level is not known to reliably correlate with NAb, which is typically measured only in research labs. See my earlier tweet on this.
3/5
2. Immunity is multipronged, like the “Army, Navy and Airforce”. Antibodies form only one segment of this.
⚠️The % or level of Anti Spike Antibody measured in the study cannot be taken as “% of protection delivered” to the recipient.
4/5
3. What matters in the end is:
a) the % of people who get infected inspite of vaccination
b) how sick they get
c) duration of protection
Both vaccines are seen to be providing excellent protection on the ground. The exact %, as the authors say, will only be seen in an RCT.
5/5
Congratulations to Dr AK Singh @singhak_endo and colleagues for conducting this study and for writing it up comprehensively using professional language, covering all possible angles, discussing the limitations and correlating with published research.
Study by Dr Padmanabha Shenoy @drdpshenoy and co from Cochin shows similar trends, although their work was primarily among patients with rheumatological disease.
The latest COVID-19 guideline from Directorate General of Health Services at Ministry of Health & Family Welfare @MoHFW_INDIA, are pristine no-nonsense science.
The neutralizing ability of vaccine drops with time, and age. The variants of concern B.1.617.2, B.1.351
and B.1.1.7, have a 5.8, 4.6 and 2.6 - fold reduction respectively when compared with the original Wild type strain. Study from UK comparing variants against vaccines.
The study measured neutralizing ability of post-vaccine serum against variants. Theoretically, it means VOC are more likely to get past vaccine protection, esp. those who had only 1 dose.
However, such lab studies are best interpreted along with clinical observations.
2/5
The reason for seeking clinical correlation is that immunity is multi-pronged, and we are not measuring T cell protection in such studies.
While neutralizing antibodies stop the virus from infecting our cells, what happens AFTER the infection is largely decided by T cells.
3/5
Among 506 healthcare worker infections from a cohort of 12,248 at PGI Chandigarh, 64% were unvaccinated, 9.5% were fully vaccinated (>2 weeks past II dose)
However, the shorter follow up post 2nd dose (time bias) means the real % could be higher.
The graph does not factor in the duration of follow up. During an ongoing vaccination process, those who are unvaccinated “get longer time” (compared to the vaccinated healthcare workers) to pick up the infection.
2/10
Cont’d
Since vaccination takes time, those who were 2 weeks past second dose in the pie chart would have had fewer days of observation, than others.
This means that the odds of picking up infection will be smaller by default. This also gets reflected in the pie chart.