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Monica Gandhi MD, MPH Profile picture
@MonicaGandhi9
Aug 30 • 8 tweets • 3 min read Twitter logo Read on Twitter
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
@florian_krammer Antibodies (binding) last longer than we thought. Can get breakthroughs (which is why hard to prevent all infections, but we have good immunity against severe disease) but antibodies longer-lasting than thought! What about T/B cells? How long do they last?
In terms of T cells, this is one of my favorite papers of pandemic. Even with mild infections, T cell production strong and the T cell half-life is estimated to be very LONG, maybe last a lifetime (like T cells from yellow fever vaccine). Hopeful data
science.org/doi/10.1126/sc…
And how about B cells? Again, don't know because COVID young but this study in Nature examined patients who had influenza 1918 strain ~80 years earlier & B cells to that strain still there; could produce neutralizing antibodies which protected mice
nature.com/articles/natur…
Breakthrough infections increase IgA uniformly (protection in mucosa or from new infections for while); deepen T cells responses (stimulate from memory); increase immunity to non-spike antigens (the vaccine shows you the spike protein)
nature.com/articles/s4146…
Bottom line: Immunity seems to last longer than thought; we must incorporate T & B cell immunity into our discussions from now on (T/B cells cover all variants) which can help determine who needs boosters and when. Thank you; so much good immunology data came out of the pandemic.

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
May 3
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
Monica Gandhi MD, MPH Profile picture
Mar 21
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
Monica Gandhi MD, MPH Profile picture
Mar 15
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
Monica Gandhi MD, MPH Profile picture
Mar 6
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
Monica Gandhi MD, MPH Profile picture
Feb 8
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
Monica Gandhi MD, MPH Profile picture
Jan 30
POPULATION IMMUNITY: Nothing stresses a respiratory pathogen like winter months & this 3rd pandemic winter shows what high population immunity has done to decrease mortality rates from COVID:
ourworldindata.org/covid-deaths
Place with the lowest amount of population immunity is China as less natural infection from zero COVID policies and vaccination (and boosting rates in elderly) not as high as desired. World & @WHO very rightly worried about China- need vax & therapeutics
PANORAMIC trial (ongoing) in UK will define use of Paxlovid with high population immunity- latter not there in China; China vulnerable 65 & up vax'd or unvax'd high risk need wide availability of Paxlovid (Pfizer CEO ruling out generic in China troubling)
reuters.com/business/healt…)
Read 8 tweets

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