Antibody Responses in Elderly Residential Care Persons following COVID-19 mRNA Vaccination

  1. David A. Nace
  2. Kevin E. Kip
  3. Octavia M. Peck Palmer
  4. Michael R. Shurin
  5. Katie Mulvey
  6. Melissa Crandall
  7. April L. Kane
  8. Amy Lukanski
  9. Paula L. Kip
  10. Alan L. Wells

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Objective

COVID-19 disproportionately impacts older adults residing at long-term care facilities. Data regarding antibody response to COVID-19 vaccines in this population is limited. Our objective was to quantify the presence and magnitude of antibody response in older, vaccinated residents at assisted living, personal care, and independent living facilities.

Design

A cross-sectional quality improvement study was conducted March 15 – April 1, 2021 in the Pittsburgh region.

Setting and Population

Participants were volunteers at assisted living, personal care, and independent living facilities, who received mRNA COVID-19 vaccine. Conditions that obviate 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. Descriptive statistics, Pearson correlation coefficients, and multiple linear regression analysis were performed to evaluate relationships between factors potentially associated with antibody levels.

Results

All participants (N=70) had received two rounds of vaccination for COVID-19 and were found to have antibodies to SARS-CoV-2. There was wide variation in relative levels of antibodies as determined by extinction coefficients. Antibody levels trended lower in male sex, advanced age, steroid medications, and longer length of time from vaccination.

Conclusions and Implications

Higher functioning long-term care residents mounted detectable antibody responses when vaccinated with COVID-19 mRNA-based vaccines. This study provides preliminary information on level of population risk of assisted living, personal care, and independent living residents which can inform reopening strategies. Data suggests some degree of immunity is present during the immediate period following vaccination. However, protective effects of such vaccination programs remain to be determined in larger studies. Clinical protection is afforded not just by pre-formed antibody levels, but by ongoing adaptive immunity, which is known to be decreased in older individuals. Thus, the implications of these levels of antibodies in preventing COVID-19 disease must be determined by clinical follow-up.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2021.04.07.21254925: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This project underwent review and was granted ethical approval as a quality improvement study by the UPMC Quality Improvement Review Committee (Project ID: 3250), the ethics, regulatory, and legal oversight body for protecting patient/participant rights, confidentiality, consent (including waiver of consent), and the analysis and dissemination of deidentified data within the UPMC system.
    Consent: This project underwent review and was granted ethical approval as a quality improvement study by the UPMC Quality Improvement Review Committee (Project ID: 3250), the ethics, regulatory, and legal oversight body for protecting patient/participant rights, confidentiality, consent (including waiver of consent), and the analysis and dissemination of deidentified data within the UPMC system.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    10-12 Study Outcomes: To quantify the presence and magnitude of antibody response in this population, sera were collected from each participant to measure IgG anti-SARS-CoV-2 antibody level with reflex to total anti-SARS-CoV-2 immunoglobulin levels.
    anti-SARS-CoV-2
    suggested: None
    anti-SARS-CoV-2 immunoglobulin levels.
    suggested: None
    13,14 The Beckman Coulter assay uses S1 Spike antigens as capture and anti-IgG as reporter; the Siemens uses S1 Spike antigens as both capture and reporter and thus IgM antibodies are detected and at a higher molar ‘index value’ than IgG antibodies.
    anti-IgG
    suggested: None
    IgM
    suggested: None
    Software and Algorithms
    SentencesResources
    Data Collection: Study data were collected and managed using the Research Electronic Data Capture (REDCap) hosted at UPMC.
    REDCap
    suggested: (REDCap, RRID:SCR_003445)
    Analyses were performed using SAS, version 9.4 (SAS Institute, Inc., Cary, NC).
    SAS
    suggested: (SASqPCR, RRID:SCR_003056)
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study has several limitations. Importantly, the presence of antibody levels does not necessarily confirm immunity. As with other viral infections, immunity to SARS-CoV-2 infection is complex and influenced by B and T cell responses and the innate immune system.17 Level of antibody, quality of antibodies produced, presence of neutralizing antibodies, and duration of antibody presence are all important unknowns in this population.18 Thus, the implications of these levels of antibodies in preventing COVID-19 disease must be determined by clinical follow-up, and incorporated into ongoing facility risk assessment as recommended.4 The modest sample limits the precision in estimates and conclusions drawn, particularly in stratified analyses. Participants were volunteers and likely to be healthier than non-participants, and individuals with known immunosuppression were excluded.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.04.07.21254925v1 on medRxiv