Serial evaluation of anti-SARS-CoV-2 IgG antibody and breakthrough infections in BNT162b2 Vaccinated migrant workers from Bangladesh

  1. Ashraful Hoque
  2. Md Marufur Rahman
  3. Anindita Das

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Background

While Bangladesh has started its mass COVID-19 vaccination drive, it is struggling to cover its huge population similar to other low- and middle-income countries due to the lack of vaccine availability. One of the major remittance sources for Bangladesh is its migrant workers who are required to receive mRNA vaccines to return to their jobs. Despite reports of higher efficacy of mRNA vaccine against COVID-19, breakthrough infection cases are arising especially with the emergence of Delta variant. It is highly important to understand the post-vaccination immune response and breakthrough infections in different populations so that the necessity of booster dosage can be assessed properly.

Methods

We observed post BNT162b2 full vaccination immune response in a small older group (mean age= 59.5±5.44 years) of migrant workers (n=10) for six months at the Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh. The plasma samples from the participants were collected after 14 days, 2 months, 3 months, 4 months, 5 months, and 6 months of receiving the 2 nd dose of the BNT162b2 vaccine. Anti S1 RBD IgG responses were measured as optical density ratios using a commercially available ELISA kit.

Results

All 10 of the participants were male migrant workers and none of them had a history of previous COVID-19 infection. The median antibody response [IQ1:IQ3] was 9.05 [7.53; 10.0] on day 14 then it increases to 13.6 [12.0; 14.0] at the second month which gradually decreased to a median of 8.63 [8.34; 9.37] on the 6th-month post-vaccination. There were two breakthrough infection cases after receiving the second dose and the antibody responses were highly increased in the following months. Two of the breakthrough cases were diagnosed with mild COVID-19 as the symptom duration was less than 3 days with no respiratory complications and no hospital admission were required.

Conclusions

The BNT162b2 mRNA vaccine produces a strong immune response that sustains at least 6 months after getting fully vaccinated. But even after getting fully vaccinated people are susceptible to breakthrough infections that are not severe and boost the immune response greatly offering a hybrid immunity from both vaccine and natural infection. Hence, it is still important to fully vaccinate a greater number of people rather than thinking of offering booster dosage to a privileged population out of the fear of breakthrough cases. If the LMICs can quickly cover at least 80% of their population with usual priority targets (healthcare workers, migrant workers, older people, etc.) then a global risk reduction and pandemic control would be possible that will allow additional variant-specific boosters for targeted populations if evidence support.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2021.09.07.21263221: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: The study protocol was reviewed and approved by the Institutional Review Committee of the Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka (approval memo number: SHNIBPS/Jan-14(09)).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Serological testing for antibodies to the RBD of the S1 subunit of the viral spike protein (IgG) was performed from the plasma samples using a commercially available Anti-SARS-CoV-2 ELISA kit as per instruction supplied by the manufacturer.
    viral spike protein (IgG
    suggested: None
    Anti-SARS-CoV-2
    suggested: None
    Software and Algorithms
    SentencesResources
    The analysis was performed in Graphpad Prism 9.0.
    Graphpad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)

    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:
    One of the key limitations of our study is the small sample size which does not represent the larger population. That is our findings need to be carefully evaluated and tested further through more extensive research with larger samples. Overall, our observation and findings from other studies suggest COVID-19 vaccines are likely to provide long-term protection. Despite occurrences of breakthrough infections, it’s not worrisome yet as most breakthrough cases are mild even with the current aggressive delta variant prevalence all over the world. The World Health Organization has strongly protested against the decision of giving booster doses as there is a lack of evidence in support of such doses (20). The rise of breakthrough cases is worrying thus we can conduct more studies on them and try to identify who is getting more affected so that they can be prioritized for variant-specific booster dosages if strong evidence arises. As Saha et. al. mentioned the world is seeing vaccine apartheid where richer countries are experimenting with booster shots and the low-middle income countries in the Global South including Bangladesh are struggling to control the case and death numbers from COVID as they couldn’t provide a single shot of COVID vaccine to most of its people (21). We must not advise for booster shots unless stronger evidence arises and an equitable vaccine distribution is ensured throughout the world.

    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.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    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 10.1101/2021.09.07.21263221v1 on medRxiv