Influencing factors of anti‐SARS‐CoV‐2‐spike‐IgG antibody titers in healthcare workers: A cross‐section study

  1. Julia Reusch
  2. Isabell Wagenhäuser
  3. Alexander Gabel
  4. Annika Eggestein
  5. Anna Höhn
  6. Thiên‐Trí Lâm
  7. Anna Frey
  8. Alexandra Schubert‐Unkmeir
  9. Lars Dölken
  10. Stefan Frantz
  11. Oliver Kurzai
  12. Ulrich Vogel
  13. Manuel Krone
  14. Nils Petri

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Abstract

Against the background of the current COVID‐19 infection dynamics with its rapid spread of SARS‐CoV‐2 variants of concern (VOC), the immunity and the vaccine prevention of healthcare workers (HCWs) against SARS‐CoV‐2 continues to be of high importance. This observational cross‐section study assesses factors influencing the level of anti‐SARS‐CoV‐2‐spike IgG after SARS‐CoV‐2 infection or vaccination. One thousand seven hundred and fifty HCWs were recruited meeting the following inclusion criteria: age ≥18 years, PCR‐confirmed SARS‐CoV‐2 infection convalescence and/or at least one dose of COVID‐19 vaccination. anti‐SARS‐CoV‐2‐spike IgG titers were determined by SERION ELISA agile SARS‐CoV‐2 IgG. Mean anti‐SARS‐CoV‐2‐spike IgG levels increased significantly by number of COVID‐19 vaccinations (92.2 BAU/ml for single, 140.9 BAU/ml for twice and 1144.3 BAU/ml for threefold vaccination). Hybrid COVID‐19 immunized respondents (after infection and vaccination) had significantly higher antibody titers compared with convalescent only HCWs. Anti‐SARS‐CoV‐2‐spike IgG titers declined significantly with time after the second vaccination. Smoking and high age were associated with lower titers. Both recovered and vaccinated HCWs presented a predominantly good humoral immune response. Smoking and higher age limited the humoral SARS‐CoV‐2 immunity, adding to the risk of severe infections within this already health impaired collective.

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  1. Version published to 10.1002/jmv.28300
  2. ScreenIT

    SciScore for 10.1101/2022.05.10.22274912: (What is this?)

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

    Table 1: Rigor

    EthicsConsent: The CoVacSer study participants had to meet the following inclusion criteria: (i) age ≥ 18 years, (ii) signed consent form, (iii) 14 days minimal interval after first polymerase chain reaction (PCR) derived confirmation of SARS-CoV-2 infection and/or at least one dose of COVID-19 vaccination independent of the vaccination concept, and (iv) employment in the healthcare sector.
    IRB: 2.4 Ethical approval: The study protocol was approved by the Ethics committee of the University of Wuerzburg in accordance with the Declaration of Helsinki (file no. 79/21).
    Sex as a biological variableStatistical differences between the age distributions of male and female HCWs were separately calculated with the Kolmogorov Smirnov test against the corresponding age distribution within the German population in 2019 [26].
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    For detecting Anti-SARS-CoV-2-Spike IgG antibody levels beyond the maximum limit of 250 U/ml (525.0 BAU/ml), serum blood samples were diluted based on a dilution series with dilution factors both 10 and 100.
    Anti-SARS-CoV-2-Spike IgG
    suggested: None
    Software and Algorithms
    SentencesResources
    The questionnaire survey including WHOQOL-BREF [14, 15] and WAI [16] was performed using REDCap (Research Electronic Data Capture, projectredcap.org). 2.3 SARS-CoV-2 IgG ELISA: Anti-SARS-CoV-2-Spike IgG titres were determined by SERION ELISA agile SARS-CoV-2 IgG (SERION Diagnostics, Wuerzburg, Germany), technically carried out as an enzyme linked immunoassay (ELISA).
    REDCap
    suggested: (REDCap, RRID:SCR_003445)

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The data presented should be interpreted considering the possible influence of the following limitations. Firstly, the study population consists of 80.5% female HCWs and thereby represents the typical female focused gender composition in the public healthcare sector in Germany with a female share of 75.5% among HCWs in 2019 [32]. Nevertheless, due to the large study population and the gender differentiated data analysis, this only slightly limits the transferability of the described findings to both HCWs and the public. Secondly, the vaccines administered are heterogeneously distributed in our cohort, with BNT162b2mRNA double administration accounting for the largest proportion by far. The share of Anti-SARS-CoV-2-Spike IgG titres after vaccination with other COVID-19 vaccines than BNT162b2mRNA is consequently limited and needs to be investigated in further studies. Similarly, the intervals between the individual COVID-19 vaccine administrations vary as recommended vaccination intervals are not adhered to in all cases. This also limits the generalisability but represents a real-life scenario. Another limitation resides within unknown, not PCR confirmed SARS-CoV-2 infections, which might lead to higher Anti-SARS-CoV-2-Spike IgG levels after vaccination. Only Anti-SARS-CoV-2-Spike IgG were serologically obtained, consequently the differentiation of antibody levels being solely a result of COVID-19 vaccination or consequences of an unknown SARS-CoV-2 infection is not possible. H...

    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.

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  3. Version published to 10.1101/2022.05.10.22274912 on medRxiv