Characterization of immune responses in fully vaccinated individuals after breakthrough infection with the SARS-CoV-2 delta variant

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Abstract

Breakthrough infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants have been reported frequently in vaccinated individuals with waning immunity. In particular, a cluster of over 1000 infections with the SARS-CoV-2 delta variant was identified in a predominantly fully vaccinated population in Provincetown, Massachusetts in July 2021. In this study, vaccinated individuals who tested positive for SARS-CoV-2 ( n = 16) demonstrated substantially higher serum antibody responses than vaccinated individuals who tested negative for SARS-CoV-2 ( n = 23), including 32-fold higher binding antibody titers and 31-fold higher neutralizing antibody titers against the SARS-CoV-2 delta variant. Vaccinated individuals who tested positive also showed higher mucosal antibody responses in nasal secretions and higher spike protein–specific CD8 + T cell responses in peripheral blood than did vaccinated individuals who tested negative. These data demonstrate that fully vaccinated individuals developed robust anamnestic antibody and T cell responses after infection with the SARS-CoV-2 delta variant. Moreover, these findings suggest that population immunity will likely increase over time by a combination of widespread vaccination and breakthrough infections.

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  1. SciScore for 10.1101/2021.10.18.21265113: (What is this?)

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

    Table 1: Rigor

    EthicsConsent: Participants were provided contact information for the Beth Israel Deaconess Medical Center (BIDMC) study team for recruitment and informed consent.
    IRB: The BIDMC Institutional Review Board approved this study (#2021P000344) as part of a parent biorepository study (#2020P000361).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Cell Line Authenticationnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    The plates were again washed 3 times and 50 μL of SULFO-Tagged anti-Human IgG detection antibody diluted to 1x in Diluent 100 was added to each well and incubated shaking at 700 rpm at room temperature for at least 1 h.
    anti-Human IgG
    suggested: (RevMAb Biosciences Cat# 31-1019-MK, RRID:AB_2783627)
    Intracellular cytokine staining (ICS) assay: 106 peripheral blood mononuclear cells well were re-suspended in 100 µL of R10 media supplemented with CD49d monoclonal antibody (1 µg/mL) and CD28 monoclonal antibody (1 µg/mL) as described previously.
    CD49d
    suggested: (BD Biosciences Cat# 347690, RRID:AB_647457)
    CD28
    suggested: None
    The next day, the cells were washed twice with DPBS, stained with aqua live/dead dye for 10 mins and then stained with predetermined titers of monoclonal antibodies against CD279 (clone EH12.1, BB700), CD4 (clone L200, BV711),
    CD279
    suggested: (BD Biosciences Cat# 746185, RRID:AB_2743534)
    CD4
    suggested: None
    BV711
    suggested: None
    Cells were washed twice with 1X Perm Wash buffer (BD Perm/WashTM Buffer 10X in the CytoFix/CytoPerm Fixation/ Permeabilization kit diluted with MilliQ water and passed through 0.22µm filter) and stained with intracellularly with monoclonal antibodies against IFN-γ (clone B27; BUV395), and CD3 (clone SP34.2, Alexa 700), for 30 min.
    IFN-γ
    suggested: (BD Biosciences Cat# 563563, RRID:AB_2738277)
    CD3
    suggested: (BD Biosciences Cat# 556610, RRID:AB_396483)
    Enzyme-linked immunospot (ELISPOT) assay: ELISPOT plates were coated with mouse anti-human IFN-γ monoclonal antibody from MabTech at 1 µg/well and incubated overnight at 4°C.
    anti-human IFN-γ
    suggested: None
    Experimental Models: Cell Lines
    SentencesResources
    luciferase reporter plasmid pLenti-CMV Puro-Luc (Addgene) and spike protein expressing pcDNA3.1-SARS-CoV-2 SΔCT were co-transfected into HEK293T cells (ATCC CRL_3216) with lipofectamine 2000 (ThermoFisher Scientific).
    HEK293T
    suggested: ATCC Cat# CRL-3216, RRID:CVCL_0063)
    The mixture was incubated at 37 °C for 1 h before adding to HEK293T-hACE2 cells.
    HEK293T-hACE2
    suggested: RRID:CVCL_A7UK)
    Recombinant DNA
    SentencesResources
    Pseudovirus neutralizing antibody assay: The SARS-CoV-2 pseudoviruses expressing a luciferase reporter gene were used to measure pseudovirus neutralizing antibodies as described previously.5,6 In brief, the packaging construct psPAX2 (AIDS Resource and Reagent Program)
    psPAX2
    suggested: RRID:Addgene_12260)
    luciferase reporter plasmid pLenti-CMV Puro-Luc (Addgene) and spike protein expressing pcDNA3.1-SARS-CoV-2 SΔCT were co-transfected into HEK293T cells (ATCC CRL_3216) with lipofectamine 2000 (ThermoFisher Scientific).
    pLenti-CMV Puro-Luc
    suggested: None
    pcDNA3.1-SARS-CoV-2
    suggested: None
    Software and Algorithms
    SentencesResources
    Pseudovirus neutralizing antibody assay: The SARS-CoV-2 pseudoviruses expressing a luciferase reporter gene were used to measure pseudovirus neutralizing antibodies as described previously.5,6 In brief, the packaging construct psPAX2 (AIDS Resource and Reagent Program)
    AIDS Resource and Reagent Program
    suggested: None
    Fixed cells were transferred to 96-well round bottom plate and analyzed by BD FACSymphony™ system.
    BD FACSymphony™
    suggested: None
    Data were analyzed using FlowJo v9.9
    FlowJo
    suggested: (FlowJo, RRID:SCR_008520)
    Statistical analysis: Descriptive statistics were calculated using GraphPad Prism 8.4.3, (
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    (GraphPad Software, San Diego, California).
    GraphPad
    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 limitation of this study is the relatively small number of individuals in this immunologic analysis compared with the large total number of individuals in this outbreak. Nevertheless, the magnitude and consistency of the immunologic differences observed between vaccinated infected and vaccinated uninfected individuals suggest the generalizability of the conclusions. Another limitation is the fact that the vaccinated infected group was generally younger than the vaccinated uninfected group, which may reflect different risk behaviors or exposures based on age. However, age did not appear to correlate with the magnitude of binding or neutralizing antibody titers in this cohort (Fig. S2). In conclusion, we describe humoral and cellular immune responses in the first large, well described cluster of breakthrough infections with the SARS-CoV-2 delta variant in fully vaccinated individuals in the United States. Breakthrough infection led to a large increase in antibody and T cell responses in vaccinated individuals, suggesting important immunologic benefits of vaccination even when infection was not prevented. Moreover, anamnestic antibody responses in breakthrough infections were similar in magnitude regardless of the length of time from vaccination (Fig. S3), suggesting the possibility of protection against severe disease for a prolonged period of time even after serum antibody titers decline. These data provide unique insights into the immunology of breakthrough infections wit...

    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.