Effect of the third dose of BNT162b2 vaccine on quantitative SARS-CoV-2 spike 1–2 IgG antibody titers in healthcare personnel

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Abstract

Vaccination is our main strategy to control SARS-CoV-2 infection. Given the decrease in quantitative SARS-CoV-2 spike 1–2 IgG antibody titers three months after the second BNT162b2 dose, healthcare workers received a third booster six months after completing the original protocol. This study aimed to analyze the quantitative SARS-CoV-2 spike 1–2 IgG antibody titers and the safety of the third dose.

Material and methods

A prospective longitudinal cohort study included healthcare workers who received a third booster six months after completing the BNT162b2 regimen. We assessed the quantitative SARS-CoV-2 spike 1–2 IgG antibody titers 21–28 days after the first and second dose, three months after the completed protocol, 1–7 days following the third dose, and 21–28 days after booster administration.

Results

The cohort comprised 168 participants aged 41(10) years old, 67% of whom were female. The third dose was associated with an increase in quantitative antibody titers, regardless of previous SARS-CoV-2 history. In cases with a negative SARS-CoV-2 history, the median (IQR) antibody titer values increased from 379 (645.4) to 2960 (2010) AU/ml, whereas in cases with a positive SARS-CoV-2 history, from 590 (1262) to 3090 (2080) AU/ml (p<0.001). The third dose caused a lower number of total (local and systemic) adverse events following immunization (AEFI) compared with the first two vaccines. However, in terms of specific symptoms such as fatigue, myalgia, arthralgia, fever, and adenopathy, the proportion was higher in comparison with the first and second doses (p<0.05). The most common AEFI after the third BNT162b2 vaccine was pain at the injection site (n = 82, 84.5%), followed by fatigue (n = 45, 46.4%) of mild severity (n = 36, 37.1%).

Conclusion

The third dose applied six months after the original BNT162b2 regimen increased the quantitative SARS-CoV-2 spike 1–2 IgG antibody titers. The booster dose was well tolerated and caused no severe AEFI.

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  1. SciScore for 10.1101/2021.10.20.21265269: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: The study was approved by the local Institutional Review Board (Ref.:26022021-CN-1e-CI) and conducted per the Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments that involve humans.
    Consent: The inclusion criteria for the patients’ recruitment were individuals of both genders between the age of 18 and 100 years old, who had accepted and signed an informed consent form and pretended to complete the BNT126b2 regimen.
    Sex as a biological variableThe inclusion criteria for the patients’ recruitment were individuals of both genders between the age of 18 and 100 years old, who had accepted and signed an informed consent form and pretended to complete the BNT126b2 regimen.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    The individuals were introduced to the research process, which consisted of a follow-up during an entire year through SARS-CoV-2 specific IgG antibodies measurement samples followed by questionnaires.
    SARS-CoV-2 specific IgG
    suggested: None
    Since this protocol was approved after the application of the first BNT, twenty-one days after receiving the first dose, the research team reached every participant to take a plasma sample for the IgG antibodies measurement and apply the first questionnaire.
    IgG
    suggested: None
    The third, fourth, and fifth IgG antibodies samples were planned to be taken three, six, and twelve months after completing the two-dose regimen of BNT126b2, respectively.
    fifth IgG
    suggested: None
    The equipment used by the laboratory personnel to analyze the samples was the LIAISON SARS-CoV-2 S1 / S2 IgG antibody detection kit (Italy).
    S2 IgG
    suggested: None
    To determine the amount of specific anti-S1 and anti-S2 IgG antibodies against SARS-CoV-2 in plasma samples, the laboratory personnel used the chemiluminescence immunoassay (CLIA); which had a sensitivity of 97.4% (95% CI, 86.8-99.5) and a specificity of 98.5% (95% CI, 97.5-99.2).
    anti-S1
    suggested: None
    86.8-99.5
    suggested: (GenWay Biotech Inc. Cat# GWB-868995, RRID:AB_10516413)
    In the three-month follow-up, there was a decrease in the amount of specific anti-S1 and anti-S2 IgG antibodies against SARS-CoV-2.
    SARS-CoV-2
    suggested: None
    The analyzed biochemical variables were: SARS-CoV-2 quantitative antibodies from 21-28 days post-BNT126b2 first dose (S1), 21-28 days post-BNT126b2 second dose (S2), three-month follow-up after completing the two-dose BNT126b2 regimen (S3), and 1-7 days (S4) and 21-28 days post-BNT-boost (S5).
    S3
    suggested: None
    S5
    suggested: None
    Software and Algorithms
    SentencesResources
    The statistical program used was SPSS, version 2.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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:
    A limitation to our study was that the recruited group did not have a baseline sample taken before the first BNT162b2 dose because our protocol was approved after the health workers had received the first dose. However, we believe that this study is significant because of the non-immunocompromised population that we used. Another limitation was the analysis of the third dose’s side effects only in the short-term (21-28 days after the booster dose). We will continue following this cohort group to see any long-term side effects related to the vaccine, but we just reported the short-term side effects for this study.

    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.