Abstract

Following primary SARS-CoV-2 vaccination, whether boosters or breakthrough infections provide greater protection against SARS-CoV-2 infection is incompletely understood. Here we investigated SARS-CoV-2 antibody correlates of protection against new Omicron BA.4/5 (re-)infections and anti-spike IgG antibody trajectories after a third/booster vaccination or breakthrough infection following second vaccination in 154,149 adults ≥18 y from the United Kingdom general population. Higher antibody levels were associated with increased protection against Omicron BA.4/5 infection and breakthrough infections were associated with higher levels of protection at any given antibody level than boosters. Breakthrough infections generated similar antibody levels to boosters, and the subsequent antibody declines were slightly slower than after boosters. Together our findings show breakthrough infection provides longer-lasting protection against further infections than booster vaccinations. Our findings, considered alongside the risks of severe infection and long-term consequences of infection, have important implications for vaccine policy.

The duration and strength of protection against SARS-CoV-2 infection resulting from a booster vaccine dose or breakthrough infection are not well understood. This study uses data from the UK COVID-19 Infection Survey to investigate correlates of protection against Omicron BA.4/5 infection and assess antibody responses to booster vaccination and breakthrough infections.

Details

Title
Protection against SARS-CoV-2 Omicron BA.4/5 variant following booster vaccination or breakthrough infection in the UK
Author
Wei, Jia 1 ; Matthews, Philippa C. 2   VIAFID ORCID Logo  ; Stoesser, Nicole 3   VIAFID ORCID Logo  ; Newton, John N. 4 ; Diamond, Ian 5 ; Studley, Ruth 5 ; Taylor, Nick 5 ; Bell, John I. 6 ; Farrar, Jeremy 7 ; Kolenchery, Jaison 8 ; Marsden, Brian D. 9   VIAFID ORCID Logo  ; Hoosdally, Sarah 10 ; Jones, E. Yvonne 10 ; Stuart, David I. 10 ; Crook, Derrick W. 3 ; Peto, Tim E. A. 3 ; Walker, A. Sarah 11 ; Pouwels, Koen B. 12   VIAFID ORCID Logo  ; Eyre, David W. 13   VIAFID ORCID Logo  ; Thomas, Tina 5 ; Ayoubkhani, Daniel 5 ; Black, Russell 5 ; Felton, Antonio 5 ; Crees, Megan 5 ; Jones, Joel 5 ; Lloyd, Lina 5 ; Sutherland, Esther 5 ; Pritchard, Emma 10 ; Vihta, Karina-Doris 10 ; Doherty, George 10 ; Kavanagh, James 10 ; Chau, Kevin K. 10 ; Hatch, Stephanie B. 10 ; Ebner, Daniel 10 ; Ferreira, Lucas Martins 10 ; Christott, Thomas 10 ; Dejnirattisai, Wanwisa 10 ; Mongkolsapaya, Juthathip 10 ; Cameron, Sarah 10 ; Tamblin-Hopper, Phoebe 10 ; Wolna, Magda 10 ; Brown, Rachael 10 ; Cornall, Richard 10 ; Screaton, Gavin 10 ; Lythgoe, Katrina 14 ; Bonsall, David 14 ; Golubchik, Tanya 14 ; Fryer, Helen 14 ; Cox, Stuart 15 ; Paddon, Kevin 15 ; James, Tim 15 ; House, Thomas 16 ; Robotham, Julie 17 ; Birrell, Paul 17 ; Jordan, Helena 18 ; Sheppard, Tim 18 ; Athey, Graham 18 ; Moody, Dan 18 ; Curry, Leigh 18 ; Brereton, Pamela 18 ; Jarvis, Ian 19 ; Godsmark, Anna 19 ; Morris, George 19 ; Mallick, Bobby 19 ; Eeles, Phil 19 ; Hay, Jodie 20 ; VanSteenhouse, Harper 20 ; Lee, Jessica 21 ; White, Sean 22 ; Evans, Tim 22 ; Bloemberg, Lisa 22 ; Allison, Katie 23 ; Pandya, Anouska 23 ; Davis, Sophie 23 ; Conway, David I. 24 ; MacLeod, Margaret 24 ; Cunningham, Chris 24 

1  University of Oxford, Nuffield Department of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); University of Oxford, Big Data Institute, Nuffield Department of Population Health, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948) 
2  University of Oxford, Nuffield Department of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); The Francis Crick Institute, London, UK (GRID:grid.451388.3) (ISNI:0000 0004 1795 1830); University College London, Division of infection and immunity, London, UK (GRID:grid.83440.3b) (ISNI:0000000121901201) 
3  University of Oxford, Nuffield Department of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Department of Infectious Diseases and Microbiology, Oxford, UK (GRID:grid.8348.7) (ISNI:0000 0001 2306 7492); The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); The National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK (GRID:grid.454382.c) (ISNI:0000 0004 7871 7212) 
4  University of Exeter, European Centre for Environment and Human Health, Truro, UK (GRID:grid.8391.3) (ISNI:0000 0004 1936 8024) 
5  Office for National Statistics, Newport, UK (GRID:grid.426100.1) (ISNI:0000 0001 2157 6840) 
6  University of Oxford, Office of the Regius Professor of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948) 
7  Wellcome Trust, London, UK (GRID:grid.52788.30) (ISNI:0000 0004 0427 7672) 
8  University of Oxford, Nuffield Department of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Department of Infectious Diseases and Microbiology, Oxford, UK (GRID:grid.8348.7) (ISNI:0000 0001 2306 7492) 
9  University of Oxford, Nuffield Department of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948) 
10  University of Oxford, Nuffield Department of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948) 
11  University of Oxford, Nuffield Department of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); University of Oxford, Big Data Institute, Nuffield Department of Population Health, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); MRC Clinical Trials Unit at UCL, UCL, London, UK (GRID:grid.83440.3b) (ISNI:0000000121901201) 
12  The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); University of Oxford, Health Economics Research Centre, Nuffield Department of Population Health, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948) 
13  University of Oxford, Big Data Institute, Nuffield Department of Population Health, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Department of Infectious Diseases and Microbiology, Oxford, UK (GRID:grid.8348.7) (ISNI:0000 0001 2306 7492); The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); The National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK (GRID:grid.454382.c) (ISNI:0000 0004 7871 7212) 
14  University of Oxford, Big Data Institute, Nuffield Department of Population Health, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948) 
15  Oxford University Hospitals NHS Foundation Trust, Oxford, UK (GRID:grid.410556.3) (ISNI:0000 0001 0440 1440) 
16  University of Manchester, Manchester, UK (GRID:grid.5379.8) (ISNI:0000000121662407) 
17  Public Health England, Health Improvement Directorate, London, UK (GRID:grid.271308.f) (ISNI:0000 0004 5909 016X) 
18  IQVIA, London, UK (GRID:grid.482783.2) 
19  National Biocentre, Milton Keynes, UK (GRID:grid.482783.2) 
20  Glasgow Lighthouse Laboratory, London, UK (GRID:grid.482783.2) 
21  Department of Health and Social Care, London, UK (GRID:grid.57981.32) 
22  Welsh Government, Cardiff, UK (GRID:grid.422594.c) (ISNI:0000 0004 1787 8223) 
23  Scottish Government, Edinburgh, UK (GRID:grid.421126.2) (ISNI:0000 0001 0698 0044) 
24  Public Health Scotland, Edinburgh, UK (GRID:grid.508718.3) 
Pages
2799
Publication year
2023
Publication date
2023
Publisher
Nature Publishing Group
e-ISSN
20411723
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1038/s41467-023-38275-1
ProQuest document ID
2814207983
Copyright
© The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.