COVID-19 vaccine-Long term immune decline and breakthrough infections

Background: Since the introduction of BNT162b2 mRNA COVID-19 vaccine by Pfizer in late 2020, efficacy and immunogenicity waning of COVID-19 vaccines was reported, and decision making regarding a boos-ter remains a top priority worldwide, a decision that should be made based on breakthrough infection rate and antibody titer decline overtime. Methods: We conducted a 5-month longitudinal prospective study involving vaccinated healthcare per-sonnel, who were tested monthly for antibody titer, and sampled biweekly and on clinical indication for SARS-COV-2 polymerase chain reaction (PCR), to determine antibody decline and breakthrough infection. Results: 100 participants were recruited to the study. Antibody titer reached the climate after one month of the second dose of the vaccine, and declined rapidly thereafter: the median antibody levels were 895; 22,266; 9,682; 2,554 and 1,401 AU/ml in the day of the second dose, and in one month interval thereafter, respectively. In other words, four months after vaccination, the mean antibody level was 6% of the peak levels. During the study period, 4 breakthrough infections were diagnosed, 2 of which were asymp-tomatic, and the remaining two were mild cases; sharp elevation of antibody titer was seen after infec-tion. Conclusion: Antibody titer drops rapidly one month after the second dose of the vaccine. All infections within the study period were mild or asymptomatic, after which titer elevations were seen. (c) 2021 Elsevier Ltd. All rights reserved.

Automated summary

The antibody levels decline rapidly one month after the second dose of the vaccine, with the average antibody level four months after vaccination being only 6% of the peak levels. During the study period, there were 4 breakthrough infections, all of which were mild or asymptomatic, with a sharp elevation in antibody levels seen after infection.