Background <p>Individuals with asymptomatic SARS-CoV-2 infection can unknowingly transmit the virus, yet identifying such subclinical infections in post-vaccinated populations remains challenging.</p> Methods <p>We conducted a longitudinal study of 129 infection-naïve vaccine recipients immunized with various combinations of SARS-CoV-2 spike (S) protein vaccine platforms. Sera were collected before the first dose (<i>v</i>1), at 2&#xa0;weeks (<i>v</i>7) and 6&#xa0;months (<i>v</i>8) after the third dose. Taiwan’s first major COVID-19 outbreak occurred between <i>v</i>7 and <i>v</i>8. We measured anti-nucleocapsid (anti-N) and anti-S IgG antibody titers by ELISA and assessed virus-neutralizing activity using live virus and pseudovirus assays.</p> Results <p>By developing an iterative serial screening method, we identified asymptomatic breakthrough (post-vaccination) infections among unconfirmed cases. Our <i>v</i>7-<i>v</i>8 paired cohort resolved into three distinct groups: confirmed cases (21%), asymptomatic breakthrough infections (17%), and uninfected subjects (62%). In normalized <i>v</i>8 sera, confirmed cases exhibited an anti-S<sup>+++</sup> (high) /anti-N<sup>+++</sup> (high) phenotype, while uninfected subjects showed an anti-S<sup>+</sup> (low)/anti-N<sup>+</sup>(baseline) phenotype. Statistical analysis validated a distinct asymptomatic group characterized by an antibody profile anti-S<sup>++</sup> (intermediate) /anti-N<sup>+</sup> (baseline).</p> Conclusions <p>This approach may enable more accurate estimates of vaccine efficacy and infection prevalence. In a spike-vaccinated population, anti-N antibody is more a potential specific marker for COVID-19 symptomatic disease than an ideal marker for SARS-CoV-2 infection. To our knowledge, this is the first preliminary report of identification of asymptomatic breakthrough infection from a well-vaccinated population using self-matched longitudinal pairs of serum samples.</p>

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Hidden asymptomatic breakthrough infection in a proof-of-concept longitudinal study on SARS-CoV-2 vaccine recipients

  • Chiaho Shih,
  • You-Zhen Liao,
  • Che-Yu Hsu,
  • Ying-Chen Tsai,
  • Ming-Yen Lin,
  • Hsin-Ying Clair Chiou,
  • Wen-Hui Kuan,
  • Chih-Hsu Chang,
  • An-Ting Liou,
  • Yu-Chi Chou,
  • Jih-Jin Tsai,
  • Ping-Chang Lin,
  • Ming-Lung Yu,
  • Wan-Long Chuang,
  • Jia-Jung Lee,
  • Jer-Ming Chang,
  • Shang-Jyh Hwang,
  • Justin Shih,
  • Wen-Chun Hung,
  • Ming-Feng Hou,
  • Inn-Wen Chong,
  • Yuh-Jyh Jong,
  • Jung-San Chang

摘要

Background

Individuals with asymptomatic SARS-CoV-2 infection can unknowingly transmit the virus, yet identifying such subclinical infections in post-vaccinated populations remains challenging.

Methods

We conducted a longitudinal study of 129 infection-naïve vaccine recipients immunized with various combinations of SARS-CoV-2 spike (S) protein vaccine platforms. Sera were collected before the first dose (v1), at 2 weeks (v7) and 6 months (v8) after the third dose. Taiwan’s first major COVID-19 outbreak occurred between v7 and v8. We measured anti-nucleocapsid (anti-N) and anti-S IgG antibody titers by ELISA and assessed virus-neutralizing activity using live virus and pseudovirus assays.

Results

By developing an iterative serial screening method, we identified asymptomatic breakthrough (post-vaccination) infections among unconfirmed cases. Our v7-v8 paired cohort resolved into three distinct groups: confirmed cases (21%), asymptomatic breakthrough infections (17%), and uninfected subjects (62%). In normalized v8 sera, confirmed cases exhibited an anti-S+++ (high) /anti-N+++ (high) phenotype, while uninfected subjects showed an anti-S+ (low)/anti-N+(baseline) phenotype. Statistical analysis validated a distinct asymptomatic group characterized by an antibody profile anti-S++ (intermediate) /anti-N+ (baseline).

Conclusions

This approach may enable more accurate estimates of vaccine efficacy and infection prevalence. In a spike-vaccinated population, anti-N antibody is more a potential specific marker for COVID-19 symptomatic disease than an ideal marker for SARS-CoV-2 infection. To our knowledge, this is the first preliminary report of identification of asymptomatic breakthrough infection from a well-vaccinated population using self-matched longitudinal pairs of serum samples.