Accelerated waning of the humoral response to COVID-19 vaccines in obesity

Accelerated waning of the humoral response to COVID-19 vaccines in obesity

Obesity is associated with an increased risk of severe Coronavirus Disease 2019 (COVID-19) infection and mortality. COVID-19 vaccines reduce the risk of serious COVID-19 outcomes; however, their effectiveness in people with obesity is incompletely understood. We studied the relationship among body m...

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Bibliographic Details
Main Authors: van der Klaauw, AA, Horner, EC, Pereyra-Gerber, P, Agrawal, U, Foster, WS, Spencer, S, Vergese, B, Smith, M, Henning, E, Ramsay, ID, Smith, JA, Guillaume, SM, Sharpe, HJ, Hay, IM, Thompson, S, Innocentin, S, Booth, LH, Robertson, C, McCowan, C, Kerr, S, Mulroney, TE, O'Reilly, MJ, Gurugama, TP, Gurugama, LP, Rust, MA, Ferreira, A, Ebrahimi, S, Ceron-Gutierrez, L, Scotucci, J, Kronsteiner, B, Dunachie, SJ, Klenerman, P, Park, AJ, Rubino, F, Lamikanra, AA, Stark, H, Kingston, N, Estcourt, L, Harvala, H, Roberts, DJ, Doffinger, R, Linterman, MA, Matheson, NJ, Sheikh, A, Farooqi, IS, Thaventhiran, JED
Other Authors: PITCH Consortium
Format: Journal article
Language:English
Published: Springer Nature 2023
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Summary:Obesity is associated with an increased risk of severe Coronavirus Disease 2019 (COVID-19) infection and mortality. COVID-19 vaccines reduce the risk of serious COVID-19 outcomes; however, their effectiveness in people with obesity is incompletely understood. We studied the relationship among body mass index (BMI), hospitalization and mortality due to COVID-19 among 3.6 million people in Scotland using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) surveillance platform. We found that vaccinated individuals with severe obesity (BMI > 40 kg/m<sup>2</sup>) were 76% more likely to experience hospitalization or death from COVID-19 (adjusted rate ratio of 1.76 (95% confidence interval (CI), 1.60–1.94). We also conducted a prospective longitudinal study of a cohort of 28 individuals with severe obesity compared to 41 control individuals with normal BMI (BMI 18.5–24.9 kg/m<sup>2</sup>). We found that 55% of individuals with severe obesity had unquantifiable titers of neutralizing antibody against authentic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus compared to 12% of individuals with normal BMI (<i>P</i> = 0.0003) 6 months after their second vaccine dose. Furthermore, we observed that, for individuals with severe obesity, at any given anti-spike and anti-receptor-binding domain (RBD) antibody level, neutralizing capacity was lower than that of individuals with a normal BMI. Neutralizing capacity was restored by a third dose of vaccine but again declined more rapidly in people with severe obesity. We demonstrate that waning of COVID-19 vaccine-induced humoral immunity is accelerated in individuals with severe obesity. As obesity is associated with increased hospitalization and mortality from breakthrough infections, our findings have implications for vaccine prioritization policies.

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