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

van der Klaauw, A. A. et al. (2023) Accelerated waning of the humoral response to COVID-19 vaccines in obesity. Nature Medicine, 29(5), pp. 1146-1154. (doi: 10.1038/s41591-023-02343-2) (PMID:37169862) (PMCID:PMC10202802)

Abstract

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/m2) 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/m2). 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 (P = 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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Mccowan, Professor Colin
• Authors: van der Klaauw, A. A., Horner, E. C., Pereyra-Gerber, P., Agrawal, U., Foster, W. S., Spencer, S., Vergese, B., Smith, M., Henning, E., Ramsay, I. D., Smith, J. A., Guillaume, S. M., Sharpe, H. J., Hay, I. M., Thompson, S., Innocentin, S., Booth, L. H., Robertson, C., McCowan, C., Kerr, S., Mulroney, T. E., O’Reilly, M. J., Gurugama, T. P., Gurugama, L. P., Rust, M. A., Ferreira, A., Ebrahimi, S., Ceron-Gutierrez, L., Scotucci, J., Kronsteiner, B., Dunachie, S. J., Klenerman, P., Park, A. J., Rubino, F., Lamikanra, A. A., Stark, H., Kingston, N., Estcourt, L., Harvala, H., Roberts, D. J., Doffinger, R., Linterman, M. A., Matheson, N. J., Sheikh, A., Farooqi, I. S., and Thaventhiran, J. E. D.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Nature Medicine
• Publisher: Nature Research
• ISSN: 1078-8956
• ISSN (Online): 1546-170X
• Published Online: 11 May 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Nature Medicine 29(5): 1146-1154
• Publisher Policy: Reproduced under a Creative Commons License