Ann Lab Med.  2024 May;44(3):289-293. 10.3343/alm.2023.0256.

Neutralization Testing–based Immunogenicity Analysis of Recent Prevalent Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Sublineages

• Lee EJ
• Lee H
• O SW
• Rhee JE
• Kim JM
• Kim DJ
• Kim IH
• No JS
• Park AK
• Kim JA
• Lee CY
• Choi YK
• Kim EJ

• KMID: 2555707
• DOI: http://doi.org/10.3343/alm.2023.0256

Abstract

Although WHO declared the end of the public health emergency for coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), XBB lineages continue to evolve and emerge globally. In particular, XBB.1.5 and XBB.1.16 are raising concerns because of their high immune evasion, leading to apprehensions regarding vaccine efficacy reduction and potential reinfection. We aimed to investigate the COVID-19 outbreak in Korea and predict the likelihood of reinfection by testing neutralizing activity against live viruses from the S clade and 19 Omicron sublineages. We found a significant risk of infection with the currently prevalent XBB lineage for individuals who were either vaccinated early or infected during the initial Omicron outbreak. Vaccinated individuals were better equipped than unvaccinated individuals to produce neutralizing antibodies for other SARS-CoV-2 variants upon infection. Therefore, unvaccinated individuals do not easily develop neutralizing activity against other variants and face the highest risk of reinfection by the XBB lineage. Our study provides important information to facilitate the development of strategies for monitoring populations that would be the most susceptible to new COVID-19 outbreaks.

Keyword

Disease outbreaks; Neutralization antibodies; Omicron; Reinfection; SARSCoV-2

Figure

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  Fig. 1 Comparison of neutralizing antibody titers against Omicron sublineages. (A) Neutralizing activity in the unvaccinated group infected with BA.1.1 (N=6). This group had neutralizing activity against BA.5.2.1 below the cutoff, and there was no observable neutralizing activity against the XBB lineages, making it impossible to compare sublineages. (B) Neutralizing activity in the third dose–vaccinated uninfected group (N=7). This group showed lower neutralizing activity against XBB lineages than against BA.1.1 and BA.5.2.1. (C) Neutralizing activity in the third dose–vaccinated breakthrough infection (BA.1.1) group (N=16). Similar to that in the B group, the neutralizing activity against XBB lineages is the lowest, whereas the overall neutralizing ability is the highest among the three groups, indicating a hybrid immunity caused by breakthrough infections. The individual circles represent the GMT obtained from two independent experiments, each consisting of two replicates. The lines and error bars represent the geometric means and 95% confidence intervals for each group, respectively. The corresponding cutoff for PRNT50 was indicated by a dotted line at 10. The numbers at the top of each figure represent the GMT of neutralizing antibodies for each respective variant. The reference for comparative analysis, BA.1.1 and BA.5.2.1, is represented by blue circles, the analyzed XBB lineages are represented by red circles, and other variants are represented by black circles. The parentheses next to P values indicate the fold reduction in the GMTs of XBB lineages with reference to BA.1.1 and BA.5.2.1. P values were calculated via unpaired Mann–Whitney U test using Prism version 9 (GraphPad Software, San Diego, CA, USA). Abbreviations: GMT, geometric mean titer; PRNT50, 50% plaque reduction neutralization titer; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; ns, not significant.

Reference

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