Three-dose vaccination-induced immune responses protect against
SARS-CoV-2 Omicron BA.2
Abstract
Background: The ongoing outbreak of SARS-CoV-2 Omicron BA.2
infections in Hong Kong, the world model city of universal masking, has
resulted in a major public health crisis. Although the third
heterologous BNT162b2 vaccination after 2-dose CoronaVac generated
higher neutralizing antibody responses than the third homologous
CoronaVac booster, vaccine efficacy and corelates of immune protection
against the major circulating Omicron BA.2 remains to be investigated.
Methods: We investigated the vaccine efficacy against the
Omicron BA.2 breakthrough infection among 481 public servants who had
been received with SARS-CoV-2 vaccines including two-dose BNT162b2
(2×BNT, n=169), three-dose BNT162b2 (2×BNT, n=175), two-dose CoronaVac
(2×CorV, n=37), three-dose CoronaVac (3×CorV, n=68) and third-dose
BNT162b2 following 2×CorV (2×CorV+1BNT, n=32). Humoral and cellular
immune responses after three-dose vaccination were characterized and
correlated with clinical characteristics of BA.2 infection.
Results: During the BA.2 outbreak, 29.3% vaccinees were
infected. Three-dose vaccination provided protection with lower
incidence rates of breakthrough infections (2×BNT 49.2% vs 3×BNT
16.6%, p<0.0001; 2×CorV 48.6% vs 3×CoV 20.6%, p=0.003). The
third heterologous vaccination showed the lowest incidence (2×CorV+1×BNT
6.3%). Although BA.2 conferred the highest neutralization resistance
compared with variants of concern tested, the third dose
vaccination-activated spike-specific memory B and Omicron cross-reactive
T cell responses contributed to reduced frequencies of breakthrough
infection and disease severity. Conclusions: Our results have
implications to timely boost vaccination and immune responses likely
required for vaccine-mediated protection against Omicron BA.2 pandemic.