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Clusters of SARS-CoV-2 Lineage B.1.1.7 Infection After Vaccination With Adenovirus-Vectored and Inactivated Vaccines: A Cohort Study

21 Pages Posted: 9 Jul 2021

See all articles by William M. de Souza

William M. de Souza

Virology Research Centre, Ribeirão Preto Medical School, University of São Paulo

Stefanie Primon Muraro

Universidade Estadual de Campinas (UNICAMP) - Laboratory of Emerging Viruses

Gabriela Fabiano Souza

University of São Paulo (USP) - Virology Research Centre

Mariene R. Amorim

Laboratory of Emerging Viruses, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas

Renata Sesti-Costa

National Biosciences Laboratory, Brazilian Centre for Research in Energy and Materials (CNPEM)

Luciana S. Mofatto

Laboratory of Emerging Viruses, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas

Julia Forato

Universidade Estadual de Campinas (UNICAMP) - Laboratory of Emerging Viruses

Priscilla P. Barbosa

Laboratory of Emerging Viruses, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas

Daniel Augusto de Toledo-Teixeira

Department of Genetics, Evolution, Microbiology and Immunology

Karina Bispo-dos-Santos

Laboratory of Emerging Viruses, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas

Pierina L. Parise

Laboratory of Emerging Viruses, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas

Natalia S. Brunetti

Autoimmune Research Laboratory, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas

Joselia C.O. Moreira

Universidade Estadual de Campinas (UNICAMP) - Department of Structural and Functional Biology

Vitor A. Costa

Hematology and Transfusion Medicine Centre, University of Campinas

Daniela Maira Cardozo

Universidade Estadual de Campinas (UNICAMP) - Department of Clinical Pathology

Maria Luiza Moretti

Universidade Estadual de Campinas (UNICAMP) - Department of Internal Medicine

Silvia Barros-Mazon

Universidade Estadual de Campinas (UNICAMP) - Department of Clinical Pathology

Gabriela Felix Marchesi

Campinas Department of Public Health Surveillance

Christiane Ambrosio

Campinas Department of Public Health Surveillance

Fernando R. Spilki

One Health Laboratory, Feevale University

Valeria Correia Almeida

Campinas Department of Public Health Surveillance

Andre S. Vieira

Universidade Estadual de Campinas (UNICAMP) - Department of Structural and Functional Biology

Lair Zambon

Universidade Estadual de Campinas (UNICAMP) - Department of Internal Medicine

Alessandro Farias

Autoimmune Research Laboratory, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas

Marcelo Addas-Carvalho

Hematology and Transfusion Medicine Centre, University of Campinas

Bruno D. Benites

Hematology and Transfusion Medicine Centre, University of Campinas

Rafael Elias Marques

Brazilian Centre for Research in Energy and Materials

Ester Cerdeira Sabino

University of São Paulo (USP) - LIM-46 e LIM-49 do Instituto de Medicina Tropical

Andrea Von Zuben

Campinas Department of Public Health Surveillance

Scott C. Weaver

University of Texas Medical Branch-Galveston - Department of Microbiology and Immunology

Nuno R. Faria

Imperial College London - MRC Centre for Global Infectious Disease Analysis

Fabiana Granja

Universidade Estadual de Campinas (UNICAMP) - Laboratory of Emerging Viruses

Rodrigo N. Angerami

Department of Internal Medicine, School of Medical Sciences, University of Campinas

Jose Luiz Proenca-Modena

Universidade Estadual de Campinas (UNICAMP) - Laboratory of Emerging Viruses

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Abstract

Background: Some studies have determined that the SARS-CoV-2 B.1.1.7 variant of concern (VOC) has been associated with increased transmissibility, hospitalization, and mortality. This study aimed to explore the factors associated with B.1.1.7 VOC infection in the context of vaccination with adenovirus-vectored and inactivated vaccines.

Methods: We analyzed epidemiological, clinical, and laboratory data from simultaneous COVID-19 outbreaks in a convent (Outbreak A) and in a long-term care facility (Outbreak B) in individuals vaccinated with a single dose of ChAdOx1 or two doses of the CoronaVac vaccine, respectively. First, we identified the viral lineages associated with these outbreaks by genome sequencing. Then, we assessed the relationship of viral load, specific immunoglobulin antibody levels, neutralization antibodies, case characteristics (age, vaccine type, and presence or absence of symptoms), and associations with risk of developing COVID-19.

Findings: On March 2021, we detected SARS-CoV-2 RNA in nasopharyngeal samples from 14 of 22 of the ChAdOx1 vaccine recipients (Outbreak A, n=26), and 22 of 42 of the CoronaVac-vaccinated individuals (Outbreak B, n=52) for breakthrough infection rates for ChAdOx1 of 63·6% and 52·4% for CoronaVac. Vaccinated individuals from Outbreak A received a single dose at least 23 days before the outbreak, and the Outbreak B was involved virus detection 5 to 27 days after a second dose. In these outbreaks, the median ages were 73 and 77 years old, respectively. The median viral loads were 3·4×101 and 2·3×103 RNA copies per mL in Outbreaks A and B, respectively. In total for both outbreaks, 12 people had mild-COVID-19 while 26 were asymptomatic, but one case involving a person from Outbreak B was fatal. Based on analysis of SARS-CoV-2 genome sequences, we determined that outbreaks A and B were caused by two independent clusters of the B.1.1.7 VOC. Interestingly, the serum of PCR-positive symptomatic SARS-CoV-2-infected individuals had ~1·8 to 3·4-fold more neutralizing capacity against B.1.1.7 compared to the serum of asymptomatic, SARS-CoV-2-infected individuals, indicating that the levels of neutralizing antibodies induced by ChAdOx1 and CoronaVac were not correlated with protection against symptomatic infection.

Interpretation: These data suggest that the B.1.1.7 variant can escape from the immune response elicited by immunization with a single dose of an adenovirus-vectored vaccine or two doses of an inactivated vaccine. However, partial immunization with ChAdOx1 and the complete series of CoronaVac seemed to provide protection against severe COVID-19 and death in the large majority of individuals. Continued and rapid immunization combined with nonpharmaceutical interventions (e.g., masking and physical distancing), are necessary to break the SARS-CoV-2 transmission until herd immunity improves.

Funding Information: São Paulo Research Foundation, Brazilian Ministry of Science, Technology and Innovation and Funding Authority for Studies, Coordination for the Improvement of Higher Education Personnel, Wellcome Trust, Medical Research Council, National Institutes of Health, and Brazilian National Council for Scientific and Technological Development.

Declaration of Interests: All other authors declare no competing interests.

Ethics Approval Statement: All procedures followed the ethical standards of the responsible committee on human experimentation and were approved by the ethics committees from the University of Campinas, Brazil (Approval number: CAEE 31170720.3.0000.5404).

Suggested Citation

de Souza, William M. and Muraro, Stefanie Primon and Souza, Gabriela Fabiano and Amorim, Mariene R. and Sesti-Costa, Renata and Mofatto, Luciana S. and Forato, Julia and Barbosa, Priscilla P. and Toledo-Teixeira, Daniel Augusto de and Bispo-dos-Santos, Karina and Parise, Pierina L. and Brunetti, Natalia S. and Moreira, Joselia C.O. and Costa, Vitor A. and Cardozo, Daniela Maira and Moretti, Maria Luiza and Barros-Mazon, Silvia and Marchesi, Gabriela Felix and Ambrosio, Christiane and Spilki, Fernando R. and Almeida, Valeria Correia and Vieira, Andre S. and Zambon, Lair and Farias, Alessandro and Addas-Carvalho, Marcelo and Benites, Bruno D. and Marques, Rafael Elias and Sabino, Ester Cerdeira and Von Zuben, Andrea and Weaver, Scott C. and Faria, Nuno R. and Granja, Fabiana and Angerami, Rodrigo N. and Proenca-Modena, Jose Luiz, Clusters of SARS-CoV-2 Lineage B.1.1.7 Infection After Vaccination With Adenovirus-Vectored and Inactivated Vaccines: A Cohort Study. Available at SSRN: https://ssrn.com/abstract=3883263 or http://dx.doi.org/10.2139/ssrn.3883263

William M. De Souza

Virology Research Centre, Ribeirão Preto Medical School, University of São Paulo ( email )

Av. Prof. Luciano Gualberto 380
Sao Paulo, 05508-010
Brazil

Stefanie Primon Muraro

Universidade Estadual de Campinas (UNICAMP) - Laboratory of Emerging Viruses ( email )

Cidade Universitária Zeferino Vaz - Barão
Geraldo
Campinas - SP, 13083-970
Brazil

Gabriela Fabiano Souza

University of São Paulo (USP) - Virology Research Centre ( email )

Av. Prof. Luciano Gualberto 380
Sao Paulo, 05508-010
Brazil

Mariene R. Amorim

Laboratory of Emerging Viruses, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas ( email )

Cidade Universitária Zeferino Vaz - Barão
Geraldo
Campinas - SP, 13083-970
Brazil

Renata Sesti-Costa

National Biosciences Laboratory, Brazilian Centre for Research in Energy and Materials (CNPEM) ( email )

Campinas
Sao Paulo, 13083-970
Brazil

Luciana S. Mofatto

Laboratory of Emerging Viruses, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas ( email )

Cidade Universitária Zeferino Vaz - Barão
Geraldo
Campinas - SP, 13083-970
Brazil

Julia Forato

Universidade Estadual de Campinas (UNICAMP) - Laboratory of Emerging Viruses ( email )

Cidade Universitária Zeferino Vaz - Barão
Geraldo
Campinas - SP, 13083-970
Brazil

Priscilla P. Barbosa

Laboratory of Emerging Viruses, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas ( email )

Cidade Universitária Zeferino Vaz - Barão
Geraldo
Campinas - SP, 13083-970
Brazil

Daniel Augusto de Toledo-Teixeira

Department of Genetics, Evolution, Microbiology and Immunology ( email )

Monteiro Lobato St 255
Campinas, 13083-862
Brazil

Karina Bispo-dos-Santos

Laboratory of Emerging Viruses, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas ( email )

Cidade Universitária Zeferino Vaz - Barão
Geraldo
Campinas - SP, 13083-970
Brazil

Pierina L. Parise

Laboratory of Emerging Viruses, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas ( email )

Cidade Universitária Zeferino Vaz - Barão
Geraldo
Campinas - SP, 13083-970
Brazil

Natalia S. Brunetti

Autoimmune Research Laboratory, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas ( email )

Cidade Universitária Zeferino Vaz - Barão
Geraldo
Campinas - SP, 13083-970
Brazil

Joselia C.O. Moreira

Universidade Estadual de Campinas (UNICAMP) - Department of Structural and Functional Biology ( email )

Cidade Universitária Zeferino Vaz - Barão
Geraldo
Campinas - SP, 13083-970
Brazil

Vitor A. Costa

Hematology and Transfusion Medicine Centre, University of Campinas ( email )

Cidade Universitária Zeferino Vaz - Barão
Geraldo
Campinas - SP, 13083-970
Brazil

Daniela Maira Cardozo

Universidade Estadual de Campinas (UNICAMP) - Department of Clinical Pathology ( email )

Cidade Universitária Zeferino Vaz - Barão
Geraldo
Campinas - SP, 13083-970
Brazil

Maria Luiza Moretti

Universidade Estadual de Campinas (UNICAMP) - Department of Internal Medicine ( email )

Brazil

Silvia Barros-Mazon

Universidade Estadual de Campinas (UNICAMP) - Department of Clinical Pathology ( email )

Cidade Universitária Zeferino Vaz - Barão
Geraldo
Campinas - SP, 13083-970
Brazil

Gabriela Felix Marchesi

Campinas Department of Public Health Surveillance ( email )

Campinas
Brazil

Christiane Ambrosio

Campinas Department of Public Health Surveillance ( email )

Campinas
Brazil

Fernando R. Spilki

One Health Laboratory, Feevale University ( email )

Av. Dr. Maurício Cardoso, 510
Bairro Hamburgo Velho
Novo Hamburgo, 93510-250
Brazil

Valeria Correia Almeida

Campinas Department of Public Health Surveillance ( email )

Campinas
Brazil

Andre S. Vieira

Universidade Estadual de Campinas (UNICAMP) - Department of Structural and Functional Biology ( email )

Cidade Universitária Zeferino Vaz - Barão
Geraldo
Campinas - SP, 13083-970
Brazil

Lair Zambon

Universidade Estadual de Campinas (UNICAMP) - Department of Internal Medicine ( email )

Brazil

Alessandro Farias

Autoimmune Research Laboratory, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas ( email )

Cidade Universitária Zeferino Vaz - Barão
Geraldo
Campinas - SP, 13083-970
Brazil

Marcelo Addas-Carvalho

Hematology and Transfusion Medicine Centre, University of Campinas ( email )

Cidade Universitária Zeferino Vaz - Barão
Geraldo
Campinas - SP, 13083-970
Brazil

Bruno D. Benites

Hematology and Transfusion Medicine Centre, University of Campinas ( email )

Cidade Universitária Zeferino Vaz - Barão
Geraldo
Campinas - SP, 13083-970
Brazil

Rafael Elias Marques

Brazilian Centre for Research in Energy and Materials ( email )

Campinas
Brazil

Ester Cerdeira Sabino

University of São Paulo (USP) - LIM-46 e LIM-49 do Instituto de Medicina Tropical ( email )

São Paulo
Brazil

Andrea Von Zuben

Campinas Department of Public Health Surveillance ( email )

Campinas
Brazil

Scott C. Weaver

University of Texas Medical Branch-Galveston - Department of Microbiology and Immunology ( email )

Galveston, TX 77555
United States

Nuno R. Faria

Imperial College London - MRC Centre for Global Infectious Disease Analysis ( email )

London
United Kingdom

Fabiana Granja

Universidade Estadual de Campinas (UNICAMP) - Laboratory of Emerging Viruses ( email )

Campinas
Brazil

Rodrigo N. Angerami

Department of Internal Medicine, School of Medical Sciences, University of Campinas ( email )

Cidade Universitária Zeferino Vaz - Barão
Geraldo
Campinas - SP, 13083-970
Brazil

Jose Luiz Proenca-Modena (Contact Author)

Universidade Estadual de Campinas (UNICAMP) - Laboratory of Emerging Viruses ( email )

Campinas
Brazil

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