key: cord-0763510-f8ycejy9 authors: Fiocchi, Alessandro; Jensen-Jarolim, Erika title: SARS-COV-2, can you be over it? Arguments for the Immune passport date: 2021-01-29 journal: World Allergy Organ J DOI: 10.1016/j.waojou.2021.100514 sha: 709c80e7a99b09690623265523953cfe8237eb07 doc_id: 763510 cord_uid: f8ycejy9 Objectives Uncertainty has surrounded the duration of immunity against SARS CoV-2. This uncertainty concerns both the duration of vaccine immunity and the duration of natural immunity. We aim to critically review the information available today, and draw practical conclusions. Methods This is a narrative review of the recently published information on the topic, compared with the knowledge we already have of the behavior of various viral infectious agents. Results It is too early to have any meaningful information on the duration of vaccine immunity against SARS CoV-2. The rate of reinfection is very low. Most of them are due to laboratory errors, to incomplete cure of the primary infection, to the supervening immunodeficiency of the host, or to pre-existing immunodeficiency made evident by the SARS CoV-2 infection. The available studies on the immunology of the infection converge in indicating that it generates a robust and persistent immunity. This behavior does not differ from that of respiratory viruses known to date: in naturally occurring viral respiratory infections, reinfections are exceptional. Conclusions and implications The civil community awaits suggestions from scientists not only to protect the lives of susceptible people, but to be able to safely resume activities made uncertain by the pandemic. From the information we have to date, we suggest that in principle, patients who have already overcome the infection should not be prioritized to the SARS CoV-2 vaccine. Instead, they could be provided with an immunological passport that allows them to resume a normal social life. A recent public statement post by the U.S. Center for Disease Control lists some facts about SARS- 33 COV-2 vaccines 1 . Among the reported facts, it is stated that 'People who have gotten sick with 34 COVID-19 may still benefit from getting vaccinated'. This suggestion stems from the consideration 35 that in this moment experts do not know the actual duration of immunity in individuals who have 36 had SARS-COV-2 disease. It is stated that according to some evidence, naturally developed 37 immunity does not last long. Now that vaccine efficacy is demonstrated, such attitudes can have an 38 important impact on vaccine policies at a time when priority choices lie ahead 2 . patterns of the SARS-CoV-2 outbreak in Washington State. medRxiv [Preprint] . 2020 Sep for. Infectious studies and daily practice teach us that antibodies are only part of the anamnestic immune 155 response, and a fundamental role is played by the adaptive cellular immunity in the form of memory 156 cells. Immunity against the flu 1918 pandemics have been found 90 years after the infection 36 . Many studies indicate that even for SARS-CoV-2 the immunity can be robust and persistent. In convalescent patients, antibodies to SARS-CoV-2 have been shown to persist up to 7 months, 159 albeit at lower levels compared to the response that can be detected in the first few months 5 . These This is of great importance in view of the future epidemic scenarios 48 . With all these limitations, in our opinion the Pro´s outweigh the Con´s (Table) . We propose that 259 allergists and pediatricians actively participate to the research on the current epidemic. As 260 specialists in clinical immunology, we are the best-positioned clinicians to become promoters of 261 these instances in our respective communities. We propose that our profession become not only a 262 bulwark against disease, but also a promoter of safe well-being. This will be another help to our • The persistence of the immune response has not yet been proven empirically due to the short time span of our observations of SARS-CoV-2 disease. • It is not known yet whether vaccination of a previously SARS-CoV-2 infected person has any disadvantage for the immune response or safety of the vaccine. • The decision should include the clinical diagnosis, based on a least 3 of the so far well-known and typical symptoms (e.g. taste loss, fever, dry cough), but rare symptoms could be overseen. • The ethical aspects of an immune passport have to be explored, given the potential of inequality among people and the potential of exclusion. • The persistence of the immune response after a natural infection can be expected and is logical from the experts´ view. • A previously SARS-CoV-2 infected person should therefore not be prioritized to be vaccinated. . Natural infection elicits IgA and IgG antibodies to protect the mucous surfaces and internal organs. It elicits sterilizing immunity. It is foreseeable that the antibodies produced by vaccinations administered intramuscularly or intradermally cover only the internal organs. The antibodies produced by intranasal vaccination are expected to cover the internal organs with possible less efficacy, but with good efficacy the upper airways 41 . When Will We Have a Vaccine?" -Understanding Questions and Answers about Covid-19 Vaccination Placebo-Controlled Trials of Covid-19 Vaccines -Why We Still Need Them SARSCoV-2 infection protects against rechallenge in rhesus macaques Durability of neutralizing antibodies and T-cell response post SARS-CoV-2 infection Korean Centers for Disease Control. 2020. 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