key: cord-1032222-rj4i41ky
authors: Laine, Christine; Cotton, Deborah; Moyer, Darilyn V.
title: COVID-19: Clinical and Public Health Implications of SARS-CoV-2 Immunology
date: 2021-10-12
journal: Ann Intern Med
DOI: 10.7326/m21-3840
sha: c79c71cb1b37ed3d2809db053ed82bdd8bc7bb77
doc_id: 1032222
cord_uid: rj4i41ky

This article summarizes the ACP/Annals COVID-19 Vaccine Forum VI held on 8 October 2021.

I n the fall of 2020, Annals of Internal Medicine and the American College of Physicians (ACP) hosted a virtual forum to address clinicians' questions related to the COVID-19 pandemic. That program, held on 16 October 2020, featured Dr. Anthony Fauci, Dr. H. Clifford Lane, Dr. David Kessler, Dr. Beth Bell, and Dr. Rachel Levine discussing evidence-based information related to the science, approval processes, development of clinical recommendations, and public health implications of COVID-19 vaccines that were under development at the time (1). Subsequent programs covered promoting vaccine uptake (2), vaccine allocation (3), common clinical considerations about COVID-19 (4), and persistent symptoms after acute SARS-CoV-2 infection (5). If you missed those programs or would like to share them with others, all are publicly available at Annals.org. We have learned an astounding amount about SARS-CoV-2 in the year since our first forum, yet many questions remain and, unfortunately, the spread of misinformation is rampant.

To address new questions that are emerging about immunity, the duration of protection that follows acute infection and vaccination, and the need for booster doses of vaccine, the most recent forum, held on 8 October 2021, While there is still much we do not know about the pathophysiology of COVID-19-why some people are asymptomatic and others become critically ill-we know that antibodies against the spike protein on the surface of the virus are a major line of defense. He described existing vaccine platforms and how they work to prompt and amplify these antibodies and the immunologic rationale for vaccine boosting.

Dr. Kotton is the Clinical Director of Transplant and Immunocompromised Host Infectious Diseases in the Infectious Diseases Division at the Massachusetts General Hospital. She spends the majority of her time seeing inpatients and outpatients, before and after solid organ and bone marrow transplant, as well as other immunocompromised hosts. She is the past chair of the Infectious Disease Community of Practice at the American Society of Transplantation, is on the planning committee for the American Transplant Congress, and is a member of the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP). During the forum, Dr. Kotton reviewed what we currently know about the effectiveness of initial and booster COVID-19 vaccination in various population subgroups, such as older persons and persons with immunosuppression due to underlying disease or its treatment. Recognizing the gaps in our knowledge, she described the rationale for the recommendations regarding booster vaccination issued by the ACIP and the CDC.

The panelists addressed a variety of questions submitted by registrants, including questions about measuring antibody levels to guide behaviors ranging from masking and social distancing to booster vaccination. Drs. Mascola and Kotton both emphasized that evidence is currently not available to support antibody measurement to aid clinical decisions for individual persons. While many people are seeking antibody tests through a variety of channels and using the results to guide their health decisions, we do not yet know the level of antibody associated with definitive protection. Thus, it is likely that people are making misguided decisions about their personal risks, the risk they pose to others, and the need for vaccination on the basis of unvalidated commercial antibody assays. Drs. Mascola and Kotton anticipate that we will someday know enough to use antibody levels to determine immune status as we currently can do for other viral illnesses, such as measles and hepatitis B, but emphasized that we are not there yet. They also recognized the adverse potential consequence of recommendations for booster vaccination in raising skepticism about the vaccine among those who have so far declined initial See also:

Video: COVID-19 Forum VI CME/MOC activity

COVID-19 vaccine: what physicians need to know

COVID-19 vaccine: promoting vaccine acceptance

COVID-19 vaccine distribution and allocation: what physicians need to know

COVID-19 vaccine: practical clinical considerations

COVID-19: evaluation and care of patients with persistent symptoms following acute SARS-CoV-2 infection