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    Covid-19: Clinical and Public Health Implications of Sars-Cov-2 Immunology

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    This article discusses a forum that addressed emerging questions about SARS-CoV-2 immunity and the need for booster doses of vaccines. Experts discussed what is known about vaccine effectiveness over time and in high-risk groups. While antibody tests can guide decisions someday, more data is still needed and primary vaccination remains the best tool currently against the virus.

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    Covid-19: Clinical and Public Health Implications of Sars-Cov-2 Immunology

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    silvia
    26 views2 pages
    This article discusses a forum that addressed emerging questions about SARS-CoV-2 immunity and the need for booster doses of vaccines. Experts discussed what is known about vaccine effectiveness over time and in high-risk groups. While antibody tests can guide decisions someday, more data is still needed and primary vaccination remains the best tool currently against the virus.

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    This article discusses a forum that addressed emerging questions about SARS-CoV-2 immunity and the need for booster doses of vaccines. Experts discussed what is known about vaccine effectiveness over time and in high-risk groups. While antibody tests can guide decisions someday, more data is still needed and primary vaccination remains the best tool currently against the virus.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    26 views2 pages

    Covid-19: Clinical and Public Health Implications of Sars-Cov-2 Immunology

    Uploaded by

    silvia
    This article discusses a forum that addressed emerging questions about SARS-CoV-2 immunity and the need for booster doses of vaccines. Experts discussed what is known about vaccine effectiveness over time and in high-risk groups. While antibody tests can guide decisions someday, more data is still needed and primary vaccination remains the best tool currently against the virus.

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    of 2

    Annals of Internal Medicine SPECIAL ARTICLE

    COVID-19: Clinical and Public Health Implications of


    SARS-CoV-2 Immunology
    scribed existing vaccine platforms and how they work to
    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
    prompt and amplify these antibodies
    immunologic rationale for vaccine boosting.
    and the

    COVID-19 pandemic. That program, held on 16 October Dr. Kotton is the Clinical Director of Transplant and
    2020, featured Dr. Anthony Fauci, Dr. H. Clifford Lane, Dr. Immunocompromised Host Infectious Diseases in the
    David Kessler, Dr. Beth Bell, and Dr. Rachel Levine discus- Infectious Diseases Division at the Massachusetts General
    sing evidence-based information related to the science, Hospital and an active clinician. She is the past chair of
    approval processes, development of clinical recommen- the Infectious Disease Community of Practice of the
    dations, and public health implications of COVID-19 American Society of Transplantation, is on the planning
    vaccines that were under development at the time (1). committee for the American Transplant Congress, and is
    Subsequent programs covered promoting vaccine uptake a member of the Centers for Disease Control and
    (2), vaccine allocation (3), common clinical considerations Prevention's (CDC) Advisory Committee on Immun-
    about COVID-19 (4), and persistent symptoms after acute ization Practices (ACIP). During the forum, Dr. Kotton
    SARS-CoV-2 infection (5). If you missed those programs or reviewed what we currently know about the effective-
    would like to share them with others, all are publicly ness of initial and booster COVID-19 vaccination in
    available at Annals.org. We have learned an astounding various population subgroups, such as older persons and
    amount about SARS-CoV-2 in the year since our first persons with immunosuppression due to underlying
    forum, yet many questions remain and, unfortunately, the disease or its treatment. Recognizing the gaps in our
    spread of misinformation is rampant. knowledge, she described the rationale for the recent
    To address new questions that are emerging about im- recommendations regarding booster vaccination issued by
    munity, the duration of protection that follows acute infec- the ACIP and the CDC.
    tion and vaccination, and the need for booster doses of The panelists addressed a variety of questions submit-
    vaccine, the most recent forum, held on 8 October 2021, ted by registrants, including questions about measuring
    focused on the immunology of SARS-CoV-2 and clinical antibody levels to guide behaviors ranging from masking
    and public health implications of the virus's immune and social distancing to use of booster vaccination. Drs.
    behavior. What immune mechanisms does the virus trig- Mascola and Kotton both emphasized that evidence is
    ger? Are there reliable markers of previous infection, currently not sufficient to support antibody measurement in
    adequate response to vaccination, and protection from making clinical decisions for individual persons. While
    future infection? What do we know about the risks and many people are seeking antibody tests through a variety
    benefits of booster doses of vaccine? Dr. John R. Mascola of channels and using the results to guide their health deci-
    and Dr. Camille Nelson Kotton joined us to address these sions, we do not yet know the level of antibody associated
    and other questions submitted by registrants of the live with definitive protection. Thus, people may make
    program. Readers can view the program in the Video that misguided decisions about their personal risk, the risk they
    accompanies this article (available at Annals.org). pose to others, and the need for vaccination on the basis of
    Dr. Mascola is Director of the Dale and Betty Bumpers unvalidated antibody assays. Drs. Mascola and Kotton
    Vaccine Research Center (VRC) at the National Institute of anticipate that we will someday know enough to use
    Allergy and Infectious Diseases, National Institutes of antibody levels to determine immune status as we currently
    Health. His background is in infectious diseases, viral im- can do for other viral illnesses, such as measles and
    munology, and vaccine research. As the Scientific Director hepatitis B, but emphasized that we are not there yet. They
    and Center Director, Dr. Mascola provides overall direc- also recognized the adverse potential consequence of
    tion and scientific leadership to the basic, clinical, and recommendations for booster vaccination in raising
    translational research activities of the VRC. After the emer- skepticism about the vaccine among those who have so far
    gence of the COVID-19 pandemic, Dr. Mascola led an declined initial vaccination. They sent a clear message that
    interagency team of U.S. government scientists who primary vaccination remains out best tool in controlling this
    oversaw phase 3 vaccine trials facilitating the successful pandemic.
    development and authorization of COVID-19 vaccines in
    record time. During the forum, he provided an overview of
    what we have learned about coronaviruses since the
    emergence of SARS-CoV-1 nearly 2 decades ago. See also:
    While there is still much we do not know about the
    pathophysiology of COVID-19—why some people are Web-Only
    asymptomatic and others become critically ill—we Video: COVID-19 Forum VI
    know that antibodies against the spike protein on the CME/MOC activity
    surface of the virus are a major line of defense. He de-

    This article was published at Annals.org on 12 October 2021.

    Annals.org Annals of Internal Medicine © 2021 American College of Physicians 1


    SPECIAL ARTICLE Clinical and Public Health Implications of SARS-CoV-2 Immunology

    Corresponding Author: Christine Laine, MD, MPH, Editor in


    We have much to learn about SARS-CoV-2, particularly
    Chief, Annals of Internal Medicine, 190 N. Independence Mall
    given the rapid evolution the virus has demonstrated.
    West, Philadelphia, PA 19106; e-mail, [email protected].
    However, the pace with which we have gained an understand-
    ing of SARS-CoV-2 and developed highly effective vaccines is
    unprecedented. As scientific knowledge advances, Annals Ann Intern Med. doi:10.7326/M21-3840
    and ACP will continue to endeavor to combat misinformation
    by bringing scientifically sound information to clinicians. References
    1. Laine C, Cotton D, Moyer DV. COVID-19 vaccine: what physicians
    need to know. Ann Intern Med. 2020;173:830. [PMID: 33074704]
    Christine Laine, MD, MPH doi:10.7326/M20-6841
    Editor in Chief, Annals of Internal Medicine 2. Laine C, Cotton D, Moyer DV. COVID-19 vaccine: promoting vaccine
    acceptance. Ann Intern Med. 2021;174:252-253. [PMID: 33347321]
    Deborah Cotton, MD, MPH doi:10.7326/M20-8008
    3. Laine C, Cotton D, Moyer DV. COVID-19 vaccine distribution and
    Deputy Editor, Annals of Internal Medicine
    allocation: what physicians need to know. Ann Intern Med. 2021;174:
    Darilyn V. Moyer, MD 413-414. [PMID: 33492990] doi:10.7326/M21-0331
    Executive Vice President and Chief Executive Officer, 4. Laine C, Cotton D, Moyer DV. COVID-19 vaccine: practical clinical
    considerations. Ann Intern Med. 2021;174:694. [PMID: 33769829]
    American College of Physicians
    doi:10.7326/M21-1260
    5. Laine C, Cotton D. COVID-19: evaluation and care of patients with
    persistent symptoms following acute SARS-CoV-2 infection. Ann
    Disclosures: Disclosure forms can be viewed at www.acponline. Intern Med. 2021;174:1159-1160. [PMID: 34115532] doi:10.7326
    org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-3840. /M21-2342

    2 Annals of Internal Medicine Annals.org

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