COVID-19: to vaccinate or not to vaccinate – that is the question.
Authors:
Jiří Městecký 1,2; Milan Raška 1,3
Authors‘ workplace:
Department of Microbiology, University of Alabama, Birmingham, USA
1; Laboratoř buněčné a molekulární imunologie, Mikrobiologický ústav AV ČR, v. v. i., Praha
2; Ústav imunologie LF UP a FN Olomouc
3
Published in:
Čas. Lék. čes. 2024; 163: 131-136
Category:
Review Articles
Overview
SARS-CoV-2 is a virus which infects the respiratory tract and may cause severe, occasionally life-threatening disease COVID-19. In more than 5% of symptomatic patients the infection is associated with post-acute symptoms. The initial contact of the virus with the immune system of the nasopharynx and oropharynx induces a mucosal immune response manifested by the production of secretory IgA (sIgA) antibodies which may contribute to the restriction of the infection to the upper respiratory tract and an asymptomatic or clinically mild disease.
The current systemically administered vaccines protected against the severe COVID-19 infection and its post-acute sequelae. However, they do not induce antibodies in mucosal secretions in SARS-CoV-2-naive individuals. In contrast, in those who previously experienced mucosal infection, systemically administered vaccines may stimulate sIgA production.
The clinical benefit of systemic vaccination convincingly documented in tens of millions of individuals overshadows the rare, sometimes controversial reports of complications encountered after vaccination. The inability of current SARS-CoV-2 vaccines to induce mucosal immune responses and to prevent the spreading of the virus by external secretions demonstrates the mutual independence of mucosal and systemic compartments of the immune system, and thus emphasizes need for the development of vaccines inducing protective immune responses in both compartments.
Keywords:
COVID-19; vaccination; mucosal immunity, mucosal vaccines
Sources
1. Merad M, Blish CA, Sallusto F et al. The immunology and immunopathology of COVID-19. Science 2022; 375: 1122–1127.
2. Bates TA, McBride SK, Leier HC et al. Vaccination before or after SARS-CoV-2 infection leads to robust humoral response and antibodies that effectively neutralize variants. Science Immunol 2022; 7: eabn8014.
3. Arientova S, Matuskova K, Bartos O et al. Specific immune responses after BNT162b2 mRNA vaccination and COVID-19 infection. Front Immunol 2023; 14: 1271353.
4. Consortium HUC. Undervaccination and severe COVID-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales. Lancet 2024; 403: 554–566.
5. Russell MW, Mestecky J. Mucosal immunity: rhe missing link in comprehending SARS-CoV-2 infection and transmission. Front Immunol 2022; 13: 957107.
6. Riemersma KK, Haddock LA 3rd, Wilson NA et al. Shedding of infectious SARS-CoV-2 despite vaccination. PLoS Pathog 2022; 18: e1010876.
7. Butler SE, Crowley AR, Natarajan H et al. Distinct features and functions of systemic and mucosal humoral immunity among SARS-CoV-2 convalescent individuals. Front Immunol 2020; 11: 618685.
8. Guerrieri M, Francavilla B, Fiorelli D et al. Nasal and salivary mucosal humoral immune response elicited by mRNA BNT162b2 COVID-19 vaccine compared to SARS-CoV-2 natural infection. Vaccines 2021; 9: 1499.
9. Cervia C, Nilsson J, Zurbuchen Y et al. Systemic and mucosal antibody responses specific to SARS-CoV-2 during mild versus severe COVID-19. J Allergy Clin Immunol 2021; 147: 545–557.
10. Brandtzaeg P. The mucosal B cell system. In: Mestecky J, Strober W, Russel MW et al. (eds.). Mucosal Immunology (4th ed.). Academic Press, 2015: 623–681.
11. Smythies LE, Denning TL, Smith PD. Mucosal macrophages in defense and regulation. In: Mestecky J, Strober W, Russell MW et al. (eds.). Mucosal Immunology (4th ed.). Academic Press, 2015: 543–556.
12. Landsverk OJ, Snir O, Casado RB et al. Antibody-secreting plasma cells persist for decades in human intestine. J Exp Med 2017; 214: 309–317.
13. Hurwitz JL, Orihuela C, DiRita VJ et al. Bacterial interactions with mucosal epithelial cells. In: Mestecky J, Strober W, Russell MW et al. (eds.). Mucosal Immunology (4th ed.). Academic Press, 2015: 955–974.
14. Jackson S, Moldoveanu Z, Mestecky J. Collection and processing of human mucosal secretions. In: Mestecky J, Strober W, Russell MW et al. (eds.). Mucosal Immunology (4th ed.). Academic Press, 2015: 2345–2353.
15. Ogra PL, Karzon DT, Righthand F et al. Immunoglobulin response in serum and secretions after immunization with live and inactivated poliovaccine and natural infection. N Engl J Med 1968; 279: 893–900.
16. Mestecky J. The common mucosal immune system and current strategies for induction of immune responses in external secretions. J Clin Immunol 1987; 7: 265–276.
17. Czerkinsky C, Prince SJ, Michalek SM et al. IgA antibody-producing cells in peripheral-blood after antigen ingestion - evidence for a common mucosal immune-system in humans. Proc Natl Acad Sci U S A 1987; 84: 2449–2453.
18. Baker K, Blumberg RS, Kaetzel CS. Immunoglobulin transport and immunoglobulin receptors. In: Mestecky J, Strober W, Russell MW et al. (eds.). Mucosal Immunology (4th ed.). Academic Press, 2015: 349–407.
19. Conley ME, Delacroix DL. Intravascular and mucosal immunoglobulin A: two separate but related systems of immune defense? Ann Intern Med 1987; 106: 892–899.
20. Lue C, Tarkowski A, Mestecky J. Systemic immunization with pneumococcal polysaccharide vaccine induces a predominant IgA2 response of peripheral blood lymphocytes and increases of both serum and secretory anti-pneumococcal antibodies. J Immunol 1988; 140: 3793–3800.
21. Moldoveanu Z, Clements ML, Prince SJ et al. Human immune responses to influenza virus vaccines administered by systemic or mucosal routes. Vaccine 1995; 13: 1006–1012.
22. Martinuzzi E, Benzaquen J, Guerin O et al. A single dose of BNT162b2 messenger RNA vaccine induces airway immunity in severe acute respiratory syndrome coronavirus 2 naive and recovered coronavirus disease 2019 subjects. Clin Infect Dis 2022; 75: 2053–2059.
23. Lin DY, Huang S, Milinovich A et al. Effectiveness of XBB.1.5 vaccines and antiviral drugs against severe outcomes of omicron infection in the USA. Lancet Infect Dis 2024; 24: e278–e280.
24. McDonnell J, Cousins K, Younger MEM et al. COVID-19 vaccination in patients with inborn errors of immunity reduces hospitalization and critical care needs related to COVID-19: a USIDNET report. J Clin Immunol 2024; 44: 86.
25. Vaxzevria1. COVID-19 vaccine (ChAdOx1-S [recombinant]). EMA/863593/2022. European Medicines Agency, 2022. Dostupné na: www.ema.europa.eu/en/documents/overview/vaxzevria-previously-covid-19-vaccine-astrazeneca-epar-medicine-overview_en.pdf
26. Faksova K, Walsh D, Jiang Y et al. COVID-19 vaccines and adverse events of special interest: A multinational Global Vaccine Data Network (GVDN) cohort study of 99 million vaccinated individuals. Vaccine 2024; 42: 2200–2211.
27. Frontera JA, Tamborska AA, Doheim MF et al. Neurological events reported after COVID-19 vaccines: An analysis of VAERS. Ann Neurol 2022; 91: 756–771.
28. Mercade-Besora N, Li X, Kolde R et al. The role of COVID-19 vaccines in preventing post-COVID-19 thromboembolic and cardiovascular complications. Heart 2024; 110: 635–643.
29. Parodi JB, Indavere A, Bobadilla Jacob P et al. Impact of COVID-19 vaccination in post-COVID cardiac complications. Vaccine 2023; 41: 1524–1528.
30. Xiang Y, Feng Y, Qiu J et al. Association of COVID-19 vaccination with risks of hospitalization due to cardiovascular and other diseases: a study using data from the UK Biobank. Int J Infect Dis 2024; 145: 107080.
31. Lundberg-Morris L, Leach S, Xu Y et al. Covid-19 vaccine effectiveness against post-covid-19 condition among 589 722 individuals in Sweden: population based cohort study. BMJ 2023; 383: e076990.
32. Gietel-Basten S, Rotkirch A, Sobotka T. Changing the perspective on low birth rates: why simplistic solutions won't work. BMJ 2022; 379: e072670.
33. Městecký J, Raška M. Strategické prvenství slizničního imunitního systému v obraně a toleranci. Čas Lék Česk 2011; 150: 480–488.
34. Czerkinsky C, Nilsson LA, Tarkowski A et al. The solid phase enzyme-linked immunospot assay (ELISPOT) for enumerating antibody-secreting cells: methodology and applications. In: Kemeny DMJ, Challacombe SJJ (eds.). ELISA and other solid phase immunoassays: theoretical and practical aspects. John Wiley & Sons, Chichester, 1988: 217–239.
35. Městecký J, Russell MW, Elson CO. Perspectives on mucosal vaccines: is mucosal tolerance a barrier? J Immunol 2007; 179: 5633–5638.
36. Kantele A, Zivny J, Hakkinen M et al. Differential homing commitments of antigen-specific T cells after oral or parenteral immunization in humans. J Immunol 1999; 162: 5173–5177.
37. Lim JME, Tan AT, Le Bert N et al. SARS-CoV-2 breakthrough infection in vaccinees induces virus-specific nasal-resident CD8+ and CD4+ T cells of broad specificity. J Exp Med 2022; 219: e20220780.
Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental HygienistArticle was published in
Journal of Czech Physicians
- FDA Warns Against Self-Monitoring Glucose Using Smartwatches. What About in Czechia?
- Alopecia Areata – Autoimmune Inflammatory Disease and a New Targeted Treatment Option
- Minimally Invasive Treatment of Pilonidal Sinus: Laser and Negative Pressure Therapy as a Gentle and Effective Modality
Most read in this issue
- COVID-19: to vaccinate or not to vaccinate – that is the question.
- The topic of not initiating resuscitation from the perspective of Czech law not only in the context of palliative care
- Geriatric patient at emergency department
- An international comparison and development of health system efficiency in the Czech Republic.