Comparative analysis of humoral immunity kinetics following three COVID-19 vaccines in a multi-ethnic cohort of medical students and healthcare professionals across Malaysia

Abstract

The objective of our study was to evaluate the time-dependent humoral immunity kinetics among multi-ethnic population of medical students and healthcare professionals across Malaysia following two doses of Comirnaty, Vaxzevria, and CoronaVac vaccines. Prospective observational cohort research was carried out from September 2021-March 2023. 242 vaccine recipients have completed the follow-up. After second vaccination dosage, peripheral blood was drawn every four weeks from week 0-24. Anti-S IgG and percentage of neutralization were measured from each individual plasma sample. Recipients of Comirnaty and Vaxzevria vaccine, exhibited adequate anti-S IgG and neutralizing antibody till week 24. In compared to Comirnaty/Vaxzevria vaccine group, CoronaVac group showed significant decrease of antibody as early as week 12. The Comirnaty vaccine peaked anti-S IgG production at week 4, while the Vaxzevria and CoronaVac vaccines peaked at week 2. The Comirnaty vaccine (91.3%) showed strong Ig-RBD neutralizing antibody response even after week 24, which led to the slowest rate of antibody waning when compared to CoronaVac (13%), which never achieves high Ig-RBD neutralizing antibody. The percentage of inhibition of Ig-RBD binding on ACE₂ receptor and anti-S IgG seroconversion were significantly higher in the Comirnaty vaccine. The antibody response of Comirnaty was lower in recipients with higher BMIs than in those with normal or low BMIs. Higher BMI, however, was associated with more robust humoral immune responses to Vaxzevria vaccine. Following immunisation, the Chinese and Indian populations might exhibit a stronger humoral immune response than the Malay population.

Keywords: Comirnaty vaccine; Comparative antibody response; CoronaVac vaccine; Ethnicity; Malaysia; Time dependent response; Vaxzevria vaccine; Waning of antibody.

Fig. 1

Strobe diagram for selection of study participants.

Fig. 2

Kinetics of anti-S IgG antibody. (A) The changes in the mean anti-S IgG antibody kinetics among different ethnic groups of Malaysia following the administration of the two doses of the Comirnaty vaccination. (B) The kinetics of individual anti-S IgG antibody after Comirnaty vaccine. (C) The alteration of mean anti-S IgG antibody over time following Vaxzevria vaccination. (D) The individual anti-S IgG kinetics after Vaxzevria vaccine. (E) The anti-S IgG antibody kinetics following CoronaVac vaccination. (F) The individual anti-S IgG antibody kinetics after CoronaVac vaccine. The blue line hypothetically represented the positive threshold (109 BAU/ml) of anti-S IgG antibody.

Fig. 3

(A) Area under the curve (AUC) response following Comirnaty, Vaxzevria and CoronaVac vaccine: Area under the curve line diagram over 24 week period following COVID-19 vaccination. The baseline for AUC was established at 109, as 109 BAU/ml indicated the positive threshold for anti-S IgG antibody. It was marked as the purple line. The area under Comirnaty titre was significantly higher in compare to Vaxzevria and CoronaVac (P < 0.0001). In the analysis of Comirnaty and Vaxzevria over the specified time frame, a positive peak was observed in all areas. Conversely, in the case of CoronaVac, area of negative peak was noted after week 16. (B) Receiver operating characteristic (ROC) curves of anti-S IgG response following 24 weeks of comirnaty vaccine. (C) Receiver operating characteristic (ROC) curves of anti-S IgG response following 24 weeks of Vaxzevria vaccine. (D) Receiver operating characteristic (ROC) curves of anti-S IgG response following 16 weeks of CoronaVac Vaccine.

Fig. 4

Anti-S IgG kinetics and its relation to BMI. Following WHO guideline BMI was categorized as following. BMI < 18–Underweight, BMI < 18–24.99—Normal, BMI < 25-29.99- Overweight, BMI < 30–34.99—class I obese, BMI < 35–39.99—Class II obese. (A) Anti-S IgG kinetics in relation to BMI following Comirnaty vaccine. Seroconversion of anti-S IgG response across all time line was observed much higher in underweight and normal BMI group in compare to overweight or class I and class II obese group. (B) Anti-S IgG kinetics in relation to BMI following Vaxzevria vaccine Seroconversion of anti-S IgG response of class I obese and Overweight were much potent across all the time line in compare to normal BMI and underweight. (C) Anti Anti-S IgG kinetics in relation to BMI following CoronaVac vaccine. Seroconversion of anti-S IgG response across all time line was observed much higher in overweight and underweight group in compare to normal or class I obesity.