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Supporting ResourcesEventsMaterialsVideosAboutAboutCOVID-19 overviewLong COVIDMechanism of diseaseTransmissionVariantsPreparePrepareVaccination overviewVaccination typesWaning & boostingGuidelines for managing COVID-19DiagnoseDiagnoseSigns & symptomsHigh risk patientsTestingTreatTreatTreatment guidelinesTreatment optionsSupporting ResourcesSupporting ResourcesEventsMaterialsVideos
Combatting waning immunity with boosters Immunity against diseases is built from multiple coordinating systems within the bodyUpon infection or vaccination, a pathogenic antigen is introduced into the body and triggers a cascade of events that mobilize the immune system to try to prevent infection or control the disease.1

B cells are the “first responders”. When they encounter an antigen they divide, which can lead to the production of two different cell types.1,2

Memory B cells remain in the body after the initial infection or vaccination and respond to future encounters with the same antigen.1,2

Plasma cells primarily produce antibodies that bind to the antigen.1

Antibodies are produced by B cells and bind to specific antigens.1,2

Binding antibodies label antigens as targets for other immune cells.1,2

Neutralizing antibodies may prevent antigens from infecting cells.1

T cells are also an important component of the immune response.1
  • Killer T cells bind to and destroy cells in which the antigen resides.1,2
  • Helper T cells stimulate B cells to produce antibodies and help killer T cells develop.1,2
  • Memory T cells provide long-term cell-mediated immunity by responding to future encounters with the same antigen.1,2
Multiple immune responses ensure the body can respond to diseasesSubsequent encounters with the same antigen can produce a more rapid and effective immune response than the first encounter because of the immune system’s memory cells.3

Representation of a typical primary and secondary immune response, graph is not drawn to scale.

Primary immune responseThe first encounter with a new antigen leads to a rise in antibody levels.3,4 Memory B cells and memory T cells survive after the infection or antigen has been cleared.3,4 Secondary immune responseRe-exposure to the same antigen typically triggers a concerted activation of memory B cells and memory T cells, which will induce a stronger response than the primary immune response.5,6An individual who has been vaccinated may mount a protective immune response when re-exposed to the same antigen.3Waning immunity may be managed with vaccine boostersAfter infection or vaccination, antibody levels will wane naturally over time. The extent and rate of waning may vary depending on a variety of factors including the person's age, the nature of and exposure to the antigen or disease, and the number of vaccine booster doses administered.3 If antibody levels wane, vaccine booster doses may be helpful to sustain a person’s immune response against the target pathogen.3Immune memory is an important feature of vaccine-induced protection and depends on:3
  • The incubation time following infection
  • The quality of the immune memory response
  • The level of antibodies induced by memory cells
Waning antibody levels after an infection or vaccination is a normal and well-known occurrence. Even when antibody levels decline, memory B cells can still recognize the pathogen and produce antibodies against it.1Although disease symptoms may appear in vaccinated individuals if they do become infected, the severe disease may be reduced.9Building successful population immunity may be key to managing a pandemicThe protection provided by a vaccine is measured in different ways, including efficacy, effectiveness, and immunogenicity.10,11
  • Vaccine efficacy refers to how a vaccine performs in randomized controlled clinical trials.10
  • Vaccine effectiveness refers to how a vaccine performs in real-world settings.10
  • Immunogenicity refers to the extent and duration of the immune response following vaccination or infection by considering the levels of antibodies and T cells produced.11

Immunogenicity: Antibodies

Measuring antibody response may inform of a vaccine's ability to reduce the targeted pathogen's ability to infect vaccine recipients.3,6 Total antibody and neutralizing antibody levels produced after vaccination have been investigated in several published studies.13-15 Studying antibody response can help in determining whether a vaccine of interest induces a potentially protective antibody response following vaccination.

Immunogenicity: T cells

Measuring vaccine recipients' T cell responses may improve our understanding of how a vaccine reduces severe disease.12 Several published research and clinical studies have investigated the ability of vaccines to induce helper and killer T cell responses to specific pathogenic antigens.13-16 Studying the T cell response can help inform whether a vaccine of interest induces T cell immunity following vaccination.

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References:

Nature. What the Omicron wave is revealing about human immunity. Available at: https://www.nature.com/articles/d41586-022-00214-3 (accessed January 2023). Chaplin DD. J Allergy Clin Immunol 2010;125:S3–S23. Pollard AJ and Bijker EM. Nature Rev Immunol 2021;21:83 -100. Mouro V and Fischer A. Muscosal Immunol 2022;1–11. doi: 10.1038/s41385-022-00517-8. Epub ahead of print. Wei J et al. Nat Med 2022. doi: 10.1038/s41591-022-01721-6. Epub ahead of print. Palm AKE and Henry C. Front Immunol 2019;10:1787. Nature. How ‘killer’ T cells could boost COVID immunity in face of new variants. Available at: https://www.nature.com/articles/d41586-021-00367-7 (accessed January 2023). UK Health Security Agency. How well do vaccines protect against Omicron? What the data shows. Available at: https://ukhsa.blog.gov.uk/2022/02/10/how-well-do-vaccines-protect-against-omicron-what-the-data-shows/ (accessed January 2023). Centers for Disease Control and Prevention. The Possibility of COVID-19 after Vaccination: Breakthrough Infections. Available at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/effectiveness/why-measure-effectiveness/breakthrough-cases.html (accessed January 2023). World Health Organization. Vaccine efficacy, effectiveness and protection. Available at: https://www.who.int/news-room/feature-stories/detail/vaccine-efficacy-effectiveness-and-protection (accessed January 2023). Mahanty S et al. BMC Immunol 2015;16:31. Nature. `Killer' immune cells still recognize Omicron variant. Available at: https://www.nature.com/articles/d41586-022-00063-0 (accessed January 2023). Plotkin SA. Vaccine 2020;38:2250–2257. Tebas P et al. N Engl J Med 2021;385:e35. Şahin U et al. Nature 2021;595:572–577. Page K et al. N Engl J Med 2021;384:541–549.
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