{"id":4927,"date":"2021-07-24T14:18:05","date_gmt":"2021-07-24T21:18:05","guid":{"rendered":"https:\/\/healthykidshappykids.com\/?p=4927"},"modified":"2021-09-27T07:11:40","modified_gmt":"2021-09-27T14:11:40","slug":"why-natural-immunity-should-must-count","status":"publish","type":"post","link":"https:\/\/vps37072.inmotionhosting.com\/~healt472\/2021\/07\/24\/why-natural-immunity-should-must-count\/","title":{"rendered":"Why Natural Immunity Should (Must) Count"},"content":{"rendered":"\n
\"\"<\/figure>\n\n\n\n[UPDATED: September 26, 2021 to take into account data since the Delta variant became the predominant SARS-coV-2 strain in the US at the end of June 2021.]\n\n\n\n

The World Health Organization acknowledged in its scientific brief on COVID-19 Natural Immunity dated May 10, 2021 (1) that:<\/p>\n\n\n\n

\u201cNatural infection may provide similar protection against symptomatic disease as vaccination.\u201d<\/strong><\/p>\n\n\n\n

It\u2019s time for the Centers for Disease Control (CDC) to acknowledge the same.<\/p>\n\n\n\n

It\u2019s time to look at the scientific data showing that natural immunity from prior COVID-19 infection is not only as protective, but may actually be MORE protective than a vaccine, and that prior infection may also increase the risk for serious adverse vaccine reactions.<\/p>\n\n\n\n

It\u2019s time to make a science-based policy shift and rethink the CDC’s current recommendation that all eligible individuals should get a vaccine, regardless of whether they’ve already had COVID-19.<\/p>\n\n\n\n

Antibodies, Memory B Cells, Memory T Cells & Long-Lived Plasma Cells<\/strong><\/h3>\n\n\n\n

Immunity against most human coronaviruses that cause the common cold (hCoV-OC43, hCoV-229E, hCoV-NL63 and hCoV-HKU-1) may be short lived and not last longer than a year. (2)<\/p>\n\n\n\n

But SARS-CoV-2 is NOT like most other human coronaviruses.<\/strong><\/p>\n\n\n\n

SARS-CoV-2, the human coronavirus that causes COVID-19, is much more closely related to MERS-CoV and SARS-CoV-1, which caused Middle East Respiratory Syndrome (MERS) in 2009 and Severe Acute Respiratory Syndrome (SARS) in 2003, respectively. In the case of MERS and SARS-CoV-1, antibodies have been detected years <\/em><\/strong>after initial infection, and immunity is thought to possibly be lifelong. (3,4,5)<\/p>\n\n\n\n

90-99% of people who recover from COVID-19 develop detectable neutralizing antibodies. (1) SARS-Cov-2 antibodies from COVID-19 infection are detectable for at least 6-12 months after initial infection. (6,7,8) As time passes from the beginning of the pandemic, and antibodies in those with prior infection continue to be followed, we will likely see that antibodies endure long-term as they do for SARS and MERS. <\/p>\n\n\n\n

And while SARS-CoV-2-specific IgG antibodies may wane over time, as is typical for most viral infections, this is not necessarily a sign of decreasing immunity. Increasing evidence (9,10,11,12,13,14,15) points to long-lasting B-cell and T-cell immunity and long-lived plasma cells after SARS-CoV-2 infection, even mild infection \u2013 which may confer lifelong immunity.<\/p>\n\n\n\n

Memory lymphocytes produced after SARS-CoV-2 infection exhibit potent antiviral immunity. (12) When re-exposed to SARS-CoV-2 antigens, memory lymphocytes have multiple strategies to protect against reinfection. Memory CD4+ T cells secrete an antiviral cytokine, IFN-gamma. Memory CD8+ T cells can kill virus-infected cells directly. And memory B cells differentiate into IgG+ antibody-secreting plasmablasts. This memory immune response on re-exposure is capable of neutralizing the virus and preventing <\/em><\/strong>reinfection.<\/p>\n\n\n\n

COVID-19 infection also induces lasting bone marrow plasma antibody protection. As antibody production wanes after initial infection, a small population of antibody-producing cells called “long-lived plasma cells” migrate to our bone marrow and continually secrete low levels of antibodies. Long-lived plasma cells were identified in patients with even mild COVID-19 disease, and the authors speculate that even asymptomatic people have long-term protection due to these long-lived plasma cells. (16)<\/p>\n\n\n\n

Prior SARS-Cov-2 infection induces Memory B cell, Memory T cell and Long-lived Plasma Cell protection that confers LONG-TERM and possibly LIFELONG IMMUNITY. <\/strong><\/p>\n\n\n\n

Reinfection Rates are Very Low<\/strong><\/h3>\n\n\n\n

In real life, reinfection rates are very low – even with the Delta variant. A study in Israel <\/a>comparing those who were fully vaccinated with the Pfizer COVID-19 vaccine and those with prior infection during the period March 2020 – August 2021 found that vaccinated individuals without a history of prior infection had a a 6X to 13X <\/strong>risk INCREASED of a breakthrough COVID infection than unvaccinated individuals with natural immunity. The authors conclude that:<\/p>\n\n\n\n

natural immunity confers longer lasting and stronger protection against infection, symptomatic disease and hospitalization caused by the Delta variant of SARS-CoV-2, compared to the BNT162b2 two-dose vaccine-induced immunity.<\/p>https:\/\/www.medrxiv.org\/content\/10.1101\/2021.08.24.21262415v1.full.pdf<\/a><\/cite><\/blockquote>\n\n\n\n

While reinfection with SARS-CoV-2 can occur, six large studies from the US (17), UK (18), Denmark (19), Austria (20), Qatar (21), and US Marines (22), found that infection with SARS-CoV-2 provides 82-95% protection from reinfection for at least 7 months. (23,24)<\/p>\n\n\n\n

Those with prior infection had at least 94% protection from symptomatic disease, rivaling the protection received after full COVID-19 vaccination. A retrospective Austrian study (20) of SARS-CoV-2 reinfection rates in 14,840 people with prior COVID-19 infection compared with the general population confirmed that prior infection provided 97% protection from hospitalization and 99% protection from death due to reinfection. The authors note that:<\/p>\n\n\n\n

\u201cProtection against SARS-CoV-2 after natural infection is comparable with the highest available estimates on vaccine efficacies. Further well-designed research on this issue is urgently needed for improving evidence-based decisions on public health measures and vaccination strategies.\u201d<\/strong><\/p>\n\n\n\n

Natural Immunity is as Protective Against Variants as Vaccines<\/strong><\/h3>\n\n\n\n

Recent studies have found that current global Variants of concern (VOCs) are unlikely to have an impact on CD4+ and CD8+ T cell immunity in both those with prior COVID infection and those who are vaccinated. Memory T-cell immunity from prior infection likely confers immunity against circulating variants, (25,26,27) even the Delta variant (B.1.617.2). (28) <\/p>\n\n\n\n

With increasing reports worldwide of breakthrough infections after vaccination due to the Delta variant, it is imperative to understand the protective factors against serious hospitalization and death from Delta variant infections – whether it’s natural or vaccine immunity.<\/strong><\/p>\n\n\n\n

Natural Immunity May Be MORE Protective than Vaccines Against Current & Future Variants<\/strong><\/h3>\n\n\n\n

Israel has seen a spike in recent COVID-19 infections due to the Delta variant in both vaccinated and unvaccinated individuals despite very high vaccination rates. Real-world data out from Israel<\/a> since May 2021 revealed that natural infection was actually much more protective against new infection than vaccination. In fact, those with natural immunity from prior infection were 6.72 times less<\/em><\/strong> likely to get infected than those who only had immunity via vaccination. Of the 7,700 new cases of COVID-19 infection since May 2021, 3000 or about 40% were in vaccinated individuals, compared with only 72 or less than 1% in those with prior infection. <\/p>\n\n\n\n

The Spike protein on the SARS-CoV-2 virus binds to receptors on human cells to allow the virus to invade, replicate and cause disease. The Spike protein has significant evolutionary pressure to mutate to allow easier entry into human cells. As a result, SARS-CoV-2 Variants of Concern have notable mutations in their Spike protein that increase transmissibility and infectivity.<\/p>\n\n\n\n

While the Spike protein varies significantly across variants, the Nucleocapsid protein is surprisingly stable. Because it is encased in the virus, there is less evolutionary pressure for the Nucleocapsid protein to mutate than for the Spike protein.<\/p>\n\n\n\n

The SARS-CoV-2 Nucleocapsid (N) protein (48 kDa) appears to be conserved across COVID-19 variants and does not mutate. (29)<\/strong><\/p>\n\n\n\n

The Nucleocapsid protein floats freely in the blood after it is released from infected cells and causes strong B-cell and T-cell immune responses. (30) Those with SARS-CoV-2 infection mount B-cell and T-cell responses against the SARS-CoV-2 Spike protein and<\/em> <\/strong>Nucleocapsid protein, along with many other viral antigens.<\/p>\n\n\n\n

On the other hand, current COVID-19 vaccines are designed to elicit B-cell and T-cell immune response against only <\/em><\/strong>the Spike protein of the SARS-CoV-2 virus. Concern has been raised that eventually enough mutations in the Spike protein may occur in new variants that vaccines targeting the SARS-CoV-2 Spike protein alone will lose their efficacy.<\/p>\n\n\n\n

Because the Nucleocapsid protein does not seem to mutate in variants, Nucleocapsid B-cell and T-cell immunity may provide BETTER long-term protection from all current and future variants than a vaccine that only produces Spike protein immunity.<\/p>\n\n\n\n

Because the SARS-CoV-2 Nucleocapsid protein does not mutate, the Nucleocapsid protein may be a better target for IgG antibody testing AND for future vaccine targeting. <\/strong><\/p>\n\n\n\n

Laboratories should include Nucleocapsid protein antibodies in serologic testing for prior SARS-CoV-2 infection. And vaccine manufacturers should investigate vaccines that induce immune response against the Nucleocapsid protein and other SARS-CoV-2 antigens, not just the Spike protein.<\/p>\n\n\n\n

In addition, a meta-analysis (31) of 18 T-cell response studies to COVID-19 found that memory T cells from natural infection are effective against more than <\/em><\/strong>1400 SARS-CoV-2 CD4+ and CD8+ epitopes. Epitopes are sites on the SARS-CoV-2 virus that T cells can recognize. Natural immunity confers broad T-cell response to the SARS-CoV-2 virus. Such broad T-cell response makes it difficult for SARS-CoV-2 variants to acquire enough mutations in its epitopes to \u201cescape\u201d the body\u2019s immune response after prior infection. In contrast, rapid mutations in the Spike protein may allow for increased opportunities to “escape” the body’s immune response after vaccination.<\/p>\n\n\n\n

Due to the broad immune response to SARS-COV-2 infection, enduring immunity from future variants is more likely with natural infection than vaccination<\/strong>.<\/p>\n\n\n\n

With increasing reports of breakthrough infections due to the Delta variant in fully vaccinated individuals around the world, it is imperative to determine how protective vaccination truly is against not just getting seriously sick and dying from Delta infection, but also against contracting asymptomatic or mild\/moderate disease and transmitting it to vulnerable populations, including children and the elderly who may not mount an adequate immune response even after full vaccination. <\/p>\n\n\n\n

The CDC Must Change Its Definition of Vaccine Breakthrough Infections<\/strong><\/h3>\n\n\n\n

The only way we will know how well prior infection or vaccination protects against clinical disease and the spread of the Delta variant is if the CDC changes its definition of vaccine breakthrough infections BACK to what it was before May 1, 2021.<\/p>\n\n\n\n

According to the CDC, \u201cAs of May 1, 2021, CDC transitioned from monitoring all reported vaccine breakthrough cases to focus on identifying and investigating only hospitalized or fatal cases due to any cause. This shift will help maximize the quality of the data collected on cases of greatest clinical and public health importance.\u201d (32)<\/p>\n\n\n\n

The CDC\u2019s changed definition of vaccine breakthrough infections is bad policy \u2026<\/strong><\/p>\n\n\n\n

Breakthrough Delta variant infections, deaths and hospitalizations after vaccination are increasing, but the current definition cannot accurately reflect the true numbers.<\/p>\n\n\n\n

As of July 19, 2021, the CDC reported 5,914 breakthrough infections with 5,601 hospitalizations and 1,141 deaths. On the other hand, at the end of April before <\/em><\/strong>the CDC changed its definition of breakthrough cases, the CDC had reported 2X the number of breakthrough cases, with 10,262 vaccine breakthrough infections, 10% of which resulted in hospitalization and 2% in death. Twenty-seven percent (27%) of these vaccine breakthrough infections were asymptomatic<\/em><\/strong>.(33), confirming the WHO’s observation that most breakthrough Delta variant infections are mild or asymptomatic. With the changed CDC definition, 88% of breakthrough infections noted at the end of April would not have been counted because they did not result in hospitalization or death.<\/em><\/strong><\/p>\n\n\n\n

Asymptomatic and mild-moderate infection with the Delta variant that do not result in hospitalization and death are increasingly being reported in the US and other countries. Vaccinated people can still get COVID-19 and transmit it to others. However, the CDC’s change in definition of vaccine breakthrough infections makes it impossible to understand how variants are spreading among vaccinated individuals, or how variants are spreading from vaccinated individuals to unvaccinated individuals, including children and others who remain vulnerable. <\/strong><\/em><\/p>\n\n\n\n

If we do not track asymptomatic and mild-moderate vaccine breakthrough infections, we will never know the answers to these very important questions:<\/p>\n\n\n\n