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People with Past COVID-19 Benefit from Immunization

NEJM Journal watch

Anthony L. Komaroff, MD, reviewing Stamatatos L et al. Science 2021 Mar 25 Reynolds CJ et al. Science 2021 Apr 30 Crotty S. Science 2021 Jun 25

Neutralizing antibody concentrations rose by about 100-fold after vaccination.

Some patients with past SARS-CoV-2 infections think they have been “naturally immunized” and won't benefit from COVID-19 vaccination. Two new studies add to the evidence showing that vaccination generates a more vigorous B and T cell response than does natural infection and that vaccination is particularly potent in people with previous SARS-CoV-2 infections.

Researchers evaluated people who were vaccinated (with an mRNA vaccine) after natural infection and people who were vaccinated but had no prior natural infection. In people who were vaccinated after natural infections, neutralizing antibodies against the beta variant were 25 times higher than after vaccination alone and 100 times higher than after natural infection alone. This result was remarkable, given that natural infections were almost never with the beta variant and that vaccines did not target the beta-variant spike protein. Memory B cells against SARS-CoV-2 were 5- to 10-fold higher when vaccination followed natural infection than after natural infection or vaccination alone.

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