{"doi":"10.1111/jgs.18557","title":"Neutralization and binding antibody response to second bivalent <scp>COVID</scp> ‐19 vaccination in nursing home residents","abstract":"To date, SARS-CoV-2 has infected more than 1.6 million U.S. nursing home (NH) residents and killed more than 160,000.1 Vaccination plays a vital role in preventing SARS-CoV-2 infection and reducing morbidity and mortality burden in this population. A single bivalent COVID-19 mRNA vaccine broadens SARS-CoV-2 immunity and reduces infection, hospitalization, and death beyond that from monovalent vaccination.2, 3 We extend our work here by evaluating the immune response following a second bivalent vaccine dose. The current analysis extends our longitudinal data evaluating serial blood draws from consented NH residents vaccinated with the COVID-19 mRNA vaccines.2-5 We summarize findings from 2 weeks after each of four vaccination time points (first and second monovalent boosters, first and second bivalent boosters) and an intermediate draw 3–6 months after the first bivalent booster. We exclude data points from subjects with an interval infection (positive polymerase chain reaction or antigen test) and/or laboratory criteria [positive nucleocapsid (N) protein or a rise outside of lab variance of anti-spike (S), N, or neutralizing assay results not accounted for by vaccination history] until their next vaccine dose. We tested each sample for anti-S and neutralizing antibodies against SARS-CoV-2 Omicron BA.5 and the ancestral Wuhan strains using a bead-based ELISA method and pseudovirus neutralization assays as previously reported.4, 5 One NH in our parent longitudinal cohort had 29 NH residents who received a 2nd bivalent vaccine and were not excluded by recent infection. They had a median age of 75 (range 63–97) with 62% female and 34% Black. All subjects received the primary series and first bivalent booster; 14% had only one prior monovalent booster and 86% received two prior monovalent boosters. Neutralization titers declined 3–6 months after the first bivalent vaccine with geometric mean titers (GMT) decreasing from 3925 (2805, 5492) to 659 (265, 1636) for Wuhan and from 2877 (1761, 4701) to 319 (102, 1002) for BA.5. Among these subjects with the intermediate draw, titers were restored with the receipt of a second bivalent vaccine (Figure 1) with a geometric fold rise of 2.80 for Wuhan and a remarkable 11.1 for BA.5. Similarly, declining anti-S titers were boosted significantly following the administration of the second bivalent dose (Figure 2). Notably, BA.5 anti-S levels boosted to a level significantly higher than that attained after the first bivalent dose (p = 0.002). This study investigated the impact of a second bivalent vaccine on neutralization titers and anti–S antibodies among NH residents. Our findings revealed that the administration of a second bivalent vaccine restored declining neutralization and anti-spike S, with a higher magnitude noted for the Omicron BA.5 compared to the ancestral Wuhan strain. The ability of the Omicron variant to evade immunity conferred by a previous SARS-CoV-2 infection or vaccination led to the development and emergency use of the bivalent vaccines and subsequently authorized for an additional boost in older and other at-risk populations.6 The increase in neutralization titers and anti-S antibodies in this study indicates a robust immune response induced by the second bivalent vaccine. Even as specific vaccine-induced immune correlates of protection continue to evolve, higher neutralization titers and anti-S antibodies are suggestive of a more effective immune response and have been associated with reduced disease severity and transmission.7, 8 Thus, by boosting neutralization titers and anti-S antibodies further, the second bivalent vaccine can enhance protection against the Omicron variants, reducing the risk of breakthrough infections and severe disease among this vulnerable population. Remarkably, while we observed a ceiling anti-S response to Wuhan strain across two bivalent doses, the Omicron BA.5 response still increased. This suggests that the initial bivalent immunization with","journal":"Journal of the American Geriatrics Society","year":2023,"id":370300,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":7,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9573,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1057347,"name":"Yasin Abul","orcid":"0000-0001-7062-6920","position":1,"is_corresponding":false},{"id":636593,"name":"Brigid Wilson","orcid":"0000-0003-2966-2940","position":2,"is_corresponding":false},{"id":419613,"name":"Jürgen Bosch","orcid":"0000-0002-2624-4105","position":3,"is_corresponding":false},{"id":694928,"name":"Elise M. Didion","orcid":"0000-0002-4987-8901","position":4,"is_corresponding":false},{"id":1057899,"name":"Alexandra Paxitzis","orcid":null,"position":5,"is_corresponding":false},{"id":1057900,"name":"Nicholas Sundheimer","orcid":null,"position":6,"is_corresponding":false},{"id":1057901,"name":"Vaishnavi Ragavapuram","orcid":null,"position":7,"is_corresponding":false},{"id":637483,"name":"Dennis Wilk","orcid":null,"position":8,"is_corresponding":false},{"id":637482,"name":"Debbie Keresztesy","orcid":null,"position":9,"is_corresponding":false},{"id":294172,"name":"Htin Aung","orcid":"0000-0002-0465-6256","position":10,"is_corresponding":false},{"id":1057348,"name":"Yi Cao","orcid":"0009-0000-7350-5681","position":11,"is_corresponding":false},{"id":323750,"name":"Christopher L. King","orcid":"0000-0003-3873-7860","position":12,"is_corresponding":false},{"id":108262,"name":"Alejandro B. Balazs","orcid":"0000-0002-1767-3944","position":13,"is_corresponding":false},{"id":745952,"name":"Elizabeth M. White","orcid":"0000-0003-4175-8662","position":14,"is_corresponding":false},{"id":287778,"name":"Stefan Gravenstein","orcid":"0000-0001-6000-6859","position":15,"is_corresponding":false},{"id":72323,"name":"David H. Canaday","orcid":"0000-0001-5503-7888","position":16,"is_corresponding":false},{"id":636591,"name":"Oladayo A. Oyebanji","orcid":"0000-0001-5028-7474","position":0,"is_corresponding":true}],"reference_count":9,"raw_metadata":null,"created_at":"2026-07-19T01:15:37.094100Z","pmid":"37589423","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}