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This article is leaving out several very important pieces of information: What were the pre-vaccine antibody levels in previously infected participants? How did the pre-vaccine antibody responses of those with prior infection compare to the post vaccine antibody levels of those without prior infection? The article states "those with pre-existing immunity experienced systemic side effects such as fatigue, headache, chills, fever, and muscle or joint pains with considerably higher frequency". Multiple sources of evidence have shown unvaccinated individuals with positive serum CoVid-19 antibodies had a similar level of protection from infection as those receiving the CoVid vaccine. If the goal is "to do no harm", why would any medical expert support recommending vaccination to individuals with existing antibody protection when we have evidence showing harm, supported by your statement of "considerably higher frequency of systemic side effects" in this group.
There isn't enough currently available evidence to warrant a vaccine recommendation in this population, especially when potential for harm exists. A safer approach for those with evidence of pre-existing antibodies would be to repeat antibody testing every 2-3 months to assess immunity status and only recommend vaccination if naturally acquired immunity wanes. Currently, there is zero evidence suggesting vaccine induced protection is superior to natural protection or that either will provide superior protection to newly emerging viral strains. Until evidence suggests otherwise, it is irresponsible to recommend an antibody inducing vaccine to otherwise healthy individuals with proven existing antibodies, especially with a known risk of harm.
Previous studies reported that mRNA vaccine indicated efficacy for preventing COVID-19 illness, which was helpful for controlling the COVID-19 pandemic 1,2. The mRNA vaccine works through the protein antigen it expresses. If the amino acid sequence of the mRNA changes, its antigenicity will also change accordingly. Currently, several variants of SARS-CoV-2 were reported by World Health Organization 3. If the sequence of SARS-CoV-2 infected by patients who showed efficacy on the vaccine wasn’t consistent with sequence of the mRNA vaccine, further studies would be needed to confirm the efficacy of these mRNA vaccine. Furthermore, the mRNA vaccine against SARS-CoV-2 continuously stimulates cellular production of overmuch target antibody, which may induce antibody-dependent enhancement later when infected by the virus. A method is required to be able to avoid antibody-dependent enhancement.
References
1. L. R. Baden, Sahly HM El, B. Essink, et al. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med 2021;384(5):403-16. doi: 10.1056/NEJMoa2035389 pmid:33378609.[Copyright (c) 2020 Massachusetts Medical Society.:*2021-02-04].
2. F. P. Polack, S. J. Thomas, N. Kitchin, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med 2020;383(27):2603-15. doi: 10.1056/NEJMoa2034577 pmid:33301246.[Copyright (c) 2020 Massachusetts Medical Society.:*2020-12-31].
3. World Health Organization. SARS-CoV-2 Variants Disease, Outbreak News, Dec 31, 2020. (https://www.who.int/csr/don/31-december-2020-sars-cov2-variants/en/).
Competing interests:
No competing interests
07 February 2021
Jian Zhou
Doctor
Jingjing Sun, Wanchun Wang and Tang Liu
Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
Re: Covid-19: People who have had infection might only need one dose of mRNA vaccine
Dear Editor,
This article is leaving out several very important pieces of information: What were the pre-vaccine antibody levels in previously infected participants? How did the pre-vaccine antibody responses of those with prior infection compare to the post vaccine antibody levels of those without prior infection? The article states "those with pre-existing immunity experienced systemic side effects such as fatigue, headache, chills, fever, and muscle or joint pains with considerably higher frequency". Multiple sources of evidence have shown unvaccinated individuals with positive serum CoVid-19 antibodies had a similar level of protection from infection as those receiving the CoVid vaccine. If the goal is "to do no harm", why would any medical expert support recommending vaccination to individuals with existing antibody protection when we have evidence showing harm, supported by your statement of "considerably higher frequency of systemic side effects" in this group.
There isn't enough currently available evidence to warrant a vaccine recommendation in this population, especially when potential for harm exists. A safer approach for those with evidence of pre-existing antibodies would be to repeat antibody testing every 2-3 months to assess immunity status and only recommend vaccination if naturally acquired immunity wanes. Currently, there is zero evidence suggesting vaccine induced protection is superior to natural protection or that either will provide superior protection to newly emerging viral strains. Until evidence suggests otherwise, it is irresponsible to recommend an antibody inducing vaccine to otherwise healthy individuals with proven existing antibodies, especially with a known risk of harm.
Competing interests: No competing interests