Email this article Assessment of post-vaccination collective immunity against new coronavirus infection (COVID-19) among servicemen of the Armed Forces of the Russian Federation
- Authors: Azarov I.I.1, Ovchinnikov D.V.1, Kuzin A.A.1, Lantsov E.V.1, Bulankov Y.I.1, Artebyakin S.V.1, Zharkov D.A.1, Kulikov P.V.1
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Affiliations:
- Military Medical Academy of S.M. Kirov
- Issue: Vol 24, No 2 (2022)
- Pages: 267-276
- Section: Research paper
- URL: https://journals.eco-vector.com/1682-7392/article/view/106245
- DOI: https://doi.org/10.17816/brmma106245
- ID: 106245
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Abstract
The recent vaccination campaign targeting the new coronavirus infection (COVID-19) carried out in the Armed Forces of the Russian Federation, on the background of the current unstable global pandemic situation, makes it necessary to study post-vaccination population immunity to the SARS-CoV-2 virus and thus identify key features of immunity in organized military collectives. In the future, this will make it possible to objectively assess the risks of a worsening pandemic situation, effectively adjust the ongoing sanitary and anti-epidemic measures aimed at preserving and strengthening the health of military personnel, as one of the main conditions for maintaining the combat readiness of the Armed Forces of the Russian Federation. During a study conducted on epidemic indications, it was found that vaccination with Gam-Covid-Vac contributes to the formation of collective immunity with 95% effectiveness. A gender-based analysis of the immune response showed that the proportion of persons who lack class G immunoglobulins to SARS-CoV-2 among females is twice than that among men (9.3% and 4.7%, respectively). Seroprevalence indicators, classified by blood group, range from 94.4% (AB (IV) Rh–) to 97.4% (A (II) Rh–). There were no significant differences in seroprevalence between groups of people with different blood groups; however, the highest value of seroprevalence was seen among military personnel with blood group A (II) Rh–. In this context, it is advisable to continue monitoring the formation of immunity in individuals with various blood groups. The results obtained made it possible to form a primary medical and social “portrait” of a serviceman with the most adequate immune response to the introduction of the Gam-Covid-Vac vaccine (a man under the age of 20 with blood type A (II) Rh–) and to draw a conclusion about the high effectiveness of vaccination in military units (formations) staffed by conscripts and military educational organizations.
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BACKGROUND
Two years have passed since the emergence of the coronavirus disease 2019 (COVID-19) pandemic in Russia. During this time, medical specialists have managed to gain profound experience and knowledge in preventing this infection. The pandemic has affected nearly all human activities. The population has learned to live with the “coronavirus,” which requires strict adherence to restrictions and other measures that make up a set of sanitary and antiepidemic (preventive) measures [1–3].
Despite the progress made in controlling COVID-19, the epidemic remains unstable. The pandemic has an undulating course with a downward trend. Thus, a consistent and purposeful set of evidence-based measures aimed at removing restrictions and returning society to prepandemic living is necessary [4–7].
One of the main activities is the creation of stable collective immunity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is developed after an illness and artificially through specific prophylaxis. The use of modern Russian vaccines is a scientific way of prolonging protection mechanisms in people who had COVID-19 [8–13].
In the epidemic process of COVID-19, the state of collective immunity to SARS-CoV-2, which can predict the emergence of an epidemic, is of great importance [14–17]. Collective immunity develops in a cohort of patients who had recovered and those who were vaccinated. The immune response of the body to SARS-CoV-2 develops according to this scenario: by days 5–7 from the onset of the infection, in 40%–55% of the cases, virus-neutralizing antibodies begin to form in the blood of those who had the infection, and by the end of week 3, they are detected in 100% of the patients. The intensity of immunity in patients who had recovered from COVID-19 decreases within 6–12 months after the infection. At present, the duration of postvaccination immunity, according to various expert estimates, can be up to 1 year [18–21].
According to Russian researchers in various regions of the Russian Federation (RF), 82.4%–95.2% were asymptomatic (inapparent) carriers among seropositive individuals for the entire monitoring period (2020–2021). However, no sex differences could be identified. The highest seroprevalence was detected among children aged 1–17 years [22–25].
Currently, data are limited on the formation of collective immunity in military personnel postinfection and postvaccination [26, 27]. Thus, an assessment of specific collective immunity to SARS-CoV-2 in organized military groups is necessary to identify the characteristics of its formation among military personnel. Owing to social contacts in such groups, data obtained can be used to predict the emergence of an epidemic among comparable population groups [28–31].
The study aimed to analyze population immunity to SARS-CoV-2 during the COVID-19 pandemic following immunoprophylaxis in organized military groups.
MATERIALS AND METHODS
The study was conducted from April 1 to April 30, 2021, according to the order of the Minister of Defense of the RF. The study participants were military servicemen and members of the civilian staff of the Ministry of Defense of the RF who received a full course of vaccination with Gam-COVID-Vac (component 2 of the vaccine).
The total sample was distributed into several groups according to territory (belonging to the military district and Central Authorities of the Military Administration), blood types and Rh factor, sex, and age. In total, 7586 people took part in the study, including 1721 patients from the Central Authorities of the Military Administration (CAMA), 2016 from the Western Military District, 991 from the Central Military District, 1394 from the Southern Military District, 973 from the Eastern Military District, and 491 from the Northern Fleet (NF).
One month after receiving the full vaccination course, 3–5 mL of blood was taken from the cubital vein and placed in vacuum tubes with a coagulation activator. The samples were sent to the laboratories of military medical organizations on a territorial basis in accordance with the generally accepted methodology1. Blood serum was examined using a set of reagents for the determination of class G immunoglobulins (IgG) to SARS-CoV-2 in human serum (plasma) by the enzyme-linked immunosorbent assay (a set of reagents was used for enzyme immunoassay detection of class G immunoglobulins to SARS-CoV-2 “SARS-CoV-2-IgG-ELISA-BEST”). The immunological efficacy of vaccination was analyzed based on the assessment of positivity ratio (PR) levels and IgG titers to SARS-CoV-2. A PR of ≥ 1.1 (specific antibody titer 1:100) was considered positive.
Seroprevalence was assessed by the following equation:
S = (s+ × 100%) / N,
where S is the seroprevalence index, s+ is the number of seropositive participants, and N is the sample size.
The geometric mean titer of antibodies was calculated according to the generally accepted method2.
The results were statistically analyzed using standard tools of Statistica 10.0 package in accordance with the rules of descriptive and analytical statistics. When comparing group differences, a two-sample Student’s t-test was used for variables with a normal distribution. Nominal data were analyzed and described in absolute terms, and derivatives were analyzed and described in percentages. A p value < 0.05 was considered statistically significant.
RESULTS AND DISCUSSION
The results revealed that vaccination with Gam-COVID-Vac promotes the development of collective immunity with an efficiency of 95%. No statistically significant differences were found in the total proportion of seroprevalence in the examined samples, with Student’s t-test of 0.02 (p > 0.05) (Table 1); however, the maximum indicators were registered in the CAMA group, and the minimum ones were recorded in the NF group. An indirect influence on the formation of collective immunity in this group of negative factors in military service under the conditions of the Far North (geographical and climatic factors, vitamin deficiency, etc.) cannot be ruled out; however, this hypothesis requires additional verification.
Table 1. Seroprevalence rates in military personnel of various military districts, %
Таблица 1. Показатели серопревалентности у военнослужащих различных военных округов, %
Parameter | Proportion of individuals with IgG to SARS-CoV-2+, % (М ± m) |
Central Authorities of Military Administration (CAMA) | 97.9 ± 0.3 |
Western Military District (WMD) | 95.1 ± 0.4 |
Central Military District (CMD) | 96.0 ± 0.6 |
Southern Military District (SMD) | 95.1 ± 0.5 |
Eastern Military District (EMD) | 92.1 ± 0.8 |
Northern Fleet (NF) | 88.6 ± 1.4 |
Of the overall participants, the proportion of seropositive individuals with the maximum antibody titer (1:6400) was 57.1% (n = 3254). The distribution of titers, including the geometric mean antibody titer (GMT), in the examined groups is presented in Table 2. For this indicator, the minimum values were also detected in the NF group. This is most likely due to the short time interval between the vaccination and the subsequent blood sampling for laboratory testing for the presence of IgG to SARS-CoV-2 (at the time of the study, no more than 1 month had passed). However, when evaluating these results, the influence of the above factors on the extent of the formed immune response cannot be excluded.
Table 2. Distribution of antibody titers in the examined groups, pers.
Таблица 2. Распределение титров антител в обследуемых группах, чел.
IgG titer to SARS-CoV-2 | CAMA | WMD | CMD | SMD | EMD | NF |
1 : 100 | 61 | 91 | 29 | 52 | 53 | 38 |
1 : 200 | 566 | 322 | 63 | 621 | 106 | 397 |
1 : 400 | 253 | 138 | 24 | 19 | 33 | 0 |
1 : 800 | 65 | 56 | 7 | 8 | 17 | 0 |
1 : 1600 | 137 | 98 | 6 | 26 | 61 | 0 |
1 : 3200 | 268 | 225 | 5 | 40 | 71 | 0 |
1 : 6400 | 334 | 988 | 817 | 560 | 555 | 0 |
Geometric mean antibody titer | 1 : 722 | 1 : 1342 | 1 : 2899 | 1 : 692 | 1 : 1334 | 1 : 103 |
Moreover, no significant differences were found in the distribution of seropositive individuals according to blood groups and Rh factor. Their relatively even distribution was noted, with the highest rates in the group with blood type A (II) Rh−, and the lowest rates were revealed in those with AB (IV) Rh− (Table 3).
Table 3. Seroprevalence indicators depending on blood type and Rh factor
Таблица 3. Показатели серопревалентности в зависимости от группы крови и резус-фактора
Blood type and Rh factor | 0 (I) | A (II) | B (III) | AB (IV) | ||||
Rh+ | Rh– | Rh+ | Rh– | Rh+ | Rh– | Rh+ | Rh– | |
Quantity, pers. | 1361 | 1656 | 967 | 343 | 306 | 347 | 262 | 107 |
Proportion of individuals with IgG to SARS-CoV-2+, % (М ± m) | 95.4 ± 0.6 | 95.1 ± 1.2 | 95.9 ± 0.5 | 97.4 ± 0.9 | 95.2 ± 0.7 | 94.7 ± 1.4 | 95.3 ± 1.1 | 94.4 ± 2.2 |
However, the distribution of GMT characterizing the degree of immunity to SARS-CoV-2 in the corresponding samples revealed significantly (p < 0.05) that servicemen with blood type A (II) Rh− produce the highest levels of antibodies, twice as high as those of servicemen with the AB (IV) Rh− type, with the lowest level of this indicator. This finding led to the hypothesis that individuals with blood type A (II) Rh− form the strongest immune response to Gam-COVID-Vac, whereas individuals with blood type AB (IV) Rh− demonstrate the least immunogenicity (Table 4).
Table 4. Distribution of antibody titers in samples
Таблица 4. Распределение титров антител в выборках
IgG titer to SARS-CoV-2 | 0 (I) | A (II) | B (III) | AB (IV) | ||||
Rh+ | Rh– | Rh+ | Rh– | Rh+ | Rh– | Rh+ | Rh– | |
1 : 100 | 62 | 11 | 68 | 16 | 30 | 12 | 15 | 4 |
1 : 200 | 411 | 85 | 513 | 104 | 301 | 100 | 111 | 48 |
1 : 400 | 77 | 15 | 92 | 22 | 52 | 5 | 19 | 8 |
1 : 800 | 31 | 14 | 26 | 4 | 20 | 3 | 6 | 0 |
1 : 1600 | 63 | 13 | 75 | 16 | 53 | 14 | 19 | 3 |
1 : 3200 | 134 | 23 | 144 | 31 | 94 | 20 | 28 | 4 |
1 : 6400 | 520 | 130 | 670 | 145 | 371 | 94 | 129 | 34 |
Geometric mean antibody titer | 1 : 883 | 1 : 970 | 1 : 941 | 1 : 1073 | 1 : 899 | 1 : 718 | 1 : 834 | 1 : 538 |
Considering that the number of male participants in the study was 20 times higher than that of female participants, which is quite typical for military personnel of the Armed Forces of the RF, differences in seroprevalence by sex were analyzed. Nevertheless, statistical processing of data revealed that the proportion of seroprevalence in male military personnel was 4.6% higher than in female military personnel. Indicators characterizing the degree of intensity of the formed immune response (GMT) were nearly two times higher than similar indicators in women (Table 5).
Table 5. Distribution of the examined individuals, antibody titers depending on gender
Таблица 5. Распределение обследуемых лиц, титры антител в зависимости от пола
Indicator | Men | Women |
IgG titer 1:100 | 311 | 13 |
IgG titer 1:200 | 1967 | 108 |
IgG titer 1:400 | 442 | 25 |
IgG titer 1:800 | 141 | 12 |
IgG titer 1:1600 | 313 | 15 |
IgG titer 1:3200 | 574 | 35 |
IgG titer 1:6400 | 3139 | 115 |
No IgG to SARS-CoV-2, pers. | 343 | 33 |
Quantity, pers. | 7230 | 356 |
Proportion of individuals with IgG to SARS-CoV-2+, % (М ± m) | 95.3 ± 0,3 | 90.7 ± 1,5 |
Geometric mean antibody titer | 1 : 991 | 1 : 575 |
By age, all examined servicemen were distributed into six groups, and despite statistically insignificant differences, the highest seroprevalence rate was registered in servicemen aged ≤ 20 years (Table 6). Objectively, this group includes conscripted servicemen, contracted servicemen in the first 2 years of service, and cadets of military educational organizations in the first 3 years of the study. In this regard, it is reasonable to assume that the overwhelming majority of servicemen of these categories have A1 military service eligibility, that is, they are apparently healthy people without chronic diseases. A clear trend was found toward a decrease in seroprevalence as age increases. Therefore, we can assume a direct relationship between the formation of immune protection and age indicators in the population.
Table 6. Seroprevalence indicators in different age groups
Таблица 6. Показатели серопревалентности в различных возрастных группах
Age, years | ≤ 20 | 21–30 | 31–40 | 41–50 | 51–60 | ≥ 61 |
Proportion of individuals with IgG to SARS-CoV-2+, % (М ± m) | 96.7 ± 0.5 | 95.2 ± 0.6 | 94.2 ± 0.4 | 93.4 ± 0.8 | 92.9 ± 1.6 | 90.9 ± 4.4 |
CONCLUSION
The efficiency of Gam-COVID-Vac vaccination in military personnel contributes to the development of 95% of collective immunity to SARS-CoV-2, which fully corresponds to the vaccine characteristics declared by the manufacturer. Thus, the maximum vaccination coverage of all categories of military personnel will contribute to the formation of effective collective immunity and will reduce significantly the incidence of COVID-19 in organized military groups.
The results of the analysis of seroprevalence indicators in various samples, formed by blood types and Rh factor, as well as sex and age characteristics, enable to generate primary medical and social “portrait” of a serviceman who can develop the most adequate immune response to Gam-COVID-Vac, i.e., a male serviceman aged < 20 years with blood type A (II) Rh−. Thus, the vaccination of conscripts and cadets of military universities can be considered an exhaustive and effective medical and sanitary measure and antiepidemic (preventive) activity performed in military units (formations) and military educational organizations.
The lower seroprevalence rates in comparison with other samples in the NF group require additional verification. However, even now, the vaccination of military personnel in northern regions can be recommended during additional nonspecific immunoprophylaxis using immunomodulators and multivitamin preparations.м
1 Sanitary rules SP 1.2.036–95. The procedure for accounting, storage, transfer, and transportation of microorganisms of I–IV pathogenicity groups.
2 MU 3.1.3490–17. Epidemiology. Prevention of infectious diseases. The study of population immunity to influenza in the population of the Russian Federation (approved by the Chief Public Health Officer of the Russian Federation on October 27, 2017).
About the authors
Igor I. Azarov
Military Medical Academy of S.M. Kirov
Email: lantsov83@mail.ru
SPIN-code: 7673-7523
Russian Federation, Saint Petersburg
Dmitrii V. Ovchinnikov
Military Medical Academy of S.M. Kirov
Email: 79112998764@yandex.ru
ORCID iD: 0000-0001-8408-5301
SPIN-code: 5437-3457
Scopus Author ID: 36185599800
ResearcherId: AGK-7796-2022
Candidate of Medical Sciences, Associate Professor
Russian Federation, Saint PetersburgAlexander A. Kuzin
Military Medical Academy of S.M. Kirov
Email: paster-spb@mail.ru
SPIN-code: 6220-1218
Doctor of Medical Sciences, Associate Professor
Russian Federation, Saint PetersburgEvgeniy V. Lantsov
Military Medical Academy of S.M. Kirov
Author for correspondence.
Email: lantsov83@mail.ru
SPIN-code: 4384-2924
Candidate of Medical Sciences
Russian Federation, Saint PetersburgYuriy I. Bulankov
Military Medical Academy of S.M. Kirov
Email: dr.bulankov@mail.ru
SPIN-code: 7997-0230
Doctor of Medical Sciences, Associate Professor
Russian Federation, Saint PetersburgSergey V. Artebyakin
Military Medical Academy of S.M. Kirov
Email: asvdoc@rambler.ru
SPIN-code: 5536-5620
Adjunct
Russian Federation, Saint PetersburgDenis A. Zharkov
Military Medical Academy of S.M. Kirov
Email: jardenmed@mail.ru
SPIN-code: 5330-1690
Candidate of Medical Sciences
Russian Federation, Saint PetersburgPavel V. Kulikov
Military Medical Academy of S.M. Kirov
Email: kpvsel@mail.ru
ORCID iD: 0000-0002-6623-9474
SPIN-code: 7920-4582
Candidate of Medical Sciences
Russian Federation, Saint PetersburgReferences
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