Neutralizing antibody response to Omicron subvariants BA.1 and BA.5 in children and adolescents following the two-dose CoronaVac protocol (Immunita-002, Brazil): A 12-month longitudinal study

Camila Corsini¹Guilherme Campos²Priscila Fernanda da S Martins¹Priscilla Soares Filgueiras¹Ana Esther De S Lima¹Sarah Vieira Contin Gomes¹Caroline de AL Curimbaba³Daniela A Lorencini³Eolo M Junior³Victor M da Silva³Maria Célia Cervi⁴Marcos Borges^4,5Poliana R de Lima⁵João Paulo R do Nascimento⁵Paulo Roberto L Correa⁶Leda Dos R Castilho⁷Jaquelline Germano De Oliveira¹Olindo Assis Martins Filho¹Mauricio Lacerda Nogueira^2,8,9Immunita Team¹Rafaella Fortini Queiroz e Grenfell^1,10*

• ¹Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
• ²Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brazil
• ³Butantan Institute, São Paulo, São Paulo, Brazil
• ⁴University of São Paulo, São Paulo, Rio Grande do Sul, Brazil
• ⁵Serrana Clinical Research Center, Serrana, Brazil
• ⁶Belo Horizonte Municipal Health Department, Belo Horizonte, Brazil
• ⁷Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
• ⁸Base Hospital, Sao Jose, Sao Paulo, Brazil
• ⁹University of Texas Medical Branch at Galveston, Galveston, Texas, United States
• ¹⁰University of Georgia, Athens, Georgia, United States

The covid-19 pandemic prompted an unprecedented global effort to develop and deploy vaccines, including CoronaVac, an inactivated virus-based vaccine. While these vaccines effectively reduced severe cases and hospitalizations, limited data exists on their immunogenicity in younger populations, particularly children and adolescents. Understanding the immune response in these groups is essential to guide vaccination strategies and assess protection against emerging variants of concern, such as Omicron subvariants BA.1 and BA.5. This study evaluated the neutralizing antibody response in children and adolescents aged 3-17 years over 12 months following the two-dose CoronaVac protocol in Brazil.A cohort of 108 children (3-11 years) and adolescents (12-17 years) from Serrana, Brazil, received two doses of CoronaVac. Peripheral blood samples were collected at baseline, and at 1, 3, 6, and 12 months after the second dose. Participants were stratified by serostatus prior to vaccination. Neutralizing antibodies against Omicron BA.1 and BA.5 were assessed using microneutralization assays.Neutralizing antibody titers increased significantly after vaccination in both seronegative and seropositive individuals. For seronegative participants, seroconversion rates for BA.5 rose from 16.6% pre-vaccination to 93.3% one month after the second dose in children, and from 50% to 92% in adolescents, with sustained levels for 12 months. Seropositive participants also showed enhanced antibody titers, particularly against BA.5. No significant differences in neutralization between BA.1 and BA.5 were observed post-vaccination, contrary to prior literature, suggesting uniform effectiveness against these subvariants.Discussion: This study demonstrates that CoronaVac significantly enhances and sustains neutralizing antibody titers in children and adolescents for up to one year, including against immune-evading subvariants like BA.5. The robust response highlights the vaccine's potential as a critical tool for reducing SARS-CoV-2 transmission and preventing severe disease, particularly in regions with limited access to updated vaccines. Further studies with larger cohorts are needed to validate these findings and inform vaccination strategies for immunoresistant variants.