Neutralizing antibody response to different COVID-19 vaccines in Brazil: the impact of previous infection and booster doses

Beatriz L L Caetano¹Paolla Beatriz De Almeida Pinto¹Agatha Rezende Pacheco¹Agnes R Lage¹Aline S G Pereira¹Amanda V P Nascimento¹Thiago R Machado¹Anderson P Araújo¹Thiago L Medeiros¹Lorena O Fernandes-Siqueira²Andrea Da Poian²Ingrid S Horbach¹ADRIANA Azevedo²Simone Morais Costa¹Ada Maria De Barcelos Alves^1*

• ¹Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
• ²Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil

Introduction: In Brazil, three COVID-19 vaccines were among the first widely used (CoronaVac, ChAdOx1, and BNT162b2), which aimed to induce neutralizing antibodies (NAbs) against the original SARS-CoV-2 strain. Although effective against severe disease, they showed waning NAb levels and reduced efficacy against variants, demanding prompting booster doses. Thus, it is important to investigate and compare the response induced by these vaccines and boosters. Methods: In this study, we compare the magnitude, durability, and cross-reactivity of NAbs among vaccinated volunteers in Brazil using an ELISA-based assay that measures Abs capable of blocking the interaction between the receptor binding domain (RBD) and human angiotensin-converting enzyme 2 (ACE2) receptor the blocking of Ab binding to human ACE2. Results: The BNT162b2 two-dose regimen resulted in the highest and most durable NAb levels, followed by ChAdOx1, while those induced by CoronaVac significantly declined over time. Breakthrough infections boosted NAb levels, especially for CoronaVac and ChAdOx1. All vaccines showed reduced neutralizing capacity against Gamma, Delta, and Omicron variants. Booster doses, particularly the first one, significantly increased and maintained NAb levels, including those against Omicron. Discussion: Our findings provide valuable populationbased comparison of NAb levels elicited by different vaccines following primary inoculation and booster dosesevidence of differential responses across vaccine platforms and the importance of the first booster dose. Notably, the mRNA vaccine exhibited a strong primary and initial booster NAb response against the SARS-CoV-2.