To the Editor.—Three coronavirus disease 2019 (COVID-19) vaccines targeting the viral spike protein (S)1 have received US Food and Drug Administration (FDA) Emergency Use Authorization (EUA).2 We measured levels of anti–severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in adults after they received Moderna, Pfizer-BioNTech (Pfizer), or Janssen/Johnson & Johnson (J&J) vaccines.
Between March and May 2021, we collected blood from 60 adults who had received at least 1 of 2 doses of Moderna (n = 48) or Pfizer (n = 6) vaccines or 1 dose of the J&J (n = 6) vaccine. Use of the samples was deemed exempt by the National Institutes of Health Institutional Review Board.
Plasma was analyzed for antibodies using Roche anti–SARS-CoV-2-S and anti–SARS-CoV-2-nucleocapsid (N) immunoassays on a cobas-6000 analyzer. Both assays have FDA EUAs and measure immunoglobulin (Ig) G, IgA, and IgM against their target proteins. Twelve J&J specimens were additionally analyzed for anti-S using a luciferase immunoprecipitation system assay.3
Participants had a median age of 46.2 years (range, 18–64 years) and 36 of the 60 participants (60%) were women. All Moderna (n = 48) vaccine recipients and all but 1 Pfizer vaccine recipients (n = 5) were positive for anti-S (Figure, A). This included 5 Moderna participants and 1 Pfizer participant who had received only 1 dose. All anti-N results were negative, except for 4 participants with history of SARS-CoV-2 infection (Figure, A).
Moderna and Pfizer vaccines induced positive anti-S as early as 7 and 19 days, respectively, post–first shot. A Pfizer participant with sequential samples was negative at day 27 and positive at day 84 (Figure, B). In J&J vaccine recipients (Figure, C), 2 participants (participant [P] 1 and P2) negative at days 16 (P1) and 19 (P2) became positive by days 20 and 30, respectively. P3 and P4 were positive when first tested at days 19 and 20 postvaccine. All 4 participants showed increases in anti-S levels, reaching 250 U/mL or more and 227.6 U/mL or more in P2 and P3, respectively, on day 69. Two participants, P5 (positive) and P6 (negative), were only tested once, at day 26. The 12 J&J specimens analyzed with a different assay showed even fewer specimens positive for anti-S (n = 6) than the Roche assay (n = 9) (Figure, D).
We found that nearly all vaccinated Moderna participants had anti-S levels that exceeded the upper limit of the Roche assay. By contrast, J&J vaccine recipients had anti-S levels that were negative or low 2 weeks after vaccination and gradually increased over time. Our results suggest that if J&J vaccine recipients were tested 2 weeks after vaccination, many may erroneously have been considered vaccine failures. It is possible that the commercial assay is insensitive, but there were even fewer positives with the immunoprecipitation assay. Alternatively, the J&J vaccine may induce an effective amnestic response, and/or another antibody or T-cell response may correlate with efficacy. Of note, the highly effective varicella vaccine induces antibody responses that are often not detected using commercial assays, and thus it is recommended that vaccinated patients not get tested.4 Our study is limited by the number of participants, particularly those who had received the Pfizer vaccine, which does not allow for strong conclusions regarding the similarities with or differences from Moderna or J&J in antibody temporal responses. Despite this limitation, the repeated testing of J&J participants indicates that measuring antibody levels within the first weeks of vaccination may give negative results and lead to unwarranted additional doses of vaccine.
The authors have no relevant financial interest in the products or companies described in this article.
This work was supported by the intramural research programs of the National Institutes of Health (NIH) Clinical Center, the National Institute of Allergy and Infectious Diseases, the National Institute of Dental and Craniofacial Research, and the National Heart, Lung, and Blood Institute.