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Nat Aging . Immunovirological and environmental screening reveals actionable risk factors for fatal COVID-19 during post-vaccination nursing home ou

tetano

Editor, Senior Moderator
Nat Aging


. 2023 May 22.
doi: 10.1038/s43587-023-00421-1. Online ahead of print. Immunovirological and environmental screening reveals actionable risk factors for fatal COVID-19 during post-vaccination nursing home outbreaks

Lize Cuypers[SUP] #[/SUP][SUP] 1 2 [/SUP], Els Keyaerts[SUP] #[/SUP][SUP] 1 2 [/SUP], Samuel Leandro Hong[SUP] 3 [/SUP], Sarah Gorissen[SUP] 2 [/SUP], Soraya Maria Menezes[SUP] 3 [/SUP], Marick Starick[SUP] 3 [/SUP], Jan Van Elslande[SUP] 1 [/SUP], Matthias Weemaes[SUP] 1 [/SUP], Tony Wawina-Bokalanga[SUP] 3 [/SUP], Joan Marti-Carreras[SUP] 3 [/SUP], Bert Vanmechelen[SUP] 3 [/SUP], Bram Van Holm[SUP] 3 [/SUP], Mandy Bloemen[SUP] 3 [/SUP], Jean-Michel Dogne[SUP] 4 [/SUP], François Dufrasne[SUP] 5 6 [/SUP], Keith Durkin[SUP] 7 [/SUP], Jean Ruelle[SUP] 8 [/SUP], Ricardo De Mendonca[SUP] 9 [/SUP], Elke Wollants[SUP] 3 [/SUP], Pieter Vermeersch[SUP] 1 [/SUP]; COVID-19 Genomics Belgium Consortium; Caroline Boulouffe[SUP] 10 [/SUP], Achille Djiena[SUP] 10 [/SUP], Caroline Broucke[SUP] 11 [/SUP], Boudewijn Catry[SUP] 12 [/SUP], Katrien Lagrou[SUP] 1 2 [/SUP], Marc Van Ranst[SUP] 1 3 [/SUP], Johan Neyts[SUP] 13 [/SUP], Guy Baele[SUP] 3 [/SUP], Piet Maes[SUP] 3 [/SUP], Emmanuel André[SUP] 1 2 [/SUP], Simon Dellicour[SUP] 3 14 [/SUP], Johan Van Weyenbergh[SUP] 15 [/SUP]



Collaborators, Affiliations
Abstract

Coronavirus Disease 2019 (COVID-19) vaccination has resulted in excellent protection against fatal disease, including in older adults. However, risk factors for post-vaccination fatal COVID-19 are largely unknown. We comprehensively studied three large nursing home outbreaks (20-35% fatal cases among residents) by combining severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) aerosol monitoring, whole-genome phylogenetic analysis and immunovirological profiling of nasal mucosa by digital nCounter transcriptomics. Phylogenetic investigations indicated that each outbreak stemmed from a single introduction event, although with different variants (Delta, Gamma and Mu). SARS-CoV-2 was detected in aerosol samples up to 52 d after the initial infection. Combining demographic, immune and viral parameters, the best predictive models for mortality comprised IFNB1 or age, viral ORF7a and ACE2 receptor transcripts. Comparison with published pre-vaccine fatal COVID-19 transcriptomic and genomic signatures uncovered a unique IRF3 low/IRF7 high immune signature in post-vaccine fatal COVID-19 outbreaks. A multi-layered strategy, including environmental sampling, immunomonitoring and early antiviral therapy, should be considered to prevent post-vaccination COVID-19 mortality in nursing homes.


 
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