Vaccination-infection interval determines cross-neutralization potency to SARS-CoV-2 Omicron after breakthrough infection by other variants

Sho Miyamoto, Takeshi Arashiro, Yu Adachi, Saya Moriyama, Hitomi Kinoshita, Takayuki Kanno, Shinji Saito, Harutaka Katano, Shun Iida, Akira Ainai, Ryutaro Kotaki, Souichi Yamada, Yudai Kuroda, Tsukasa Yamamoto, Keita Ishijima, Eun Sil Park, Yusuke Inoue, Yoshihiro Kaku, Minoru Tobiume, Naoko Iwata-YoshikawaNozomi Shiwa-Sudo, Kenzo Tokunaga, Seiya Ozono, Takuya Hemmi, Akira Ueno, Noriko Kishida, Shinji Watanabe, Kiyoko Nojima, Yohei Seki, Takuo Mizukami, Hideki Hasegawa, Hideki Ebihara, Ken Maeda, Shuetsu Fukushi, Yoshimasa Takahashi, Tadaki Suzuki

Research output: Contribution to journalArticlepeer-review


Background: The immune profile against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has dramatically diversified due to a complex combination of exposure to vaccines and infection by various lineages/variants, likely generating a heterogeneity in protective immunity in a given population. To further complicate this, the Omicron variant, with numerous spike mutations, has emerged. These circumstances have created the need to assess the potential of immune evasion by Omicron in individuals with various immune histories. Methods: The neutralization susceptibility of the variants, including Omicron and their ancestors, was comparably assessed using a panel of plasma/serum derived from individuals with divergent immune histories. Blood samples were collected from either mRNA vaccinees or from those who suffered from breakthrough infections of Alpha/Delta with multiple time intervals following vaccination. Findings: Omicron was highly resistant to neutralization in fully vaccinated individuals without a history of breakthrough infections. In contrast, robust cross-neutralization against Omicron was induced in vaccinees that experienced breakthrough infections. The time interval between vaccination and infection, rather than the variant types of infection, was significantly correlated with the magnitude and potency of Omicron-neutralizing antibodies. Conclusions: Immune histories with breakthrough infections can overcome the resistance to infection by Omicron, with the vaccination-infection interval being the key determinant of the magnitude and breadth of neutralization. The diverse exposure history in each individual warrants a tailored and cautious approach to understanding population immunity against Omicron and future variants. Funding: This study was supported by grants from the Japan Agency for Medical Research and Development (AMED).

Original languageEnglish (US)
Pages (from-to)249-261.e4
Issue number4
StatePublished - Apr 8 2022


  • BNT162b2 mRNA vaccine
  • COVID-19 vaccine
  • Omicron variant
  • SARS-CoV-2
  • Translation to patients
  • breakthrough infection
  • neutralizing antibody

ASJC Scopus subject areas

  • Medicine(all)


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