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National- and State-level SARS-CoV-2 Immunity Trends From January 2020 to December 2023: a Mathematical Modeling

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The Journal of Infectious Diseases
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Population immunity against SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) wanes, increasing risk of infection and severe COVID-19. Despite widespread exposure, protection against infection is low, highlighting ongoing public health challenges.

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SARS-CoV-2effective protectionimmunological exposurevaccination

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Area of Science:

  • Epidemiology
  • Immunology
  • Public Health

Background:

  • Immune protection against SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is dynamic, influenced by viral evolution and diminishing immunity over time.
  • Estimating population-level immunity is crucial for understanding and mitigating COVID-19 disease burden.

Purpose of the Study:

  • To estimate population-level immunity and effective protection against SARS-CoV-2 infection and severe COVID-19 disease across the United States from January 2020 to December 2023.

Main Methods:

  • An updated mathematical model incorporating SARS-CoV-2 natural history and immunity waning was used.
  • The model integrated diverse data sources throughout the pandemic to generate population estimates.

Main Results:

  • By December 30, 2023, 98.6% of the U.S. population had immunological exposure to SARS-CoV-2.
  • Despite high exposure, population-level protection against infection was 31.6%, while protection against severe disease was 66.1%.

Conclusions:

  • A resurgence of SARS-CoV-2 infections and hospitalizations occurred in late 2023, coinciding with the JN.1 variant.
  • The U.S. population remains vulnerable to SARS-CoV-2 infection and severe COVID-19 due to waning immunity and viral evolution, despite high cumulative exposure.