Poster Presentation Lancefield International Symposium for Streptococci and Streptococcal Diseases 2025

Where did all the antibodies go? Exploring Immunity Gaps to Group A Streptococcus and other endemic respiratory pathogens following pandemic Restrictions in Aotearoa New Zealand (#286)

Natalie Lorenz 1 2 , Reuben McGregor 1 2 , Tiaan van Rooyen 1 , Aimee Paterson 1 , Lauren Carlton 1 , Ciara Ramiah 1 , Prachi Sharma 1 , Alex James 3 , Richard Charlewood 4 , Michael Baker 2 5 , Nikki Moreland 1 2
  1. School of Medical Sciences, University of Auckland, Auckland, New Zealand
  2. Maurice Wilkins Centre for Biodiscovery, Auckland, New Zealand
  3. Department of Mathematics, University of Canterbury, Christchurch, New Zealand
  4. The New Zealand Blood Service, Auckland, New Zealand
  5. Department of Public Health, University of Otago, Wellington, New Zealand

New Zealand, like many countries, reported reduced community transmission of Group A Streptococcus (Strep A) and other non-vaccine preventable respiratory pathogens as a consequence of COVID-19 pandemic restrictions. Subsequent to the relaxation of these restrictions, surges in infections caused by these pathogens were documented, often exceeding pre-pandemic levels. This large-scale study investigated whether reduced pathogen exposure during the pandemic resulted in immunity gaps that may have contributed to these surges. It utilised samples from long term plasma donors collected by the New Zealand Blood Service between January 2020 and September 2023 and involved screening >4500 individual donations. Building on our prior assay systems for Strep A and SARS-CoV-2 serology, a new multi-pathogen bead-based assay comprised of major antigens from Strep A (Streptolysin-O, SpnA, DNaseB and SpeA), respiratory syncytial virus (RSV; glycoproteins G and F), endemic human coronaviruses (hCoV; NL63 and HKU1 spike), and SARS-CoV-2 (spike) was developed for detection of pathogen specific antibodies (IgG). Both paired analysis and mixed effect modelling showed significant reductions in IgG to antigens from Strep A, RSV, and hCoV over the 3-year period, with average, antigen-specific decreases ranging from 6-20%. In contrast, IgG for SARS-CoV-2 spike increased exponentially over the same time period. The observed reduction in IgG to Strep A and other respiratory pathogens likely reflects reduced exposure to these endemic agents during the pandemic, and may have contributed to the pronounced infection surges in 2023.