Serum per- and polyfluoroalkyl substance concentrations and longitudinal change in post-infection and post-vaccination SARS-CoV-2 antibodies.

Per- and polyfluoroalkyl substances (PFAS) are ubiquitous throughout the United States. Previous studies have shown PFAS exposure to be associated with a reduced immune response. However, the relationship between serum PFAS and antibody levels following SARS-CoV-2 infection or COVID-19 vaccination has not been examined. We examined differences in peak immune response and the longitudinal decline of antibodies following SARS-CoV-2 infection and COVID-19 vaccination by serum PFAS levels in a cohort of essential workers in the United States. We measured serum antibodies using an in-house semi-quantitative enzyme-linked immunosorbent assay (ELISA). Two cohorts contributed blood samples following SARS-CoV-2 infection or COVID-19 vaccination. We used linear mixed regression models, adjusting for age, race/ethnicity, gender, presence of chronic conditions, location, and occupation, to estimate differences in immune response with respect to serum PFAS levels. Our study populations included 153 unvaccinated participants that contributed 316 blood draws over a 14-month period following infection, and 860 participants and 2451 blood draws over a 12-month period following vaccination. Higher perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA) concentrations were associated with a lower peak antibody response after infection (p = 0.009, 0.031, 0.015). Higher PFOS, perfluorooctanoic acid (PFOA), PFHxS, and PFNA concentrations were associated with slower declines in antibodies over time after infection (p = 0.003, 0.014, 0.026, 0.025). PFOA, PFOS, PFHxS, and PFNA serum concentrations prior to vaccination were not associated with differences in peak antibody response after vaccination or with differences in decline of antibodies over time after vaccination. These results suggest that elevated PFAS may impede potential immune response to SARS-CoV-2 infection by blunting peak antibody levels following infection; the same finding was not observed for immune response to vaccination.

Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Allison L Naleway reports a relationship with Pfizer Inc that includes: funding grants. Allison L Naleway reports a relationship with Vir Biotechnology Inc that includes: funding grants. Kurt Hegmann reports a relationship with American College of Occupational and Environmental Medicine that includes: consulting or advisory. Kurt Hegmann reports a relationship with National Institute for Occupational Safety and Health that includes: funding grants. Manjusha Gaglani reports a relationship with Westat Inc that includes: funding grants. Manjusha Gaglani reports a relationship with Vanderbilt University Medical Center that includes: funding grants. Manjusha Gaglani reports a relationship with Abt Associates Inc that includes: funding grants. Manjusha Gaglani reports a relationship with Infectious Diseases and Immunization Committee, Texas Pediatric Society, Texas Chapter of the American Academy of Pediatrics that includes: board membership. Ryan Sprissler reports a relationship with American Council of Life Insurers that includes: speaking and lecture fees. Ryan Sprissler reports a relationship with California legal case Ebers v. Castle Park that includes: consulting or advisory. Ryan Sprissler reports a relationship with Geneticure, Inc. that includes: equity or stocks. Ryan Sprissler reports a relationship with Beckman Coulter that includes: speaking and lecture fees. Ryan Sprissler reports a relationship with Shay Emma Hammer Research Foundation that includes: board membership. Ryan Sprissler has patent issued to Arizona Board of Regents on Behalf of the University of Arizona.

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