The assessment of surrogate endpoints of vaccine effectiveness is essentially based on laboratory tests, and encompasses SARS-CoV-2 serological immunoassays, as surrogate measures of humoral immunity and neutralizing antibodies, interferon-gamma release assays, as surrogate tests aimed at deciphering and monitoring cellular immunity, along with flow cytometry techniques for assessing the presence and number of memory B cells. Notably, the value of monitoring anti-SARS-CoV-2 neutralizing antibodies is well documented in the literature, thus providing a reliable basis for optimizing vaccine strategies aimed at controlling SARS-CoV-2 outbreaks. Conversely, major efforts are still needed to better standardize laboratory tests for investigating cellular immunity and evaluating their overall utility in clinical practice. There is now an open debate on the distribution of COVID-19 vaccines among different settings and countries, with the need to set a delicate balance between administration of the first vaccine dose to naïve individuals versus the use of additional boosters for preventing waning of immunity in those who have already received previous doses. While this debate continues, we proffer that laboratory-guided vaccine stewardship may represent a feasible and potentially valuable tool in this ongoing and strenuous fight against COVID-19.
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