A Multidimensional Immune Signature Predicts Susceptibility to Omicron Infection in Vaccinated Individuals

Substantial inter-individual variation in susceptibility to viral infection persists despite widespread vaccination, and its immunological basis remains poorly understood. We investigated how innate and adaptive immune responses contribute to susceptibility to SARS-CoV-2 infection during the early COVID-19 pandemic. We compared two groups of vaccinated individuals who either remained uninfected or became infected during the first Omicron wave. Blood samples were collected at baseline and 24 weeks later. Peripheral blood mononuclear cells (PBMCs) and polymorphonuclear neutrophils (PMNs) were isolated and stimulated with the TLR7/8 agonist R848 to assess innate responses. PBMCs were stimulated with SARS-CoV-2 peptide pools and highly purified inactivated viruses (ancestral and Omicron BA.1) to evaluate adaptive immunity. Prior to infection, individuals in the infected group exhibited reduced CD4 and CD8 T cells proliferative responses, alongside with increased TNF production across all stimulation conditions, despite largely comparable immune phenotypes, indicating a pre-existing functional immune deficit. Following infection, T-cell proliferation and IFN-gamma production were partially restored in response to viral antigens, although responses to Omicron BA.1 remained suboptimal. This functional deficit was accompanied by heightened inflammatory activity, including increased TNF and IFN-gamma production, elevated anti-nucleocapsid IgG3 levels, higher frequencies of B cells and myeloid cells, reduced circulating interferon-inducible T-cell Alpha Chemoattractant (I-TAC) concentrations, and a modest impairment in PMN IL-8 responses. Notably, these alterations were detectable prior to infection and persisted thereafter, indicating that they represent determinants rather than consequences of viral infection. Importantly, beyond differences in the magnitude of immune responses, protection was associated with the degree of functional coordination within the humoral compartment, as reflected by the relationship between Spike-binding antibodies and neutralizing activity. Together, these results demonstrate that susceptibility to Omicron infection is linked to a pre-existing and persistent functional immune imbalance affecting both innate and adaptive arms of immunity.