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We explored the impact of ancestral\/BA.1 bivalent mRNA booster vaccination (Autumn 2022) on peripheral and nasal antibody and T-cell responses to SARS-CoV-2 in an observational cohort of 133 healthcare workers, building on previous longitudinal vaccination studies. We demonstrate that maintenance of antibody and T-cell responses up to eighteen months following the third vaccine is at least partially driven by intercurrent infection. Boosting with the bivalent vaccine increases the breadth of circulating and nasal antibodies to spike, which waned over time but was still detectable six months post-dose. T-cell responses are well maintained and highly cross-reactive to VOCs irrespective of booster vaccination. Vaccination strongly boosted nasal IgG, but this was short-lived compared to circulating antibodies. 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He has received consulting fees from Astrazeneca and Synairgen paid to the University of Liverpool and support for conference attendance from AstraZeneca. TIdS has provided consultancy services to CSL Sequiris, Synairgen and Geovax which were paid to the University of Sheffield. GRS sits on the GSK Vaccines Scientific Advisory Board and is a founder member of RQ Biotechnology. CJAD has acted on behalf of Newcastle upon Tyne Hospitals NHS Foundation Trust as an investigator on clinical trials of COVID-19 and other vaccines sponsored by Moderna, AstraZeneca, Janssen, and Valneva, receiving no personal financial renumeration. CJAD has provided consultative advice to Synairgen, with renumeration to Newcastle University. CJAD serves on data safety and monitoring boards for non-commercial clinical trials conducted by University of Oxford, for which no renumeration is provided. EB is a member of the UK Joint Committee of Vaccines and Immunisation (JCVI). She holds patents in HBV and HCV vaccine antigens,  has consulted for Vaccitech, and has conducted vaccine studies funded by Vaccitech, Astrazeneca and NeoVac. All the remaining authors declare no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"45438"}}