Background

SARS-CoV-2 vaccination is recommended in patients with inborn errors of immunity (IEIs); however, little is known about immunogenicity and safety in these patients.

Objective

We sought to evaluate the impact of genetic diagnosis, age, and treatment on antibody response to COVID-19 vaccine and related adverse events in a cohort of patients with IEIs.

Methods

Plasma was collected from 22 health care worker controls, 81 patients with IEIs, and 2 patients with thymoma; the plasma was collected before immunization, 1 to 6 days before the second dose of mRNA vaccine, and at a median of 30 days after completion of the immunization schedule with either mRNA vaccine or a single dose of Johnson & Johnson’s Janssen vaccine. Anti-spike (anti-S) and anti-nucleocapsid antibody titers were measured by using a luciferase immunoprecipitation systems method. Information on T- and B-cell counts and use of immunosuppressive drugs was extracted from medical records, and information on vaccine-associated adverse events was collected after each dose.

Results

Anti-S antibodies were detected in 27 of 46 patients (58.7%) after 1 dose of mRNA vaccine and in 63 of 74 fully immunized patients (85.1%). A lower rate of seroconversion (7 of 11 [63.6%]) was observed in patients with autoimmune polyendocrinopathy–candidiasis–ectodermal dystrophy. Previous use of rituximab and baseline counts of less than 1000 CD3⁺ T cells/mL and less than 100 CD19⁺ B cells/mL were associated with lower anti-S IgG levels. No significant adverse events were reported.

Conclusion

Vaccinating patients with IEIs is safe, but immunogenicity is affected by certain therapies and gene defects. These data may guide the counseling of patients with IEIs regarding prevention of SARS-CoV-2 infection and the need for subsequent boosts.

中文翻译：

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具有各种先天性免疫缺陷的个体对 SARS-CoV-2 疫苗的抗体反应

背景

建议患有先天性免疫缺陷 (IEI) 的患者接种 SARS-CoV-2 疫苗；然而，人们对这些患者的免疫原性和安全性知之甚少。

客观的

我们试图评估基因诊断、年龄和治疗对 IEI 患者队列中 COVID-19 疫苗抗体反应和相关不良事件的影响。

方法

血浆采集自 22 名医护人员对照、81 名 IEI 患者和 2 名胸腺瘤患者；在免疫接种前、第二次 mRNA 疫苗接种前 1 至 6 天以及完成 mRNA 疫苗或单剂强生杨森疫苗免疫计划后的中位 30 天收集血浆。通过使用荧光素酶免疫沉淀系统方法测量抗刺突（抗-S）和抗核衣壳抗体滴度。从医疗记录中提取有关 T 细胞和 B 细胞计数以及使用免疫抑制药物的信息，并在每次接种后收集有关疫苗相关不良事件的信息。

结果

在接种 1 剂 mRNA 疫苗后，46 名患者中的 27 名 (58.7%) 和 74 名完全免疫的患者中的 63 名 (85.1%) 检测到了抗 S 抗体。在自身免疫性多内分泌病-念珠菌病-外胚层营养不良患者中观察到较低的血清转化率（11 例中有 7 例 [63.6%]）。先前使用利妥昔单抗和基线计数低于 1000 个 CD3 ⁺ T 细胞/mL 和低于 100 个 CD19 ⁺ B 细胞/mL 与较低的抗 S IgG 水平相关。没有报告明显的不良事件。

结论

为患者接种 IEIs 是安全的，但免疫原性会受到某些疗法和基因缺陷的影响。这些数据可以指导 IEIs 患者关于预防 SARS-CoV-2 感染和后续加强需求的咨询。