SARS-CoV-2 Vaccine Responses in Individuals with Antibody Deficiency: Findings from the COV-AD Study

被引：46

作者：

Shields, Adrian M. ^{[1
,2
]}

Faustini, Sian E. ^{[1
]}

Hill, Harriet J. ^{[3
]}

Al-Taei, Saly ^{[1
]}

Tanner, Chloe ^{[1
]}

Ashford, Fiona ^{[1
]}

Workman, Sarita ^{[4
]}

Moreira, Fernando ^{[4
]}

Verma, Nisha ^{[4
]}

Wagg, Hollie ^{[5
]}

Heritage, Gail ^{[5
]}

Campton, Naomi ^{[5
]}

Stamataki, Zania ^{[3
]}

Klenerman, Paul ^{[6
]}

Thaventhiran, James E. D. ^{[7
]}

Goddard, Sarah ^{[8
]}

Johnston, Sarah ^{[9
]}

Huissoon, Aarnoud ^{[2
]}

Bethune, Claire ^{[10
]}

Elcombe, Suzanne ^{[11
]}

Lowe, David M. ^{[4
,12
]}

Patel, Smita Y. ^{[6
,13
]}

Savic, Sinisa ^{[14
]}

Burns, Siobhan O. ^{[4
,12
]}

Richter, Alex G. ^{[1
,2
]}

机构：

[1] Univ Birmingham, Inst Immunol & Immunotherapy, Clin Immunol Serv, Birmingham, W Midlands, England

[2] Univ Hosp Birmingham NHS Fdn Trust, Birmingham, W Midlands, England

[3] Univ Birmingham, Inst Immunol & Immunotherapy, Birmingham, W Midlands, England

[4] Royal Free London NHS Fdn Trust, Dept Immunol, London, England

[5] Univ Birmingham, Inst Translat Med, Birmingham, W Midlands, England

[6] Univ Oxford, Nuffield Dept Med, Oxford, England

[7] Univ Cambridge, Med Res Council Toxicol Unit, Gleeson Bldg,Tennis Court Rd, Cambridge CB2 1QW, England

[8] Univ Hosp North Midlands, Dept Clin Immunol, Stoke On Trent, Staffs, England

[9] North Bristol NHS Trust, Dept Clin Immunol, Bristol, Avon, England

[10] Univ Hosp Plymouth NHS Trust, Dept Allergy & Clin Immunol, Plymouth, Devon, England

[11] Newcastle Upon Tyne Hosp NHS Fdn Trust, Dept Allergy & Clin Immunol, Newcastle Upon Tyne, Tyne & Wear, England

[12] UCL, Inst Immun & Transplantat, London, England

[13] Univ Oxford, NIHR BRC Oxford Biomed Ctr, Oxford, England

[14] Leeds Teaching Hosp NHS Trust, Dept Allergy & Clin Immunol, Leeds, W Yorkshire, England

来源：

JOURNAL OF CLINICAL IMMUNOLOGY | 2022年 / 42卷 / 05期

基金：

英国科研创新办公室;

关键词：

COVID-19; CVID; Inborn errors of immunity; Primary immunodeficiency; Secondary immunodeficiency; Vaccination; SARS-CoV-2; COVID-19; IMMUNODEFICIENCY;

D O I：

10.1007/s10875-022-01231-7

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background Vaccination prevents severe morbidity and mortality from COVID-19 in the general population. The immunogenicity and efficacy of SARS-CoV-2 vaccines in patients with antibody deficiency is poorly understood. Objectives COVID-19 in patients with antibody deficiency (COV-AD) is a multi-site UK study that aims to determine the immune response to SARS-CoV-2 infection and vaccination in patients with primary or secondary antibody deficiency, a population that suffers from severe and recurrent infection and does not respond well to vaccination. Methods Individuals on immunoglobulin replacement therapy or with an IgG less than 4 g/L receiving antibiotic prophylaxis were recruited from April 2021. Serological and cellular responses were determined using ELISA, live-virus neutralisation and interferon gamma release assays. SARS-CoV-2 infection and clearance were determined by PCR from serial nasopharyngeal swabs. Results A total of 5.6% (n = 320) of the cohort reported prior SARS-CoV-2 infection, but only 0.3% remained PCR positive on study entry. Seropositivity, following two doses of SARS-CoV-2 vaccination, was 54.8% (n = 168) compared with 100% of healthy controls (n = 205). The magnitude of the antibody response and its neutralising capacity were both significantly reduced compared to controls. Participants vaccinated with the Pfizer/BioNTech vaccine were more likely to be seropositive (65.7% vs. 48.0%, p = 0.03) and have higher antibody levels compared with the AstraZeneca vaccine (IgGAM ratio 3.73 vs. 2.39, p = 0.0003). T cell responses post vaccination was demonstrable in 46.2% of participants and were associated with better antibody responses but there was no difference between the two vaccines. Eleven vaccine-breakthrough infections have occurred to date, 10 of them in recipients of the AstraZeneca vaccine. Conclusion SARS-CoV-2 vaccines demonstrate reduced immunogenicity in patients with antibody deficiency with evidence of vaccine breakthrough infection.

引用

页码：923 / 934

页数：12

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