Response to Severe Acute Respiratory Syndrome Coronavirus 2 Initial Series and Additional Dose Vaccine in Patients With Predominant Antibody Deficiency.
J Allergy Clin Immunol Pract
; 10(6): 1622-1634.e4, 2022 06.
Article
em En
| MEDLINE
| ID: mdl-35381395
ABSTRACT
BACKGROUND:
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with predominant antibody deficiency (PAD) is associated with high morbidity, yet data regarding the response to SARS-CoV-2 immunization in PAD patients, including additional dose vaccine, are limited.OBJECTIVE:
To characterize antibody response to SARS-CoV-2 vaccine in PAD patients and define correlates of vaccine response.METHODS:
We assessed the levels and function of anti-SARS-CoV-2 antibodies in 62 PAD patients compared with matched healthy controls at baseline, at 4 to 6 weeks after the initial series of immunization (a single dose of Ad26.COV2.S [Janssen] or two doses of BNT162b2 [Pfizer-BioNTech] or mRNA-1273 [Moderna]), and at 4 to 6 weeks after an additional dose immunization, if received.RESULTS:
After the initial series of SARS-CoV-2 vaccination, PAD patients had lower mean anti-spike antibody levels compared with matched healthy controls (140.1 vs 547.3 U/mL; P = .02). Patients with secondary PAD (eg, B-cell depletion therapy was used) and those with severe primary PAD (eg, common variable immunodeficiency with autoinflammatory complications) had the lowest mean anti-spike antibody levels. Immune correlates of a low anti-spike antibody response included low CD4+ T helper cells, low CD19+ total B cells, and low class-switched memory (CD27+IgD/M-) B cells. In addition, a low (<100 U/mL) anti-spike antibody response was associated with prior exposure to B-cell depletion therapy, both at any time in the past (odds ratio = 5.5; confidence interval, 1.5-20.4; P = .01) and proximal to vaccination (odds ratio = 36.4; confidence interval, 1.7-791.9; P = .02). Additional dose immunization with an mRNA vaccine in a subset of 31 PAD patients increased mean anti-spike antibody levels (76.3 U/mL before to 1065 U/mL after the additional dose; P < .0001).CONCLUSIONS:
Patients with secondary and severe primary PAD, characterized by low T helper cells, low B cells, and/or low class-switched memory B cells, were at risk for low antibody response to SARS-CoV-2 immunization, which improved after an additional dose vaccination in most patients.Palavras-chave
Additional dose; Anti-nucleocapsid antibody; Anti-spike antibody; COVID-19; CVID; Common variable immunodeficiency; Humoral immunodeficiency; Hypogammaglobulinemia; IgG subclass deficiency; Neutralization assay; Predominant antibody deficiency; SARS-CoV-2; Specific antibody deficiency; Vaccine response
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Vacinas Virais
/
COVID-19
Limite:
Humans
Idioma:
En
Revista:
J Allergy Clin Immunol Pract
Ano de publicação:
2022
Tipo de documento:
Article