BNT162b2 mRNA COVID-19 vaccination in immunocompromised patients: A prospective cohort study

Rahav, Galia; Lustig, Yaniv; Lavee, Jacob; Benjamini, Ohad; Magen, Hila; Hod, Tammy; Shem‐Tov, Noga; Shmueli, Einat; Merkel, Drorit; Ben‐Ari, Ziv; Halperin, Rebecca F.; Indenbaum, Victoria; Olmer, Liraz; Huppert, Amit; Mor, Eytan; Regev‐Yochay, Gili; Cohen, Carmit; Finesod, Anat Wieder; Levy, Itzchak

doi:10.1016/j.eclinm.2021.101158

“…72% of doses in Tyrol by the end of the study [14], compared to 16% with ChAdOx1-S and 10% with mRNA-1273) are in close agreement with the time trends following receipt of first and second dose vaccination previously reported for mRNA COVID-19 vaccines [15][16][17]. Given the limited phenotypic information available in our study, we could not investigate in detail why a small fraction of participants (0.4%) were nonresponders to full vaccination, but different immunocompromising conditions are associated with a lack in immunogenicity [18]. Nevertheless, substantially higher anti-S IgG levels were visible in younger individuals and individuals with prior SARS-CoV-2 infection, while lower anti-S IgG levels were detected among male participants and smokers.…”

Section: Discussionsupporting

confidence: 88%

Seroprevalence, waning, and correlates of anti-SARS-CoV-2 IgG antibodies in Tyrol, Austria: Large-scale study of 35,193 blood donors conducted between June 2020 and September 2021

Siller

¹

,

Seekircher

²

,

Wachter

³

et al. 2021

Preprint

0

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Background: There is uncertainty about the seroprevalence of anti-SARS-CoV-2 antibodies in the general population of Austria, and about the extent to which antibodies elicited by vaccination or infection wane over time. Aim: To estimate seroprevalence, waning, and correlates of anti-SARS-CoV-2 IgG antibodies in the Federal State of Tyrol, Austria. Methods: We conducted a seroepidemiological study between June 2020 and September 2021, enrolling blood donors aged 18-70 years across Tyrol, Austria (participation rate 84.0%). We analysed serum samples for antibodies against spike or nucleocapsid proteins of SARS-CoV-2 with Abbott SARS-CoV-2 IgG assays. Results: We performed 47,363 serological tests among 35,193 individuals (median age 43.1 years [IQR: 29.3-53.7], 45.3% women, 10.0% with prior SARS-CoV-2 infection). Seroprevalence increased from 3.4% (95% CI: 2.8-4.2%) in June 2020 to 82.7% (95% CI: 81.4-83.8%) in September 2021, largely due to vaccination. Anti-spike IgG seroprevalence was 99.6% (99.4-99.7%) among fully vaccinated individuals, 90.4% (88.8-91.7%) among unvaccinated with prior infection, and 11.5% (10.8-12.3%) among unvaccinated without known prior infection. Anti-spike IgG levels were reduced by 44.0% (34.9-51.7%) at 5-6 months compared to 0-3 months after infection. In fully vaccinated individuals, they decreased by 31.7% (29.4-33.9%) per month. In multivariable adjusted analyses, both seropositivity among unvaccinated and antibody levels among fully vaccinated individuals were higher at young age (<25 years), higher with a known prior infection, and lower in current smokers. Conclusion: Seroprevalence in Tyrol increased to 82.7% in September 2021, with the bulk of seropositivity stemming from vaccination. Antibody levels substantially and gradually declined after vaccination or infection.

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“…Overall, 82 studies were included for meta-analysis ( table 1 , supplementary table 2). 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 …”

Section: Resultsmentioning

confidence: 99%

“…The current meta-analysis further stratified results according to seroconversion and antibody titres after a first dose and second dose. * Study by Rahav et al 27 included patients with solid cancers, haematological cancers, immune mediated inflammatory disorders, organ transplants, and HIV/AIDS. Study by Monin et al 28 included patients with solid cancers and haematological cancers.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of covid-19 vaccines in immunocompromised patients: systematic review and meta-analysis

Lee

¹

,

Wong

²

,

Chai

³

et al. 2022

BMJ

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Objective To compare the efficacy of covid-19 vaccines between immunocompromised and immunocompetent people. Design Systematic review and meta-analysis. Data sources PubMed, Embase, Central Register of Controlled Trials, COVID-19 Open Research Dataset Challenge (CORD-19), and WHO covid-19 databases for studies published between 1 December 2020 and 5 November 2021. ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched in November 2021 to identify registered but as yet unpublished or ongoing studies. Study selection Prospective observational studies comparing the efficacy of covid-19 vaccination in immunocompromised and immunocompetent participants. Methods A frequentist random effects meta-analysis was used to separately pool relative and absolute risks of seroconversion after the first and second doses of a covid-19 vaccine. Systematic review without meta-analysis of SARS-CoV-2 antibody titre levels was performed after first, second, and third vaccine doses and the seroconversion rate after a third dose. Risk of bias and certainty of evidence were assessed. Results 82 studies were included in the meta-analysis. Of these studies, 77 (94%) used mRNA vaccines, 16 (20%) viral vector vaccines, and 4 (5%) inactivated whole virus vaccines. 63 studies were assessed to be at low risk of bias and 19 at moderate risk of bias. After one vaccine dose, seroconversion was about half as likely in patients with haematological cancers (risk ratio 0.40, 95% confidence interval 0.32 to 0.50, I 2 =80%; absolute risk 0.29, 95% confidence interval 0.20 to 0.40, I 2 =89%), immune mediated inflammatory disorders (0.53, 0.39 to 0.71, I 2 =89%; 0.29, 0.11 to 0.58, I 2 =97%), and solid cancers (0.55, 0.46 to 0.65, I 2 =78%; 0.44, 0.36 to 0.53, I 2 =84%) compared with immunocompetent controls, whereas organ transplant recipients were 16 times less likely to seroconvert (0.06, 0.04 to 0.09, I 2 =0%; 0.06, 0.04 to 0.08, I 2 =0%). After a second dose, seroconversion remained least likely in transplant recipients (0.39, 0.32 to 0.46, I 2 =92%; 0.35, 0.26 to 0.46), with only a third achieving seroconversion. Seroconversion was increasingly likely in patients with haematological cancers (0.63, 0.57 to 0.69, I 2 =88%; 0.62, 0.54 to 0.70, I 2 =90%), immune mediated inflammatory disorders (0.75, 0.69 to 0.82, I 2 =92%; 0.77, 0.66 to 0.85, I 2 =93%), and solid cancers (0.90, 0.88 to 0.93, I 2 =51%; 0.89, 0.86 to 0.91, I 2 =49%). Seroconversion was similar between people with HIV and immunocompetent controls (1.00, 0.98 to 1.01, I 2 =0%; 0.97, 0.83 to 1.00, I 2 =89%). Systematic review of 11 studies showed that a third dose of a covid-19 mRNA vaccine was associated with seroconversion among vaccine non-responders with solid cancers, haematological cancers, and immune mediated inflammatory disorders, although response was variable in transplant recipients and inadequately studied in people with HIV and those receiving non-mRNA vaccines. Conclusion Seroconversion rates after covid-19 vaccination were significantly lower in immunocompromised patients, especially organ transplant recipients. A second dose was associated with consistently improved seroconversion across all patient groups, albeit at a lower magnitude for organ transplant recipients. Targeted interventions for immunocompromised patients, including a third (booster) dose, should be performed. Systematic review registration PROSPERO CRD42021272088.

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“…The mRNA vaccines for COVID-19 were developed more quickly than any other vaccine in history. The first one is from Pfizer/BioNTech mRNA vaccine (BNT162b2) with 95% efficacy in neutralizing COVID-19 symptoms in 44,000 participants (89). The second vaccination, known as Moderna mRNA-1273 vaccine, was found 94.1% effective in a study conducted in 30,000 subjects (90).…”

Section: Importance and Challenges Of Vaccine Developmentmentioning

confidence: 99%