Effect of Immunosuppression on the Immunogenicity of mRNA Vaccines to SARS-CoV-2

Abstract

Evidence suggests that immunogenicity to mRNA-based SARS-CoV-2 vaccination in immunosuppressed patients may be reduced. This study assessed the response to 2 doses of mRNA-based SARS-CoV-2 vaccine among 133 participants with underlying chronic inflammatory disease, many of whom were receiving glucocorticoids, B-cell depletion therapy, or other immunosuppressant therapy.

Effectiveness of 2-Dose Vaccination with mRNA COVID-19 Vaccines Against COVID-19–Associated Hospitalizations Among Immunocompromised Adults — Nine States, January–September 2021

“…This study also found that VE was lower among certain subgroups of immunocompromised adults, such as solid organ or stem cell transplant recipients, than among others. These findings are consistent with other studies suggesting that certain immunocompromised persons experience an attenuated immune response to COVID-19 vaccines and make up a large proportion of hospitalizations for infections after vaccination (3,4). The prevalence of SARS-CoV-2 infection was approximately two times greater among unvaccinated immunocompetent patients compared with unvaccinated immunocompromised patients.…”

The Advisory Committee on Immunization Practices’ Interim Recommendations for Additional Primary and Booster Doses of COVID-19 Vaccines — United States, 2021

“…¶ ¶ ACIP recommendations for an additional dose of mRNA COVID-19 vaccine in certain immunocompromised persons were guided by data on reduced immunogenicity and effectiveness of the initial primary COVID-19 vaccination series in this population, as well as evidence of an immune response and an acceptable safety profile after an additional mRNA COVID-19 vaccine dose. During the period preceding the emergence of the highly transmissible SARS-CoV-2 B.1.617.2 (Delta) variant, vaccine effectiveness (VE) of a primary mRNA COVID-19 vaccination series against SARS-CoV-2 infection in persons aged ≥16 years was estimated to be 71% (95% confidence interval [CI] = 37%-87%) in immunocompromised persons versus 90% (95% CI = 83%-96%) in the general population and 59% (95% CI = 12%-81%) against COVID-19-associated hospitalization in immunocompromised persons aged ≥18 years versus 91% (95% CI = 86%-95%) in persons who were not immunocompromised (3). In a series of small studies, 16% to 80% of solid organ transplant recipients and hemodialysis patients had no detectable antibody § § As part of GRADE, the ACIP COVID-19 Vaccines Work Group conducted a systematic review of published and unpublished data.…”

“…Additional information on the GRADE approach used by ACIP is available at https://www.cdc.gov/vaccines/acip/recs/grade/about-grade.html. ¶ ¶ https://www.cdc.gov/vaccines/acip/recs/grade/downloads/acip-evidence-recsframework.pdf response after the second dose of an mRNA COVID-19 vaccine; among these persons, 33% to 55% developed antibodies after receiving an additional dose (3). Local and systemic reactions reported after an additional dose of mRNA COVID-19 vaccine in certain immunocompromised persons were mostly mild to moderate and similar to those observed after previous doses; no severe adverse events were reported (3).…”

COVID-19 vaccination in patients with immunity-mediated kidney disease

“…Patients treated with B cell-depleting agents such as rituximab show markedly diminished serological responses to both mRNA-based and adenoviral vector-based SARS-CoV-2 vaccines. The serological response correlates positively with B cell count and time elapsed since rituximab treatment 4 , 8 , 9 . In one study, only 41% of patients treated with rituximab in the preceding 6 months had a detectable serological response 8 .…”

“…Similar to other vaccines, treatment with high-dose glucocorticoids (>10 mg/day) is associated with low serological responses to SARS-CoV-2 mRNA vaccines 9 . In a study that included patients with systemic lupus erythematosus and vasculitis, treatment with mycophenolate mofetil was also associated with an impaired humoral response to mRNA vaccination 4 .…”