Immunosuppression and SARS-CoV-2 breakthrough infections

Kim, Alfred H.J.

doi:10.1016/s2665-9913(22)00127-8

Cited by 11 publications

(11 citation statements)

References 9 publications

(8 reference statements)

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“…Of note, 14.3% of vaccinated seronegative patients were affected by primary or secondary immunosuppression, in contrast with 2.3% of vaccinated seropositive patients. This is in line with described observations of an increased ratio of breakthrough infections in vaccinated immunosuppressed patients [ 12 , 25 ], although in the study of Kim et al . differences were not significant at multivariate analyses [ 12 ].…”

Section: Discussionsupporting

confidence: 92%

“…This is in line with described observations of an increased ratio of breakthrough infections in vaccinated immunosuppressed patients [ 12 , 25 ], although in the study of Kim et al . differences were not significant at multivariate analyses [ 12 ].…”

Section: Discussionsupporting

confidence: 92%

“…A recent meta-analysis [ 8 ] showed that the overall vaccine effectiveness for severe infection is 89%. Despite the evident efficacy toward preventing severe disease and COVID-19 related hospitalisations, other factors such as age, comorbidities, and treatment availability may contribute to the outcome of SARS-CoV-2 vaccinated patients hospitalised for COVID-19 [ 9 – 12 ]: not only the elderly population seems more susceptible to severe disease due to waning immunity and breakthrough infections [ 13 ],but recent data also suggest that seronegative (anti-S IgG antibodies, Abs) vaccinated patients are at higher risk for severe breakthrough infections [ 12 , 14 ]. Incidence of COVID-19 related mortality in vaccinated patients seems to increase with age, comorbidities and male sex, and appeared to be particularly correlated with some ethnicities.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of COVID-19 vaccinated and unvaccinated patients admitted to Careggi University Hospital, Florence, Italy

et al. 2023

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More than 11.5 billion COVID-19 vaccine doses have been administered around the world. Although vaccine effectiveness for severe infections is reported to be 89.0%, breakthrough infections are common and may lead to severe outcome in fragile population. We conducted a real-world observational study on 420 COVID-19 admitted patients from July 2021 to January 2022 in a tertiary level Italian hospital. We collected patient’s vaccination and SARS-CoV-2 serological status, SARS-CoV-2 treatments, oxygen supports, intensive (ICU) and subintensive (sub-ICU) care unit admissions, length of staying (LoS) and in-hospital mortality. One-hundred-seventy-two vaccinated and 248 unvaccinated patients were admitted during the study period. Vaccinated group (Vg) had a significantly more elevated Charlson Comorbidity Index than Unvaccinated group (UVg), and no statistical differences were found in terms of in-hospital mortality, LoS or ICU and sub-ICU admissions. Among Vg, anti-S antibodies were detected in 86.18% of patients (seropositives). Vaccinated seronegative patients’ in-hospital mortality was significantly higher than vaccinated seropositive patients (33.33% vs 10.69%, p = 0.0055): in particular, mortality rate in 45–69 years old population was higher in vaccinated seronegative group, and comparable in patients ≥ 70 years old. No differences in terms of outcome were registered between Vg and UVg, taking into account that Vg was considerably older and with more comorbidities. In line with other recent observations, higher mortality rate was evidenced for seronegative vaccinated patients. Primary prophylaxis and early treatments result to be necessary, especially for older and immunosuppressed populations.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Characteristics of COVID-19 vaccinated and unvaccinated patients admitted to Careggi University Hospital, Florence, Italy

et al. 2023

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“…Cancer patients have a higher risk and susceptibility to infectious diseases (especially respiratory system) due to a compromised immune system as a result of the chronic disease and the immune-suppressive treatments they receive [ 29 ]. Many studies have highlighted the importance of the vaccine for this group of patients [ 30 , 31 ]. Following the first two vaccine doses, the majority of cancer patients surveyed were found to carry antibodies against COVID-19, with diminished levels in patients receiving conventional cytotoxic chemotherapy [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Response Rate of the Third and Fourth Doses of the BNT162b2 Vaccine Administered to Cancer Patients Undergoing Active Anti-Neoplastic Treatments

Agbarya,

Sarel,

Ziv-Baran

et al. 2023

Diseases

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The BNT162b2 vaccine is globally used for preventing morbidity and mortality related to COVID-19. Cancer patients have had priority for receiving the vaccine due to their diminished immunity. This study reports the response rate of administering the third and fourth vaccine doses to cancer patients receiving active anti-neoplastic treatment. A total of 142 patients received two doses of the mRNA-based BNT162b2 COVID-19 vaccine, while 76 and 25 patients received three and four doses, respectively. The efficacy of the humoral response following two vaccine doses was diminished in cancer patients, especially in the group of patients receiving chemotherapy. In a multivariate analysis, patients who received three and four BNT162b2 vaccine doses were more likely to have antibody titers in the upper tertile compared to patients who received two doses of the vaccine (odds ratio (OR) 7.62 (95% CI 1.38–42.12), p = 0.02 and 17.15 (95% CI 5.01–58.7), p < 0.01, respectively). Unlike the response after two doses, the third and fourth BNT162b2 vaccine booster doses had an increased efficacy of 95–100% in cancer patients while undergoing active treatment. This result could be explained by different mechanisms including the development of memory B cells.

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“…Our work also allows recognition of vaccination as a potential cost-effective strategy in terms of the burden of disease caused by COVID-19 and years of potential life lost because of mortality or disability in a young population that has several comorbidities. [27][28][29] There are also implications for clinical practice because receiving immunosuppressive drugs is a direct risk factor for COVID-19 death, 30 although vaccination could be a preventive intervention for it. It also has to be considered that both the ability to prevent infection by activating the immune system and the risk of COVID-19 infection are related to the person's immunosuppression status and to its competence to mount an immune response; therefore, the greater the immunodeficiency, the higher chance of an inadequate response to the biologic or the vaccine-induced immunization.…”

Section: Discussionmentioning

confidence: 99%

Real-world Evidence of COVID-19 Vaccines Effectiveness in Solid-organ Transplant Recipient Population in Colombia: A Study Nested in the Esperanza Cohort

et al. 2022

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Background. Solid-organ transplant recipients (SOTRs) have a higher risk of coronavirus disease 2019 (COVID-19) complications and death and a less powerful and lasting response to vaccines and to natural infection. In Colombia, this population was prioritized in the National Vaccination Plan against COVID-19 and received vaccines from different platforms. The aim of this study was to estimate the effectiveness of the complete vaccination schedule and of the vaccine booster for COVID-19 administered to SOTRs in Colombia. Methods. A nested-cohort was assembled within the population-based ESPERANZA cohort and included the subset of 16 y and older SOTRs (n = 6963); the follow-up period spanned March 11, 2021, to May 11, 2022. The vaccine effectiveness was estimated with Cox proportional-hazards models so that the overall effectiveness of the complete vaccination schedule, the vaccine booster, each used vaccine, and the homologous and heterologous schedules were estimated, adjusting by the main confounders. Results. The overall effectiveness of being fully vaccinated was 73.7% (95% confidence interval [CI], 68.9%-77.0%) to prevent COVID-19 infection, 83.7% (95% CI, 78.7%-87.5%) to prevent hospitalization, and 92.1% (95% CI, 88.8%-94.4%) to prevent death due to COVID-19. Similarly, the effectiveness of the vaccine booster was 76.7% (95% CI, 70.6%-81.5%), 86.9% (95% CI, 79.4%-91.6%), and 94.5% (95% CI, 89.8%-97.1%) to prevent confirmed COVID-19 infection, hospitalization, and death due to COVID-19, respectively. In both cases, there were no statistically significant differences across age groups. Conclusions. Findings from this work show a high protection of vaccination against infection, hospitalization, and death due to COVID-19 in SOTRs, which increases with the vaccine booster.

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Immunosuppression and SARS-CoV-2 breakthrough infections

Cited by 11 publications

References 9 publications

Characteristics of COVID-19 vaccinated and unvaccinated patients admitted to Careggi University Hospital, Florence, Italy

Characteristics of COVID-19 vaccinated and unvaccinated patients admitted to Careggi University Hospital, Florence, Italy

Response Rate of the Third and Fourth Doses of the BNT162b2 Vaccine Administered to Cancer Patients Undergoing Active Anti-Neoplastic Treatments

Real-world Evidence of COVID-19 Vaccines Effectiveness in Solid-organ Transplant Recipient Population in Colombia: A Study Nested in the Esperanza Cohort

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