Short-term effectiveness of COVID-19 vaccines in immunocompromised patients: A systematic literature review and meta-analysis

Abstract

Objectives : We aimed to assess the short-term effectiveness of COVID-19 vaccines among immunocompromised patients to prevent laboratory-confirmed symptomatic COVID-19 infection. Methods: Systematic review and meta-analysis. We calculated the pooled diagnostic odds ratio [DOR] (95% CI) for COVID-19 infection between immunocompromised patients and healthy people or those with stable chronic medical conditions. VE was estimated as 100% x (1-DOR). We also investigated the rates of developing anti-SARS-CoV-2 spike protein IgG between the 2 groups. Results: Twenty studies evaluating COVID-19 vaccine response, and four studies evaluating VE were included in the meta-analysis. The pooled DOR for symptomatic COVID-19 infection in immunocompromised patients was 0.296 (95% CI: 0.108-0.811) with an estimated VE of 70.4% (95% CI: 18.9%- 89.2%). When stratified by diagnosis, IgG antibody levels were much higher in the control group compared to immunocompromised patients with solid organ transplant (pOR 232.3; 95% Cl: 66.98-806.03), malignant diseases (pOR 42.0, 95% Cl: 11.68-151.03), and inflammatory rheumatic diseases (pOR 19.06; 95% Cl: 5.00-72.62). Conclusions: We found COVID-19 mRNA vaccines were effective against symptomatic COVID-19 among the immunocompromised patients but had lower VE compared to the controls. Further research is needed to understand the discordance between antibody production and protection against symptomatic COVID-19 infection.

Symptoms and severity in vaccinated and unvaccinated patients hospitalised with SARS-CoV-2 delta (B.1.617.2) variant infection

“…Moreover, immunocompromised patients remained at high risk of a severe form (OR=2·55) even after adjustment for parameters such as other risk factors and vaccination (Table 1). Decreased efficacy in this population was previously noted for virtually all vaccines, particularly influenza vaccines 24 , and was also observed with Covid-19 vaccines 25 . This led some countries to recommend an additional dose of the vaccine to these patients, and the prophylactic use of passive immunisation by monoclonal antibodies in immunocompromised patients with no or insufficient antibody response to vaccines 26 .…”

A systematic review of COVID-19 vaccine efficacy and effectiveness against SARS-CoV-2 infection and disease

“…Previous reviews of COVID-19 vaccines have focused mainly on the developmental pathway and early results from pre-clinical and clinical trials, the immunological basis of vaccine-induced protection, a narrow subset of vaccines or clinical outcomes, or have been rapid in nature and limited to earlier studies 30–47 . There remains an urgent need for comprehensive, up-to-date review of COVID-19 vaccine effects, including real-world evidence.…”

Multiple Sclerosis Patients and Disease Modifying Therapies: Impact on Immune Responses against COVID-19 and SARS-CoV-2 Vaccination

“…There are some studies on the effect of anti-CD20 therapies on the COVID-19 vaccine efficacy among immunosuppressed patients. The results of these studies demonstrate that the level of anti-SARS-CoV-2 IgG, and also vaccine efficacy, were decreased in patients with malignancies, solid organ transplantation or inflammatory rheumatic diseases [68,69]. With regard to these facts, some authors suggest consideration of a 4-6 month time-window before and after vaccination due to the induction of rapid and prolonged (up to 24 weeks) B-cell depletion and attenuated humoral immune responsiveness by anti-CD20 antibodies and also differential kinetics of B-cells repopulation in immunocompromised patients.…”