Vaccine effectiveness of the mRNA-1273 3-dose primary series against COVID-19 in an immunocompromised population: A prospective observational cohort study

Ku, Jennifer; Sy, Lina S; Qian, Lei; Ackerson, PBradley K.; Luo, Yi; Tubert, Julia E.; Lee, Gina S.; Florea, Ana; Bruxvoort, Katia; Talarico, Carla; Qiu, Sijia; Tian, Yun; Tseng, Hung Fu

doi:10.1016/j.vaccine.2023.04.075

Cited by 9 publications

(5 citation statements)

References 40 publications

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“…25 The uptake of an additional primary dose was also high (87.0%) in our study. A large, matched cohort study conducted at Kaiser Permanente Southern California demonstrated that receipt of 3 doses of mRNA-1273 was associated with significantly higher relative vaccine effectiveness against SARS-CoV-2 infection and severe outcomes (compared with 2 doses) in immunocompromised populations, 26 highlighting the importance of receiving 3 COVID-19 vaccine doses for immunocompromised populations. The rapid uptake of the additional primary dose observed in the present study suggests that significant morbidity and mortality may have been prevented in this vulnerable population.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Vaccination Coverage and Factors Associated With Vaccine Uptake Among People With HIV

Hechter,

Qian,

Liu

et al. 2024

JAMA Netw Open

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ImportancePeople with HIV (PWH) may be at increased risk for severe outcomes with COVID-19 illness compared with people without HIV. Little is known about COVID-19 vaccination coverage and factors associated with primary series completion among PWH.ObjectivesTo evaluate COVID-19 vaccination coverage among PWH and examine sociodemographic, clinical, and community-level factors associated with completion of the primary series and an additional primary dose.Design, Setting, and ParticipantsThis retrospective cohort study used electronic health record data to assess COVID-19 vaccination information from December 14, 2020, through April 30, 2022, from 8 health care organizations of the Vaccine Safety Datalink project in the US. Participants were adults diagnosed with HIV on or before December 14, 2020, enrolled in a participating site.Main Outcomes and MeasuresThe percentage of PWH with at least 1 dose of COVID-19 vaccine and PWH who completed the COVID-19 vaccine primary series by December 31, 2021, and an additional primary dose by April 30, 2022. Rate ratios (RR) and 95% CIs were estimated using Poisson regression models for factors associated with completing the COVID-19 vaccine primary series and receiving an additional primary dose.ResultsAmong 22 058 adult PWH (mean [SD] age, 52.1 [13.3] years; 88.8% male), 90.5% completed the primary series by December 31, 2021. Among 18 374 eligible PWH who completed the primary series by August 12, 2021, 15 982 (87.0%) received an additional primary dose, and 4318 (23.5%) received a booster dose by April 30, 2022. Receipt of influenza vaccines in the last 2 years was associated with completion of the primary series (RR, 1.17; 95% CI, 1.15-1.20) and an additional primary dose (RR, 1.61; 95% CI, 1.54-1.69). PWH with uncontrolled viremia (HIV viral load ≥200 copies/mL) (eg, RR, 0.90 [95% CI, 0.85-0.95] for viral load 200-10 000 copies/mL vs undetected or &lt;200 copies/mL for completing the primary series) and Medicaid insurance (eg, RR, 0.89 [95% CI, 0.87-0.90] for completing the primary series) were less likely to be fully vaccinated. By contrast, greater outpatient utilization (eg, RR, 1.07 [95% CI, 1.05-1.09] for ≥7 vs 0 visits for primary series completion) and residence in counties with higher COVID-19 vaccine coverage (eg, RR, 1.06 [95% CI, 1.03-1.08] for fourth vs first quartiles for primary series completion) were associated with primary series and additional dose completion (RRs ranging from 1.01 to 1.21).Conclusions and RelevanceFindings from this cohort study suggest that, while COVID-19 vaccination coverage was high among PWH, outreach efforts should focus on those who did not complete vaccine series and those who have uncontrolled viremia.

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Section: Discussionmentioning

confidence: 99%

COVID-19 Vaccination Coverage and Factors Associated With Vaccine Uptake Among People With HIV

Hechter,

Qian,

Liu

et al. 2024

JAMA Netw Open

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“…This highlights the importance of an extended primary series with an additional (third) dose of COVID-19 vaccine for this vulnerable population. Although most of the earlier pivotal COVID-19 vaccine trials excluded immunocompromised groups, the recent RCTs and large observational studies have subsequently begun to shed light on the benefits of an extra dose of COVID-19 vaccine among this population [21][22][23][24]30,31]. Yet, an appropriate vaccine regimen for a third primary dose has been controversial.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of the Immunogenicity and Safety of an Additional Heterologous versus Homologous COVID-19 Vaccination among Non-Seroconverted Immunocompromised Patients after a Two-Dose Primary Series of mRNA Vaccination: A Systematic Review and Meta-Analysis

Nangsue,

Srisurapanont,

Sudjaritruk

2024

Vaccines

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This systematic review and meta-analysis aimed to compare the immunogenicity and safety of an additional heterologous (viral vector) versus homologous (mRNA) COVID-19 vaccine dose among non-seroconverted immunocompromised patients after a two-dose primary series of mRNA vaccine. We searched studies published up to 21 June 2023 in PubMed, Scopus, and Embase. The meta-analysis was conducted to compare the seropositivity rates based on anti-SARS-CoV-2 spike protein IgG (anti-S IgG) and SARS-CoV-2-specific T-cell immune response rates, assessed by interferon-γ release assay at 4 weeks, and the incidences of serious adverse events (SAEs) within 28 days between the two vaccine regimens. In four included randomized controlled trials (RCTs), there were no statistically significant differences in the seropositive rate of anti-S IgG (risk ratio [RR]: 0.79, 95% CI: 0.48–1.29) and the concentration of SARS-CoV-2 interferon-γ (RR: 1.19, 95% CI: 0.96–1.48) between heterologous and homologous regimens. The heterologous regimen exhibited a significantly lower incidence of injection pain (RR: 0.55, 95% CI: 0.45–0.69), but a higher incidence of headache (RR: 1.44, 95% CI: 1.02–2.02) compared with the homologous regimen. No vaccine-related SAEs were reported within 28 days following vaccination. An additional heterologous or homologous COVID-19 vaccine dose was well tolerated and demonstrated a comparable vaccine immunogenicity among non-seroconverted immunocompromised patients who were initially vaccinated with a two-dose COVID-19 mRNA vaccine. This finding supports the recommendations of an extended primary series of COVID-19 vaccination in immunocompromised persons.

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“…31,32 The COVID vaccine has also been shown to benefit immunocompromised individuals and, notably, the benefit increases substantially with a number of vaccine doses. 33 One study looking at a heterogeneous population of immunocompromised patients showed a higher relative vaccine effectiveness (rVE) in patients who received three doses of the mRNA-1273 series compared with only two doses. Specifically, the rVE of three versus two doses of the series was 55% for COVID-19 infection, 83% for COVID-related hospitalization, and 87% for COVID-related death.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID‐19 monoclonal antibodies on outcomes of COVID‐19 infection in hematopoietic stem cell transplant and chimeric antigen receptor therapy recipients

Hahn,

Li,

Sauter

et al. 2024

Transplant Infectious Dis

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BackgroundHematopoietic stem cell transplant (HSCT) and chimeric antigen receptor T‐cell therapy (CAR‐T) recipients are at higher risk of serious complications of COVID‐19 infection than the general population. Though there is evidence that monoclonal antibodies (MCA) against COVID‐19 reduce the risk of death and hospitalization in the general population, data regarding their efficacy in HSCT and CAR‐T recipients remains scarce.MethodsWe conducted a retrospective review of HSCT and CAR‐T recipients to compare 30‐day outcomes between patients who did and did not receive MCA after their first episode of COVID‐19 between May 1, 2020 and December 31, 2022. Outcomes were defined as the most severe complication experienced out of the following: 30‐day emergency department visit, hospitalization, intensive care unit admission, and death after COVID‐19 infection.ResultsWe identified 166 patients comprised of 53.6% allogeneic HSCT, 35.5% autologous HSCT, and 10.8% CAR‐T recipients; 107 had received a COVID‐19 vaccine >2 weeks prior to testing positive, and 40 were treated with MCA. After adjusting for age, presence of symptoms at the initial positive test, and COVID‐19 vaccination status, patients who did not receive MCA were five times more likely to develop complications after COVID‐19 infection (adjusted odds ratio 5.0 [95% CI, 1.9–12.8], p = .001).ConclusionHSCT and CAR‐T recipients who received MCA following COVID‐19 infection were far less likely to develop COVID‐related complications than those who did not receive MCA, regardless of vaccination status. This underscores the potential benefit of developing novel MCA with efficacy against circulating COVID‐19 strains. image

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Vaccine effectiveness of the mRNA-1273 3-dose primary series against COVID-19 in an immunocompromised population: A prospective observational cohort study

Cited by 9 publications

References 40 publications

COVID-19 Vaccination Coverage and Factors Associated With Vaccine Uptake Among People With HIV

COVID-19 Vaccination Coverage and Factors Associated With Vaccine Uptake Among People With HIV

A Comparison of the Immunogenicity and Safety of an Additional Heterologous versus Homologous COVID-19 Vaccination among Non-Seroconverted Immunocompromised Patients after a Two-Dose Primary Series of mRNA Vaccination: A Systematic Review and Meta-Analysis

Impact of COVID‐19 monoclonal antibodies on outcomes of COVID‐19 infection in hematopoietic stem cell transplant and chimeric antigen receptor therapy recipients

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