Tomas Milota, Jitka Smetanova, Aneta Skotnicova, Michal Rataj, Jan Lastovicka, Hana Zelena, Zuzana Parackova, Martina Fejtkova, Eva Fronkova, Katerina Rejlova, Anna Sediva, Tomas Kalina. The Journal of Allergy and Clinical Immunology: In Practice. 2022 November 13. doi.org/10.1016/j.jaip.2022.10.046 IF: 11,02
MUDr. Tomáš Milota, Ph.D., Ústav imunologie 2. LF UK a FN Motol
Abstract
Background
Common variable immunodeficiency (CVID) is characterized by an impaired postvaccination response, high susceptibility to respiratory tract infections, and a broad spectrum of noninfectious complications. Thus, patients with CVID may be at high risk for COVID-19, and vaccination’s role in prevention is questionable.
Objective
We evaluated the clinical outcomes, safety, and dynamics of humoral and T-cell immune responses induced by the mRNA vaccine BNT162b2 in CVID.
Methods
This prospective observational cohort study focused on the clinical outcomes (proportion of infected patients and disease severity), safety (incidences of adverse events and changes in laboratory parameters), and dynamics of humoral (specific postvaccination and virus-neutralizing antibody assessment) and T-cell immune responses (anti-SARS-CoV-2–specific T-cell detection) in 21 patients with CVID after a two-dose administration of BNT162b2. The patients were observed for 6 months.
Results
Humoral response was observed in 52% of patients (11 of 21) at month 1 after vaccination but continuously decreased to 33.3% at month 6 (five of 15). Nevertheless, they had a remarkably lower anti-SARS-CoV-2 neutralizing antibody titer compared with healthy controls. The T-cell response was measurable in 46% of patients with CVID (six of 13) at month 1 and persisted over the study period. Mild infection occurred in three patients within the follow-up period (14.3%). The vaccine also exhibited a favorable safety profile.
Conclusions
The BNT162b2 vaccine elicited a measurable antibody response in a high proportion of patients, but it was limited by low titer of virus-neutralizing antibodies and rapid waning of anti–receptor-binding domain SARS-CoV-2–specific antibodies. T-cell response was detected in one-third of patients and remained stable within the follow-up period. Vaccination has favorable safety and clinical-related outcomes in preventing severe COVID-19.
