COVID-19 vaccination in immunocompromised patients

Sonani, Bhavin; Aslam, Fawad; Goyal, Amandeep; Patel, Janki; Bansal, Pankaj

doi:10.1007/s10067-020-05547-w

Cited by 52 publications

(60 citation statements)

References 10 publications

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“…It was also noted that flares were more common in patients with 4-week pauses of their methotrexate around timing of vaccination 97 . But the effects of immune suppression on COVID-19 vaccine response are not yet determined and consideration to hold immunosuppressants post-vaccine need to considered on a case-by-case basis and ideally studied in clinical trials 98 . The CDC at the time of publication does not recommend re-vaccination of those who may have received the vaccine during chemotherapy or while on immunosuppressive medications and does not suggest antibody testing to assess for immunity after vaccination 95 .…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on Pediatric Immunocompromised Patients

Connelly

Chong

Esbenshade

et al. 2021

Pediatric Clinics of North America

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Synopsis: Although living with the threat of severe infection is a constant worry for many pediatric immunocompromised patients, the pandemic begotten by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) created new fears and challenges for families and health care providers. As people around the world through government directive or independent choice moved into protective isolation, immunosuppressed children who routinely require medical management were challenged with necessary public ventures to health care facilities. Medical centers adapted by developing new approaches to care for immunocompromised children such as expanding telemedicine services and conversion to at home immune therapies to reduce infectious exposure. Testing for SARS-CoV-2 of asymptomatic patients prior to medical therapies became routine in most modern health care units and development of highly sensitive assays was critical to avoid patient and staff exposure as well as initiation of new immunosuppressive treatment in positive patients. As the prevalence of coronavirus disease (COVID-19) amplified and infected immunocompromised patients became more common, questions quickly arose including how aggressively to treat the infection with most agents still in clinical trials. Additionally how should chronic immunosuppressant drugs that may interfere with the ability to clear the virus be adjusted? Finally, what if the infection leads to excessive immune responses or flares of the underlying disorder? In this review, we explore the impact of the COVID-19 pandemic on immunocompromised children during the first year, summarizing what is known and yet to be discovered, approaches to testing and treatment of SARS-CoV-2, considerations in management of underlying immune suppressive medications, outcomes published to date, and strategies for vaccinating this unique population.

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Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on Pediatric Immunocompromised Patients

Connelly

Chong

Esbenshade

et al. 2021

Pediatric Clinics of North America

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“…In a study of 261 patients with cancer, Thakkar et al showed the signi cantly lower seroconversion observed in patients with hematological malignancy after Covid-19 infection, particularly in patients exposed to anti-CD20 antibody containing therapy [5]. B-cell depletion by treatment with rituximab or obinutuzumab can also cause suppression of the immune response to vaccines [6][7][8][9][10][11]. These monoclonal antibodies act against the surface antigen protein CD20 expressed on B-lymphocyte during most of its developmental stages [12].…”

Section: Introductionmentioning

confidence: 99%

“…Another study found that In uenza vaccine responsiveness was poor in patients on rituximab [8]. In light of such results, several groups advise patients to consider the timing of Covid-19 vaccination relative to their anti-CD20 antibody therapy schedule [9][10][11]. Detection of regional lymphadenopathy after Covid-19 vaccines on various imaging modalities has been reported in case reports and small cohorts [13][14][15][16][17][18][19][20][21][22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Correlation Between BNT162b2 mRNA Covid-19 Vaccine-associated Hypermetabolic Lymphadenopathy and Humoral Immunity in Patients With Hematologic Malignancy

Cohen

Krauthammer

Cohen

et al. 2021

Preprint

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Purpose: Vaccine-associated hypermetabolic lymphadenopathy (VAHL) is frequently observed on [18F]FDG PET-CT following BNT162b2 administration. Recent data suggest a prominent B-cell germinal-center (GC) response elicited by mRNA vaccines in draining lymph nodes. Thus, in this study we aimed to explore the correlation between VAHL and humoral immunity as reflected by post-vaccination serologic testing, and by comparing the incidence of VAHL between lymphoma patients treated recently with B-cell depleting therapy and those that did not. Methods: A total of 137 patients with hematologic malignancy that had post-vaccination [18F]FDG PET-CT were included (All-PET group), 86 received both vaccine doses before imaging (PET-2 group). Their VAHL status and grade on imaging were recorded. Among 102 lymphoma patients, 34 (33.3%) were treated during the year prior vaccination with anti-CD20 antibody containing therapy. A subgroup of 54 patients also underwent serologic testing 2-3 weeks after the booster dose, and their anti-spike titers were recorded and graded as well.Results: The overall incidence of VAHL in patients with hematologic malignancy was 31.4%. The 34 lymphoma patients treated during the year prior vaccination with anti-CD20 antibody containing therapy had significantly lower rates of VAHL comparted to all other lymphoma patients (8.8% versus 41.2% in all-PET patients, Pv < 0.01). VAHL rates were 10% in patients with negative serology, 31.3% in patients with low anti-spike titers and 72.2% in patients with high anti-spike titers. The positive predictive values of VAHL were 90% and 93.3% in all-PET and PET-2 patients, respectively. A positive statistically significant correlation was found between VAHL and serology ranks in All-PET patients (rs = 0.530, Pv < 0.001), and stronger correlation was found in PET-2 patients (rs = 0.642, Pv < 0.001).Conclusion: VAHL on [18F]FDG PET-CT of patients with hematologic malignancy may reflect GC B-cell proliferation and an effective humoral response elicited by BNT162b2 vaccine.

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“…Immunocompromised patients were excluded from trial phases and the efficacy of the vaccine in them still needs to be scrutinized. The effects of immunosuppressives, especially methotrexate (MTX) and rituximab on a SARS-CoV2 vaccine response, are undetermined [29]. However, it has been suggested that withholding MTX for two weeks post vaccination may enhance the response.…”

Section: Discussionmentioning

confidence: 99%

Rheumatology university faculty opinion on coronavirus disease-19 (COVID-19) vaccines: the vaXurvey study from Egypt

et al. 2021

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Objectives The aim of the present work was to explore the perspectives of Egyptian Rheumatology staff members as regards the coronavirus disease-19 (COVID-19) vaccine. Methods The survey is composed of 25 questions. Some questions were adapted from the global rheumatology alliance COVID-19 survey for patients. Results 187 rheumatology staff members across Egypt from 18 universities and authorizations actively participated with a valid response. The mean time needed to complete the survey was 17.7 ± 13 min. Participants were 159 (85%) females (F:M 5.7:1). One-third agreed that they will be vaccinated once available, 24.6% have already received at least one dose, 29.4% are unsure while 16% will not take it. Furthermore, 70.1% agreed that they will recommend it to the rheumatic diseases (RD) patients once available, 24.1% are not sure while 5.9% will not recommend it. RD priority to be vaccinated against COVID-19 in descending order include SLE (82.9%), RA (55.1%), vasculitis (51.3%), systemic sclerosis (39.6%), MCTD (31.6%), Behcet's disease (28.3%). The most common drugs to be avoided before vaccination included biologics (71.7%), DMARDs (44.4%), biosimilars (26.7%), IVIg (17.1%) and NSAIDs (9.1%). Conclusions The results of the study and specifically the low rate of acceptability are alarming to Egyptian health authorities and should stir further interventions to reduce the levels of vaccine hesitancy. As rheumatic disease patients in Egypt were not systematically provided with the vaccine till present, making the vaccine available could as well enhance vaccine acceptance. Further studies to investigate any possible side effects, on a large scale of RD patients are warranted.

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COVID-19 vaccination in immunocompromised patients

Cited by 52 publications

References 10 publications

Impact of COVID-19 on Pediatric Immunocompromised Patients

Impact of COVID-19 on Pediatric Immunocompromised Patients

Correlation Between BNT162b2 mRNA Covid-19 Vaccine-associated Hypermetabolic Lymphadenopathy and Humoral Immunity in Patients With Hematologic Malignancy

Rheumatology university faculty opinion on coronavirus disease-19 (COVID-19) vaccines: the vaXurvey study from Egypt

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