Immunizing the imperfect immune system

Durkee-Shock, Jessica; Keller, Michael D.

doi:10.1016/j.anai.2022.06.009

Cited by 22 publications

(13 citation statements)

References 92 publications

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“…Impaired vaccine response, with defective neutralizing antibody production, has been implied in the development of LC in the general population [ 19 ]. A reduced formation of neutralizing antibodies can be present in CVID patients, and we could speculate that this incomplete response may, at least in part, explain the increased prevalence of LC in our CVID patients compared to the general population, even if serological data were not available in our cohort [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Long COVID in Common Variable Immunodeficiency: An Italian Multicentric Study

Villa,

Milito,

Deiana

et al. 2024

J Clin Immunol

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The long-term effects of SARS-CoV-2 infection represent a relevant global health problem. Long COVID (LC) is defined as a complex of signs and symptoms developed during or after SARS-CoV-2 infection and lasting > 12 weeks. In common variable immunodeficiency (CVID) patients, we previously reported higher risk of hospitalization and death during SARS-CoV-2 infection, as well as prolonged swab positivity and frequent reinfections. The aim of the present study was to assess the risk of LC in an Italian cohort of CVID patients. We used a translated version of the survey proposed by Centers for Disease Control and Prevention (CDC) to collect data on LC. In the enrolled cohort of 175 CVID patients, we found a high prevalence of LC (65.7%). The most frequent LC symptoms were fatigue (75.7%), arthralgia/myalgia (48.7%), and dyspnea (41.7%). The majority of patients (60%) experienced prolonged symptoms, for at least 6 months after infection. In a multivariate analysis, the presence of complicated phenotype (OR 2.44, 95% CI 1.88–5.03; p = 0.015), obesity (OR 11.17, 95% CI 1.37–90.95; p = 0.024), and female sex (OR 2.06, 95% CI 1.09–3.89; p = 0.024) significantly correlated with the development of LC. In conclusion, in this multicenter observational cohort study, we demonstrated that CVID patients present an increased prevalence of LC when compared to the general population. Improved awareness on the risk of LC in CVID patients could optimize management of this new and alarming complication of SARS-CoV-2 infection.

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Section: Discussionmentioning

confidence: 99%

High Prevalence of Long COVID in Common Variable Immunodeficiency: An Italian Multicentric Study

Villa,

Milito,

Deiana

et al. 2024

J Clin Immunol

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“…The use of drugs that inhibit the viral replication without the administration of the monoclonal antibodies in the patients with IEI increases the risk of long -COVID (the effect of the persistent replication of SARS CoV2, although usually at lower intensity), while the combined therapy reduces the risk of hospitalization in intensive care units. [22] According to the Polish recommendations, it is prescribed to use either the antiviral therapies or the alternatively monoclonal antibodies. [20] An additional problem is the lack or the declining effectiveness of the monoclonal antibodies against new variants of the SARS CoV2 virus.…”

Section: Anti-sars Cov2 Therapy In Patients With Inborn Immunity Errorsmentioning

confidence: 99%

COVID-19 in patients with inborn errors of immunity - the current state of knowledge, diagnostic and therapeutic dilemmas

Kołtan

2022

Journal of Health Policy &Amp; Outcomes Research

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Patients with inborn errors of immunity (IEI) are at risk of contracting the SARS CoV2 virus, as are all humans. The risk of a serious course of COVID-19 related to the type of IEI concerns patients with combined immunodeficiencies, immune dysregulation syndromes, and certain inborn immunity defects, including type I interferon defects. Adult patients with severe humoral immunodeficiency are also at the increased risk (for example CVID or agammaglobulinemia). The additional risk results from the frequent occurrence of many comorbidities and the treatment used. Vaccination is the most effective way to prevent a severe course of COVID-19. An additional dose is required in the selected patients with IEI. The vaccine response in selected IEI groups may be ineffective. Therefore, the pre-exposure prophylaxis with the use of long-acting monoclonal antibodies is justified. With regard to the Omicron variant, there are no recommendations for the post-exposure prophylaxis - no effective preparations. Treatment of COVID-19 in patients with IEI, especially those at risk of severe disease, should be started not later than 5-10 days after the infection. It is advisable to use in paralel,the antiviral drugs and monoclonal antibodies, effective for the currently dominant variants of the virus. It is important to continue treatment of the inbornerrors of immunity, especially human immunoglobulin replacement therapy.

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“…Most research on COVID-19 vaccination among IDP focuses on seroconversion rates after the first two doses, overlooks inborn errors of immunity (IEIs), and assesses populations with homogeneous immunodeficiencies, thus limiting its generalizability (7)(8)(9)(10)(11). Longitudinal studies evaluating antibody durability and characterizing the full effects of COVID-19 vaccination through 6 months after the third dose have been limited in IDP.…”

Section: Introductionmentioning

confidence: 99%

“…9 Section for Immunoengineering, NIBIB, NIH, Bethesda, MD, USA. 10 Division of Laboratory Medicine, NIH Clinical Center, Bethesda, MD,USA. 11 Department of Immunobiology and Yale Center for Systems and Engineering Immunology, Yale School of Medicine, New Haven, CT, USA.…”

mentioning

confidence: 99%

Characterization of the antispike IgG immune response to COVID-19 vaccines in people with a wide variety of immunodeficiencies

Zendt,

Bustos Carrillo,

Kelly

et al. 2023

Sci. Adv.

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Research on coronavirus disease 2019 vaccination in immune-deficient/disordered people (IDP) has focused on cancer and organ transplantation populations. In a prospective cohort of 195 IDP and 35 healthy volunteers (HV), antispike immunoglobulin G (IgG) was detected in 88% of IDP after dose 2, increasing to 93% by 6 months after dose 3. Despite high seroconversion, median IgG levels for IDP never surpassed one-third that of HV. IgG binding to Omicron BA.1 was lowest among variants. Angiotensin-converting enzyme 2 pseudo-neutralization only modestly correlated with antispike IgG concentration. IgG levels were not significantly altered by receipt of different messenger RNA–based vaccines, immunomodulating treatments, and prior severe acute respiratory syndrome coronavirus 2 infections. While our data show that three doses of coronavirus disease 2019 vaccinations induce antispike IgG in most IDP, additional doses are needed to increase protection. Because of the notably reduced IgG response to Omicron BA.1, the efficacy of additional vaccinations, including bivalent vaccines, should be studied in this population.

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Immunizing the imperfect immune system

Cited by 22 publications

References 92 publications

High Prevalence of Long COVID in Common Variable Immunodeficiency: An Italian Multicentric Study

High Prevalence of Long COVID in Common Variable Immunodeficiency: An Italian Multicentric Study

COVID-19 in patients with inborn errors of immunity - the current state of knowledge, diagnostic and therapeutic dilemmas

Characterization of the antispike IgG immune response to COVID-19 vaccines in people with a wide variety of immunodeficiencies

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