Immunogenicity of an mRNA-Based COVID-19 Vaccine among Adolescents with Obesity or Liver Transplants

Abstract

There are limited data regarding the immunogenicity of mRNA-based SARS-CoV-2 vaccine BNT162b2 among immunosuppressed or obese adolescents. We evaluated the humoral immune response in adolescents with obesity and adolescent liver transplant recipients (LTRs) after receiving two BNT162b2 doses. Sixty-eight participants (44 males; mean age 14.9 ± 1.7 years), comprising 12 LTRs, 24 obese, and 32 healthy adolescents, were enrolled. Immunogenicity was evaluated by anti-SARS-CoV-2 spike protein immunoassay and surrogate viral neutralization tests (sVNT) against the Delta and Omicron (BA.1) variants. At 27.1 ± 3.2 days after the second dose, the antibody levels were 1476.6 ± 1185.4, 2999.4 ± 1725.9, and 4960.5 ± 2644.1 IU/mL in the LTRs, obese adolescents, and controls, respectively (p < 0.001). Among obese individuals, liver stiffness <5.5 kPa was associated with higher antibody levels. The %inhibition of sVNT was significantly lower for the Omicron than that for the Delta variant. Injection site pain was the most common local adverse event. Nine participants (three obese and six controls) developed COVID-19 at 49 ± 11 days after the second vaccination; four were treated with favipiravir. All infections were mild, and the patients recovered without any consequences. Our study supports the need for the booster regimen in groups with an inferior immunogenic response, including LTRs and obese individuals.

Clinical manifestations and outcomes of coronavirus disease 2019 among pediatric liver transplant recipients in the delta and omicron variant pandemic: A retrospective study

“…Previous reports demonstrated a lower immunogenic response in adolescents LT recipients compared to healthy controls, [20] and a booster vaccine might be required. [21] Although our study did not reveal any differences between severity, duration of symptoms, and incidence of long COVID-19 among patients with and without vaccination, we found that fever was less found in patients who Most children in this study received favipiravir for the treatment of COVID-19, according to the national treatment guidelines, [22] suggesting the consideration of favipiravir therapy among symptomatic children with immunosuppressed state. However, the efficacy of favipiravir is still debatable.…”

Association between Overweight/Obesity and the Safety and Efficacy of COVID-19 Vaccination: A Systematic Review

“…Of these, 59 were excluded because they did not meet the eligibility criteria. Therefore, 15 studies were included in the review [ 11 , 13 , 14 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ] ( Figure 1 ).…”

“…Among the 12 selected studies [ 11 , 13 , 14 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ], eight cohort studies [ 11 , 13 , 14 , 18 , 19 , 23 , 24 , 25 ] provided absolute values of antibody titers in an obese group and nonobese group, and three studies [ 11 , 13 , 25 ] offered baseline antibody titers. When compared with the nonobese groups, the antibody titers of the obese groups were lower [ 11 , 13 , 14 , 18 , 19 , 20 , 22 , 23 , 24 , 26 ]. However, two studies [ 21 , 25 ] suggested that obesity was not associated with antibody responses after two doses of ChAdOx1 nCoV-19 vaccination.…”

“…There have also been studies examining obesity and vaccine effectiveness in children and adolescents. One study [ 14 ] from Thailand examined the efficacy of the COVID-19 vaccine among obese adolescents. In this cohort study, Tubjaroen [ 14 ] aimed to evaluate immunogenicity among children with liver transplants and obesity following two doses of the BNT162b2 vaccine.…”

“…Claiming to critically evaluate the scientific data from the published peer-reviewed literature and briefing documents available at the time, the Obesity Society claimed that vaccines from Pfizer-BioNTech, Moderna, and Johnson & Johnson are highly effective, independently from weight status [ 10 ]. However, several studies on immunogenicity have mentioned that COVID-19 vaccinations for people with overweight or obesity status might be less effective due to chronic inflammation and metabolic dysregulation [ 11 , 12 , 13 , 14 ], thus resulting in a greater risk of infection. Some studies suggest that obese people may need a higher dose of the vaccine than nonobese people to generate an adequate immune response [ 11 , 12 ].…”