Response to additional COVID-19 vaccine doses in people who are immunocompromised: a rapid review

Parker, Edward P K; Desai, Shalini; Marti, Melanie; Nohynek, Hanna; Kaslow, David C.; Kochhar, Sonali; O’Brien, Katherine L.; Hombach, Joachim; Wilder‐Smith, Annelies

doi:10.1016/s2214-109x(21)00593-3

Cited by 76 publications

(70 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Immuno-compromised people were prioritized for an early third dose in Quebec. 12 To limit under-estimation of three-dose VE associated with their potentially sub-optimal immune responses 41,42 , we excluded specimens from people re-vaccinated at <90-day interval between second and third doses. Our results apply to those surviving their primary infection; with <1% of NAAT-confirmed cases dying, their exclusion will not have meaningfully influenced estimates.…”

Section: Discussionmentioning

confidence: 99%

Protection against Omicron re-infection conferred by prior heterologous SARS-CoV-2 infection, with and without mRNA vaccination

Carazo

Skowronski

Brisson

et al. 2022

Preprint

View full text Add to dashboard Cite

ImportanceOmicron is phylogenetically- and antigenically-distinct from earlier SARS-CoV-2 variants and the original vaccine strain. Protection conferred by prior SARS-CoV-2 infection against Omicron re-infection, and the added value of vaccination, require quantification.ObjectiveTo estimate protection against Omicron re-infection and hospitalization conferred by prior heterologous SARS-CoV-2 (non-Omicron) infection and/or up to three doses of (ancestral, Wuhan-like) mRNA vaccine.DesignTest-negative study between December 26 (epi-week 52), 2021 and March 12 (epi-week 10), 2022.SettingPopulation-based, province of Quebec, CanadaParticipantsCommunity-dwelling ≥12-year-olds tested for SARS-CoV-2.ExposuresPrior laboratory-confirmed infection with/without mRNA vaccination.OutcomesLaboratory-confirmed SARS-CoV-2 re-infection and hospitalization, presumed Omicron by genomic surveillance. The odds of prior non-Omicron infection with/without vaccination were compared among Omicron cases/hospitalizations versus test-negative controls (single randomly-selected per individual). Adjusted odds ratios controlled for age, sex, testing-indication and epi-week. Analyses were stratified by severity and time since last non-Omicron infection or vaccine dose.ResultsWithout vaccination, prior non-Omicron infection reduced the Omicron re-infection risk by 44% (95%CI:38-48), decreasing from 66% (95%CI:57-73) at 3-5 months to 35% (95%CI:21-47) at 9-11 months post-infection and <30% thereafter. The more severe the prior infection, the greater the risk reduction: 8% (95%CI:17-28), 43% (95%CI:37-49) and 68% (95%CI:51-80) for prior asymptomatic, symptomatic ambulatory or hospitalized infections. mRNA vaccine effectiveness against Omicron infection was consistently significantly higher among previously-infected vs. non-infected individuals at 65% (95%CI:63-67) vs. 20% (95%CI:16-24) for one-dose; 68% (95%CI:67-70) vs. 42% (95%CI:41-44) for two doses; and 83% (95%CI:81-84) vs. 73% (95%CI:72-73) for three doses.Infection-induced protection against Omicron hospitalization was 81% (95%CI: 66-89) increasing to 86% (95%CI:77-99) with one, 94% (95%CI:91-96) with two and 97%(95%CI:94-99) with three mRNA vaccine doses. Two-dose effectiveness against hospitalization among previously-infected individuals did not wane across 11 months and did not significantly differ from three-dose effectiveness despite longer follow-up (median 158 and 27 days, respectively).Conclusions and relevancePrior heterologous SARS-CoV-2 infection provided substantial and sustained protection against Omicron hospitalization, greatest among those also vaccinated. In the context of program goals to prevent severe outcomes and preserve healthcare system capacity, >2 doses of ancestral Wuhan-like vaccine may be of marginal incremental value to previously-infected individuals.

show abstract

Section: Discussionmentioning

confidence: 99%

Protection against Omicron re-infection conferred by prior heterologous SARS-CoV-2 infection, with and without mRNA vaccination

Carazo

Skowronski

Brisson

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…In order to maximize antibody levels produced by uninfected vaccinated individuals, it was proven before that delaying the second dose by a few weeks boosts the overall immune response relative to the 3-week dosing regimen. However, delaying the second dose might reduce protection for immunocompromised individuals [28] , [29] , with an unknown increase of infection risk even among a healthy population, as the minimal amount (and quality) of circulating antibodies necessary for protective immunity against SARS-CoV-2 infection is unlikely to be determined yet, especially in light of novel circulating variants [27] , [30] . Given the shortage of available vaccines, especially in developing countries, and the urgent need to confer long-lasting protection from severe forms of the disease, antibody-based approaches might be needed in the future to optimize vaccine distribution, dosing regimens, and the maximal length of acquired immunity against COVID-19 among various population groups.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal determination of BNT162b2 vaccine induced strongly binding SARS-CoV-2 IgG antibodies in a cohort of Romanian healthcare workers

Korodi

Horváth

Rákosi

et al. 2022

Vaccine

View full text Add to dashboard Cite

“…Current data indicate that three doses of mRNA vaccines are safe, which included immunocompromised individuals in the population cohort 47. Consideration should be given to the risk of myocarditis and pericarditis in vaccine recipients who demonstrate low response or non-response to COVID-19 vaccination where additional vaccine doses are warranted; while immunocompromised patient subgroups have generally been shown to elicit sufficient immune response to COVID-19 vaccination, many of those who do respond poorly may be immunocompromised, including patients with cancer or transplant recipients 48. Further studies are required to better understand the occurrence of myocarditis and pericarditis following additional mRNA COVID-19 vaccine doses in immunocompromised individuals and for those who have demonstrated limited response to vaccination.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of spontaneous reports of myocarditis and pericarditis in transplant recipients and immunocompromised patients following COVID-19 mRNA vaccination

2022

View full text Add to dashboard Cite

ObjectivesTo determine whether spontaneous reporting rates of myocarditis and pericarditis differed in immunocompromised patients compared with the whole population overall, and in terms of demographics, vaccine dose and time-to-onset.DesignSystematic review of spontaneously reported data from the European Union/European Economic Area (EU/EEA), the USA and the UK.Data sourcesEudraVigilance (EU/EEA), Vaccine Adverse Event Reporting System (VAERS; USA) and the Medicines and Healthcare products Regulatory Agency (UK) spontaneous reporting databases were searched from date of vaccine launch to 1 December 2021.Eligibility criteriaPublicly available spontaneous reporting data for ‘myocarditis’ and ‘pericarditis’ from EU/EEA and USA following COVID-19 messenger RNA vaccines. Reports with comorbidities or concurrent medication indicative of transplantation, HIV infection or cancer (‘immunocompromised’ population) were compared with each overall database population.Data extraction and synthesisTwo researchers extracted data. Spontaneously reported events of myocarditis and pericarditis were presented for immunocompromised populations for each data source, stratified by age, sex, dose and time-to-onset (where available). Seriousness of each event was determined according to the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) Guideline E2A definition. Proportional reporting ratio (PRR) was calculated.ResultsThere were 178 reports of myocarditis and pericarditis among immunocompromised individuals overall. Seriousness was comparable between the immunocompromised and overall populations in both databases. No trends in age or sex were observed among immunocompromised individuals. Most reports followed a second vaccine dose and occurred within 14 days. The frequency of reporting was similar to the wider population (PRR=1.36 (95% CI=0.89 to 1.82) for VAERS population).ConclusionsMyocarditis and pericarditis following COVID-19 vaccination are very rare, and benefits of COVID-19 vaccination continue to outweigh any perceived risks. Reporting rates of myocarditis and pericarditis were similar in immunocompromised individuals, however defining characteristics differed compared with the whole population; therefore, continued monitoring of adverse events following vaccination remains vital to understand differences between population subgroups.

show abstract

Response to additional COVID-19 vaccine doses in people who are immunocompromised: a rapid review

Cited by 76 publications

References 10 publications

Protection against Omicron re-infection conferred by prior heterologous SARS-CoV-2 infection, with and without mRNA vaccination

Protection against Omicron re-infection conferred by prior heterologous SARS-CoV-2 infection, with and without mRNA vaccination

Longitudinal determination of BNT162b2 vaccine induced strongly binding SARS-CoV-2 IgG antibodies in a cohort of Romanian healthcare workers

Systematic review of spontaneous reports of myocarditis and pericarditis in transplant recipients and immunocompromised patients following COVID-19 mRNA vaccination

Contact Info

Product

Resources

About