The safety of COVID‐19 vaccination in immunocompromised children and young adults with immune‐mediated inflammatory disease

Sahn, Benjamin; Lu, Ying; Hui-Yuen, Joyce; Fishbein, Joanna; Gottlieb, Beth S.; Eberhard, B. Anne; Walters, Heather M

doi:10.1111/apa.16652

Cited by 6 publications

(5 citation statements)

References 33 publications

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“…53,54) In previous pediatric cohort studies, most immunocompromised children and young adults had an appropriate humoral and cellular immune response, side effects were mild, and disease flare rates were low following COVID-19 vaccination. [55][56][57] This supports the need for a continuous emphasis on COVID-19 vaccination among the immunocompromised pediatric population, consistent with recommendations. 55,58,59) We also suggest that further studies examine the relationship between immunocompromised status and the risk of long COVID in children.…”

Section: Discussionsupporting

confidence: 72%

COVID-19 in immunocompromised children and adolescents

Kwak¹,

Eun²

2023

Clin Exp Pediatr

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Since coronavirus disease 2019 (COVID-19) became a global pandemic, concerns have arisen regarding the risks of COVID-19 in immunocompromised children and adolescents. Here we aimed to evaluate the clinical outcomes and risks of severe COVID-19 in immunocompromised pediatric patients. Previous studies reported that most children and adolescents receiving immunosuppressive medications have clinical presentations and favorable outcomes similar to those of the general pediatric population. Treatments and access to health services should not be interrupted in these populations, and continuous moni toring of the potential impact of variant strains on the risk of immunocompromised pediatric patients is warranted.

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Section: Discussionsupporting

confidence: 72%

COVID-19 in immunocompromised children and adolescents

Kwak¹,

Eun²

2023

Clin Exp Pediatr

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“…Systemic AEs did not differ between patients and controls while lower rate of local symptoms was found post-vaccination in children with IBD. This is in line with previous studies in which decreased rate of post-vaccination AEs have been reported in pediatric patients with immune-mediated inflammatory disease taking immunosuppressive medication as compared to healthy subjects ( 19 ). In this cohort, only 2 IBD flares were detected 2-6 weeks after the second dose of BNT162b2 mRNA vaccination, while in 3 cases, disease activity was lower post-vaccination.…”

Section: Discussionsupporting

confidence: 93%

“…In this cohort, only 2 IBD flares were detected 2-6 weeks after the second dose of BNT162b2 mRNA vaccination, while in 3 cases, disease activity was lower post-vaccination. These results support previous data ( 19 – 22 ) and provide reassurance that BNT162b2 mRNA vaccination in paediatric IBD patients is safe and well-tolerated. Our report is the first to support the safety of mRNA vaccination in a paediatric cohort with detailed laboratory data including ACE2 activity, inflammatory parameters and thrombin generation pre- and post-vaccination.…”

Section: Discussionsupporting

confidence: 91%

Effect of anti-SARS-CoV-2 BNT162b2 mRNA vaccination on thrombin generation in children with inflammatory bowel disease

Stercel,

Lóczi,

Kadenczki

et al. 2023

Front. Immunol.

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BackgroundInflammatory bowel disease (IBD) including Crohn’s disease (CD) and ulcerative colitis (UC), are associated with higher thrombotic risk and enhanced thrombin generation (TG) in adults. Despite encouraging data reporting vaccine safety and low IBD flare rates in adults with IBD, vaccine hesitancy was demonstrated to be high in families of children with IBD. We aimed to find out whether TG is increased in children with IBD as compared to healthy controls and whether TG parameters show significant changes following SARS-CoV-2 mRNA vaccination.Patients and methodsIn this observational case-control study, 38 children with IBD (CD:18, UC: 20) aged 12-18 years and 62 healthy age-and sex-matched children were enrolled. Blood was collected before the first dose and 2-6 weeks after the second dose of BNT162b2 (Pfizer-BioNTech) mRNA vaccine dose. Blood cell counts, fibrinogen, inflammatory markers (hsCRP, ferritin), anti-SARS-CoV-2 antibody levels were investigated, TG assay was carried-out using platelet-poor plasma. Detailed clinical parameters including disease activity scores (PUCAI, PCDAI) were registered pre-and post- vaccination. A guided questionnaire was used to collect data on adverse reactions (AEs) post- vaccination.ResultsBaseline TG parameters did not differ between patients and controls. Endogenous thrombin potential showed a significant positive correlation with markers of inflammation and with PCDAI. Inflammatory parameters and TG did not increase in patients and controls post-vaccination. Vaccination significantly increased antibody levels in all three investigated groups, but post-vaccination anti-SARS-CoV-2 S IgG/IgM levels were below the 5th percentile value of healthy children in more than one third of patients. Those receiving TNFα inhibitor therapy presented significantly lower SARS-CoV-2 S IgG/IgM levels as compared to patients on other immunosuppressive regimens. Systemic AEs did not differ between patients and controls while lower rate of local symptoms was found post-vaccination in children with IBD. Only 2 IBD flares were detected 2-6 weeks after the second dose of vaccination.ConclusionOur study is the first to support the safety and efficacy of anti-SARS-CoV-2 BNT162b2 vaccination in children with IBD with detailed pre-and post-vaccination laboratory data including TG. Results of this study may further increase confidence and reduce vaccine hesitancy in caretakers of pediatric IBD patients.

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“…This might result in a reduction of the self-imposed social distancing measures, which have been shown to increase depression and anxiety rates, as well as impaired social development [41][42][43]. Taken together with the reported low risk profile of the BTN162b2 vaccination in immunocompromised patients [44], the data underscores the beneficial effect of vaccination in this vulnerable population.…”

Section: Discussionmentioning

confidence: 73%

Reduced Humoral and Cellular Immune Response to Primary COVID-19 mRNA Vaccination in Kidney Transplanted Children Aged 5–11 Years

Lalia,

Schild,

Lütgehetmann

et al. 2023

Viruses

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The situation of limited data concerning the response to COVID-19 mRNA vaccinations in immunocom-promised children hinders evidence-based recommendations. This prospective observational study investigated humoral and T cell responses after primary BNT162b2 vaccination in secondary immunocompromised and healthy children aged 5–11 years. Participants were categorized as: children after kidney transplantation (KTx, n = 9), proteinuric glomerulonephritis (GN, n = 4) and healthy children (controls, n = 8). Expression of activation-induced markers and cytokine secretion were determined to quantify the T cell response from PBMCs stimulated with peptide pools covering the spike glycoprotein of SARS-CoV-2 Wuhan Hu-1 and Omicron BA.5. Antibodies against SARS-CoV-2 spike receptor-binding domain were quantified in serum. Seroconversion was detected in 56% of KTx patients and in 100% of the GN patients and controls. Titer levels were significantly higher in GN patients and controls than in KTx patients. In Ktx patients, the humoral response increased after a third immunization. No differences in the frequency of antigen-specific CD4+ and CD8+ T cells between all groups were observed. T cells showed a predominant anti-viral capacity in their secreted cytokines; however, this capacity was reduced in KTx patients. This study provides missing evidence concerning the humoral and T cell response in immunocompromised children after COVID-19 vaccination.

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The safety of COVID‐19 vaccination in immunocompromised children and young adults with immune‐mediated inflammatory disease

Cited by 6 publications

References 33 publications

COVID-19 in immunocompromised children and adolescents

COVID-19 in immunocompromised children and adolescents

Effect of anti-SARS-CoV-2 BNT162b2 mRNA vaccination on thrombin generation in children with inflammatory bowel disease

Reduced Humoral and Cellular Immune Response to Primary COVID-19 mRNA Vaccination in Kidney Transplanted Children Aged 5–11 Years

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