Abstract
Background: Humoral and cellular immune responses to SARS-CoV-2 vaccination among immunosuppressed patients remain poorly defined, as well as variables associated with poor response.
Methods: We performed a retrospective observational cohort study at a large Northern California healthcare system of infection-naïve individuals fully vaccinated against SARS-CoV-2 (mRNA-1273, BNT162b2, or Ad26.COV2.S) with clinical SARS-CoV-2 interferon gamma release assay (IGRA) ordered between January through November 2021. Humoral and cellular immune responses were measured by anti-SARS-CoV-2 S1 IgG ELISA (anti-S1 IgG) and IGRA, respectively, following primary and/or booster vaccination.
Results: 496 immunosuppressed patients (54% female; median age 50 years) were included. 62% (261/419) of patients had positive anti-S1 IgG and 71% (277/389) had positive IGRA after primary vaccination, with 20% of patients having a positive IGRA only. Following booster, 69% (81/118) had positive anti-S1 IgG and 73% (91/124) had positive IGRA. Factors associated with low humoral response rates after primary vaccination included anti-CD20 monoclonal antibodies (P < 0.001), sphingosine 1-phsophate (S1P) receptor modulators (P < 0.001), mycophenolate (P = 0.002), and B cell lymphoma (P = 0.004); those associated with low cellular response rates included S1P receptor modulators (P < 0.001) and mycophenolate (P < 0.001). Of patients who had poor humoral response to primary vaccination, 35% (18/52) developed a significantly higher response after the booster. Only 5% (2/42) of patients developed a significantly higher cellular response to the booster dose compared to primary vaccination.
Conclusions: Humoral and cellular response rates to primary and booster SARS-CoV-2 vaccination differ among immunosuppressed patient groups. Clinical testing of cellular immunity is important in monitoring vaccine response in vulnerable populations.
Keywords: COVID-19; IGRA; Immunosuppression; SARS-CoV-2; Serology; Vaccination.
【저자키워드】 COVID-19, SARS-CoV-2, vaccination, serology, Immunosuppression, IGRA, 【초록키워드】 IgG, vaccination, Cellular immune response, mRNA-1273, monoclonal antibody, ELISA, B cell, BNT162b2, Ad26.COV2.S, cellular immunity, vaccine response, lymphoma, clinical, Patient, receptor, booster dose, booster, SARS-CoV-2 vaccination, anti-CD20, booster vaccination, cellular response, interferon gamma, retrospective, Immunosuppressed, Healthcare system, humoral, Observational cohort study, Factor, median age, individual, patient groups, positive, sphingosine, variable, populations, anti-SARS-CoV-2 S1 IgG, defined, performed, significantly higher, were measured, immunosuppressed patient, 【제목키워드】 humoral immune response, booster dose, SARS-CoV-2 vaccination, Immunosuppressed, Observational cohort study,