Abstract
Background: We conducted a prospective study of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccination in children and adolescents who were taking immunosuppressive agents.
Methods: Two doses of SARS-CoV-2 mRNA vaccine were administered to patients taking immunosuppressive agents. Titers of SARS-CoV-2 spike protein receptor-binding domain antibodies were measured before and after vaccination. Vaccine failure was defined as a postvaccination antibody titer of <0.8 U/mL. Seroconversion rates, factors associated with antibody titers after vaccination, clinical effectiveness against breakthrough infection, and adverse events were evaluated.
Results: A total of 42 patients (median age, 18.1 years) were enrolled. Immunogenicity was measured in 34 patients. The median SARS-CoV-2 spike antibody titer was 329 U/mL (interquartile range [IQR] 50-812 U/mL). Seroconversion (≥0.8 U/mL) was achieved in 29 patients (85%), whereas vaccine failure was diagnosed in five (15%). All patients with vaccine failure were recipients of solid organ transplants (SOTs) and were taking two immunosuppressants. The median antibody titer in SOT recipients (57 U/mL) was significantly lower than that in non-recipients (653 U/mL, P = 0.0002); that of patients taking two immunosuppressive agents (93 U/mL) was lower than that of patients taking one (506 U/mL, P = 0.003). Breakthrough infection occurred in three patients (7%). Adverse events were non-specific, and no flares of primary disease or acute rejection in SOT recipients occurred.
Conclusions: SARS-CoV-2 mRNA vaccine was immunogenic in children and adolescents taking immunosuppressive agents, although SOT recipients and patients taking two immunosuppressive agents tended to show lower postvaccination antibody titers.
Keywords: SARS-CoV-2 mRNA vaccine; adolescents; children; immunosuppressive agents; solid organ transplant recipients.
【저자키워드】 children, adolescents, Immunosuppressive agents, SARS-CoV-2 mRNA vaccine, Solid organ transplant recipients., 【초록키워드】 SARS-CoV-2, Vaccine, coronavirus, vaccination, immunogenicity, antibody, mRNA vaccine, Prospective Study, Infection, immunosuppressants, mRNA, titer, SARS-CoV-2 spike protein, adverse event, Patient, Antibody titer, clinical effectiveness, Breakthrough infection, disease, patients, non-specific, Antibody titers, solid organ transplant, SARS-CoV-2 spike, Vaccine failure, dose, immunosuppressive, SOT, interquartile range, Messenger RNA, acute respiratory syndrome, Factor, Adverse, recipients, median age, domain, immunogenic, recipient, rejection, significantly lower, postvaccination, Administered, FIVE, event, was measured, enrolled, defined, occurred, diagnosed, evaluated, conducted, median, were measured, immunosuppressive agent, non-recipient, 【제목키워드】 immunogenicity, SARS-CoV-2 vaccine, immunosuppressive agent,