先天性心脏病成人的新冠病毒疫苗接种：来自意大利一家三级中心的真实世界数据。
COVID-19 vaccination in adults with congenital heart disease: Real-world data from an Italian tertiary centre.
作者信息
Fusco Flavia, Scognamiglio Giancarlo, Merola Assunta, Roma Anna Selvaggia, Nicastro Carmine, Spatarella Micaela, D'Abbraccio Maurizio, Di Mauro Gabriella, Atripaldi Umberto, Atripaldi Lidia, Correra Anna, Palma Michela, Barracano Rosaria, Borrelli Nunzia, Capuano Annalisa, Sarubbi Berardo
机构信息
Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy.
Department for Laboratory Medicine, AO dei Colli - Monaldi Hospital, Naples, Italy.
出版信息
Int J Cardiol Congenit Heart Dis. 2021 Dec;6:100266. doi: 10.1016/j.ijcchd.2021.100266. Epub 2021 Oct 28.
BACKGROUND
real-world data on COVID-19 vaccine safety, immunogenicity and acceptance in adults with congenital heart disease (ACHD) are lacking.
METHODS
ACHD patients who were offered COVID-19 vaccination from January to June 2021 were included. Data on adverse events, on patients' attitude towards vaccination and antispike IgG titre were retrospectively collected. A group of healthy individuals with similar age and sex undergoing vaccination was included for comparison.
RESULTS
208 patients followed in a single ACHD tertiary centre (33.3 [26-45] years, 54% male) received COVID-19 vaccine, 65% vaccinated at our institution: 199 (96%) received Pfizer-BioNTech BNT162b2 vaccine, 4 (2%) Moderna-1273 and 5 (2%) AstraZeneca-ChAdOx1. Median follow-up after vaccination was 79 [57-96] days. No major adverse event was reported and the incidence of minor events was not different between ACHD patients and the control group. One patient was diagnosed with acute pericarditis. There were two deaths unrelated to the vaccine during follow-up. Three (1.5%) vaccinated patients tested positive for COVID-19. Antispike IgG titre, available in 159 (76%) patients, was 1334 [600-3401] BAU/ml, not significantly different from the control group (p=0.2). One patient with Fontan failure was seronegative. Advanced physiological stage was associated with lower antibody response, independently from previous viral exposure (p<0.0001). Fourteen percent refused COVID-19 vaccination at our institution. However, 50% of vaccinated patients declared to have been influenced by the discussion with the ACHD cardiologist and 66% of those vaccinated in situ reported that undergoing COVID-19 vaccination at the ACHD centre made them feel safer.
CONCLUSION
COVID-19 vaccines appear safe in ACHD with satisfactory immunogenicity. However, the most vulnerable patients showed lower antibody response. ACHD team may play a key role in vaccine acceptance.
背景
缺乏关于先天性心脏病成年患者（ACHD）接种新冠疫苗的安全性、免疫原性及接受度的真实世界数据。
方法
纳入2021年1月至6月期间接受新冠疫苗接种的ACHD患者。回顾性收集不良事件、患者对疫苗接种的态度以及抗刺突IgG滴度的数据。纳入一组年龄和性别相似的健康接种者作为对照。
结果
在一家单一的ACHD三级中心随访的208例患者（33.3[26 - 45]岁，54%为男性）接种了新冠疫苗，65%在本机构接种：199例（96%）接种了辉瑞 - 生物科技公司的BNT162b2疫苗，4例（2%）接种了莫德纳 - 1273疫苗，5例（2%）接种了阿斯利康 - ChAdOx1疫苗。接种疫苗后的中位随访时间为79[57 - 96]天。未报告重大不良事件，ACHD患者与对照组的轻微事件发生率无差异。1例患者被诊断为急性心包炎。随访期间有2例死亡与疫苗无关。3例（1.5%）接种疫苗的患者新冠病毒检测呈阳性。159例（76%）患者的抗刺突IgG滴度为1334[600 - 3401]BAU/ml，与对照组无显著差异（p = 0.2）。1例患有Fontan循环衰竭的患者血清学检测为阴性。高级生理阶段与较低的抗体反应相关，与既往病毒暴露无关（p < 0.0001）。14%的患者在本机构拒绝接种新冠疫苗。然而，50%的接种患者表示受到与ACHD心脏病专家讨论的影响，66%在本机构接种的患者报告在ACHD中心接种新冠疫苗让他们感觉更安全。
结论
新冠疫苗在ACHD患者中似乎是安全的，免疫原性令人满意。然而，最脆弱的患者抗体反应较低。ACHD团队在疫苗接受方面可能发挥关键作用。
Zotero 插件