Laboratory of Infectious Diseases, National Institute for Allergy and Infectious Diseases, Bethesda, Maryland.
Division of Allergy & Immunology and Center for Cancer and Immunology Research, Children's National Hospital, Washington, District of Columbia; Department of Pediatrics and GW Cancer Center, George Washington University, Washington, District of Columbia.
Ann Allergy Asthma Immunol. 2022 Nov;129(5):562-571.e1. doi: 10.1016/j.anai.2022.06.009. Epub 2022 Jun 16.
To update clinicians on current evidence regarding the immunogenicity and safety of coronavirus disease 2019 (COVID-19) vaccines in patients with inborn errors of immunity (IEI).
Peer-reviewed, published studies in PubMed, clinical trials listed on ClinicalTrials.gov, and professional organization and governmental guidelines.
Literature searches on PubMed and ClinicalTrials.gov were performed using a combination of the following keywords: primary immunodeficiency, COVID-19, SARS-CoV-2, and vaccination.
A total of 26 studies met the criteria and were included in this review. Overall, antibody responses to COVID-19 vaccination were found in 72% of study subjects, with stronger responses observed after messenger RNA vaccination. Neutralizing antibodies were detected in patients with IEI, though consistently at lower levels than healthy controls. Risk factors for poor antibody responses included diagnosis of common variable immunodeficiency, presence of autoimmune comorbidities, and use of rituximab. T cell responses were detectable in most patients with IEI, with poorer responses often found in patients with common variable immunodeficiency. Safety of COVID-19 vaccines in patients with IEI was acceptable with high rates of reactogenicity but very few serious adverse events, including in patients with immune dysregulation.
COVID-19 vaccines are safe in patients with IEI and seem to be immunogenic in most individuals, with stronger responses found after messenger RNA vaccinations.
为临床医生提供关于免疫缺陷患者中 COVID-19 疫苗的免疫原性和安全性的最新证据。
在 PubMed 上进行同行评审的已发表研究、ClinicalTrials.gov 上列出的临床试验以及专业组织和政府指南。
在 PubMed 和 ClinicalTrials.gov 上进行文献检索，使用以下关键词的组合：原发性免疫缺陷、COVID-19、SARS-CoV-2 和疫苗接种。
共有 26 项研究符合标准并被纳入本综述。总体而言，在 72%的研究对象中观察到 COVID-19 疫苗接种后的抗体反应，信使 RNA 疫苗接种后观察到更强的反应。在免疫缺陷患者中检测到中和抗体，但始终低于健康对照。抗体反应不良的风险因素包括常见可变免疫缺陷的诊断、自身免疫合并症的存在以及利妥昔单抗的使用。大多数免疫缺陷患者中可检测到 T 细胞反应，但在常见可变免疫缺陷患者中通常发现反应较差。COVID-19 疫苗在免疫缺陷患者中的安全性可接受，具有高反应原性但很少有严重不良事件，包括免疫失调患者。
COVID-19 疫苗在免疫缺陷患者中是安全的，并且在大多数个体中似乎具有免疫原性，信使 RNA 疫苗接种后反应更强。
