Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom.
Department of Clinical Immunology, University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, United Kingdom.
Front Immunol. 2022 Sep 23;13:984376. doi: 10.3389/fimmu.2022.984376. eCollection 2022.
Individuals with primary and secondary immunodeficiency (PID/SID) were shown to be at risk of poor outcomes during the early stages of the SARS-CoV-2 pandemic. SARS-CoV-2 vaccines demonstrate reduced immunogenicity in these patients.
To understand whether the risk of severe COVID-19 in individuals with PID or SID has changed following the deployment of vaccination and therapeutics in the context of the emergence of novel viral variants of concern.
The outcomes of two cohorts of patients with PID and SID were compared: the first, infected between March and July 2020, prior to vaccination and treatments, the second after these intervention became available between January 2021 and April 2022.
22.7% of immunodeficient patients have been infected at least once with SARS-CoV-2 since the start of the pandemic, compared to over 70% of the general population. Immunodeficient patients were typically infected later in the pandemic when the B.1.1.529 (Omicron) variant was dominant. This delay was associated with receipt of more vaccine doses and higher pre-infection seroprevalence. Compared to March-July 2020, hospitalization rates (53.3% vs 17.9%, p<0.0001) and mortality (Infection fatality rate 20.0% vs 3.4%, p=0.0003) have significantly reduced for patients with PID but remain elevated compared to the general population. The presence of a serological response to vaccination was associated with a reduced duration of viral detection by PCR in the nasopharynx. Early outpatient treatment with antivirals or monoclonal antibodies reduced hospitalization during the Omicron wave.
Most individuals with immunodeficiency in the United Kingdom remain SARS-CoV-2 infection naïve. Vaccination, widespread availability of outpatient treatments and, possibly, the emergence of the B.1.1.529 variant have led to significant improvements in morbidity and mortality followings SARS-CoV-2 infection since the start of the pandemic. However, individuals with PID and SID remain at significantly increased risk of poor outcomes compared to the general population; mitigation, vaccination and treatment strategies must be optimized to minimize the ongoing burden of the pandemic in these vulnerable cohorts.
在 SARS-CoV-2 大流行的早期阶段，原发性和继发性免疫缺陷（PID/SID）个体被认为有发生不良结局的风险。这些患者的 SARS-CoV-2 疫苗表现出免疫原性降低。
了解在出现新型关注病毒变体的情况下，疫苗接种和治疗的应用是否改变了 PID 或 SID 个体中 COVID-19 重症的风险。
比较了两批 PID 和 SID 患者的结局：第一组在 2020 年 3 月至 7 月之间感染，此时疫苗和治疗尚未应用；第二组在 2021 年 1 月至 2022 年 4 月之间这些干预措施可用之后感染。
自大流行开始以来，22.7%的免疫缺陷患者至少感染过一次 SARS-CoV-2，而这一比例在普通人群中超过 70%。免疫缺陷患者通常在大流行后期感染，当时 B.1.1.529（Omicron）变体占主导地位。这种延迟与接种更多疫苗剂量和更高的感染前血清阳性率有关。与 2020 年 3 月至 7 月相比，PID 患者的住院率（53.3% vs 17.9%，p<0.0001）和死亡率（感染病死率 20.0% vs 3.4%，p=0.0003）显著降低，但仍高于普通人群。疫苗接种产生血清学反应与鼻咽 PCR 检测到的病毒持续时间缩短有关。在 Omicron 波中，早期门诊使用抗病毒药物或单克隆抗体可减少住院。
在英国，大多数免疫缺陷患者仍对 SARS-CoV-2 感染呈无反应状态。自大流行开始以来，疫苗接种、广泛应用的门诊治疗，以及可能出现的 B.1.1.529 变体，导致 SARS-CoV-2 感染后的发病率和死亡率显著改善。然而，与普通人群相比，PID 和 SID 个体发生不良结局的风险仍然显著增加；必须优化缓解、疫苗接种和治疗策略，以最大限度地减少这些脆弱群体中持续存在的大流行负担。
