Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan.
Pediatr Int. 2022 Jan;64(1):e15331. doi: 10.1111/ped.15331.
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.
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.
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.
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.
我们对正在服用免疫抑制剂的儿童和青少年进行了一项关于严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）信使 RNA（mRNA）疫苗接种的前瞻性研究。
给正在服用免疫抑制剂的患者接种两剂 SARS-CoV-2 mRNA 疫苗。在接种前后测量 SARS-CoV-2 刺突蛋白受体结合域抗体的滴度。将接种后抗体滴度<0.8 U/mL 定义为疫苗接种失败。评估疫苗接种失败率、与接种后抗体滴度相关的因素、对突破性感染的临床疗效和不良事件。
共纳入 42 例患者（中位年龄 18.1 岁）。34 例患者的免疫原性可测。SARS-CoV-2 刺突抗体的中位数滴度为 329 U/mL（四分位距[IQR] 50-812 U/mL）。29 例（85%）患者实现了血清转化（≥0.8 U/mL），而 5 例（15%）患者诊断为疫苗接种失败。所有疫苗接种失败的患者均为实体器官移植（SOT）受者，且正在服用两种免疫抑制剂。SOT 受者的抗体滴度中位数（57 U/mL）显著低于非受者（653 U/mL，P=0.0002）；服用两种免疫抑制剂的患者（93 U/mL）低于服用一种免疫抑制剂的患者（506 U/mL，P=0.003）。有 3 例患者发生突破性感染（7%）。不良事件是非特异性的，SOT 受者未发生原发病或急性排斥反应加重。
SARS-CoV-2 mRNA 疫苗在服用免疫抑制剂的儿童和青少年中具有免疫原性，尽管 SOT 受者和服用两种免疫抑制剂的患者接种后抗体滴度往往较低。
