Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Front Public Health. 2023 Mar 23;11:1108546. doi: 10.3389/fpubh.2023.1108546. eCollection 2023.
The fourth dose the COVID-19 vaccine was first proposed to immunocompromised patients. The aim of the article is to systematically review the literature and report the humoral response and outcomes after the fourth dose administration in people with impaired immune system.
Published studies on the humoral response, efficacy and safety of the fourth dose of the COVID-19 vaccine were analyzed in various settings of immunocompromised patients. We conducted systematic searches of PubMed, Cochrane Library and WHO COVID-19 Research Database for series published through January 31, 2023, using the search terms "fourth dose" or "second booster" or "4th dose" and "Coronavirus" or "COVID-19" or "SARS-CoV-2." All articles were selected according to the PRISMA guidelines.
A total of 24 articles including 2,838 patients were comprised in the systematic review. All the studies involved immunocompromised patients, including solid organ transplant recipients, patients with autoimmune rheumatic disease, patients with human immunodeficiency virus (HIV) and patients with blood cancers or diseases. Almost all patients received BNT162b2 or mRNA-1273 as fourth dose. All the studies demonstrated the increase of antibody titers after the fourth dose, both in patients who had a serological strong response and in those who had a weak response after the third dose. No serious adverse events after the 4th dose have been reported by 13 studies. COVID-19 infection after the fourth dose ranged from 0 to 21%.
The present review highlights the importance of the fourth dose of covid-19 vaccines for immunocompromised patients. Across the included studies, a fourth dose was associated with improved seroconversion and antibody titer levels. In particular, a fourth dose was associated with increasing immunogenicity in organ transplant recipients and patients with hematological cancers, with a very low rate of serious side effects.
首次提出为免疫功能低下的患者接种第四剂 COVID-19 疫苗。本文旨在系统回顾文献，并报告免疫系统受损人群接种第四剂后的体液反应和结局。
分析了各种免疫功能低下患者背景下 COVID-19 疫苗第四剂的体液反应、疗效和安全性的已发表研究。我们通过使用“第四剂”或“第二加强剂”或“第四剂”和“冠状病毒”或“COVID-19”或“SARS-CoV-2”等检索词，对截至 2023 年 1 月 31 日在 PubMed、Cochrane 图书馆和世界卫生组织 COVID-19 研究数据库中发表的系列文章进行了系统检索。所有文章均根据 PRISMA 指南进行选择。
系统综述共纳入 24 篇文章，共计 2838 例患者。所有研究均涉及免疫功能低下患者，包括实体器官移植受者、自身免疫性风湿病患者、人类免疫缺陷病毒 (HIV) 患者以及血液癌或疾病患者。几乎所有患者均接种了 BNT162b2 或 mRNA-1273 作为第四剂。所有研究均表明，第四剂后抗体滴度增加，包括第三剂后血清学强反应和弱反应的患者。13 项研究报告第四剂后无严重不良事件。第四剂后 COVID-19 感染率为 0 至 21%。
本综述强调了免疫功能低下患者接种 COVID-19 疫苗第四剂的重要性。在纳入的研究中，第四剂与改善血清转化率和抗体滴度水平相关。特别是，第四剂与提高器官移植受者和血液癌患者的免疫原性相关，严重副作用发生率非常低。
