Ghoti Hussam, Zreid Hala, Ghoti Israa, Bourgonje Arno R, Diepstra Arjan, van Goor Harry, Avivi Irit, Jeadi Hisham, van Eijk Larissa E, Weiss Günter
Department of Hematology, Al-Shifa Hospital, 51245, Gaza, Palestine.
Hematology Clinic, National Health Services, 6818164, Tel Aviv, Israel.
EClinicalMedicine. 2023 Jul 26;62:102096. doi: 10.1016/j.eclinm.2023.102096. eCollection 2023 Aug.
COVID-19 has raised special concern for patients with β-thalassemia major (β-TM) due to frequent comorbidities, regular blood transfusions, and iron overload. However, the exact implications of COVID-19 for patients with β-TM remain uncertain. We aimed to explore the COVID-19 incidence and severity, and the serological response to SARS-CoV-2 infection and vaccination in patients with β-TM.
Patients with β-TM ( = 105) and age-matched healthy controls, all individuals of all control groups were health care workers of the hospital, were prospectively enrolled at the haematology department of Al-Shifa hospital in the Gaza Strip from January 1st, 2021 to December 31st, 2021. Data on COVID-19 incidence and severity were analysed, with Alpha, Beta, and Delta SARS-CoV-2 variants dominating at that time. Anti-SARS-CoV-2 IgG antibody levels were measured and compared between study groups.
Patients with β-TM showed a higher incidence of SARS-CoV-2 infection than the general population (61.9% vs. 7.1%, p < 0.0001). Most patients with β-TM had asymptomatic (70.8%) or mild disease (26.1%), with no fatalities recorded. COVID-19 illness was more severe among female than male patients with β-TM. Anti-SARS-CoV-2 IgG antibodies were significantly higher in symptomatic patients with β-TM than controls post-infection (geometric mean ÷ geometric standard deviation 1299.0 ÷ 3.3 vs. 555.7 ÷ 2.4 AU/mL, p = 0.009) and post-vaccination (8404.0 ÷ 3.9 vs. 2785.6 ÷ 5.0 AU/mL, p = 0.015). Similar responses were observed when comparing splenectomised to non-splenectomised (both asymptomatic and symptomatic) patients with β-TM post-infection (595.4 ÷ 3.9 vs. 280.7 ÷ 3.5 AU/mL, p = 0.005) and post-vaccination (13,778.2 ÷ 3.2 vs. 4961.8 ÷ 4.1 AU/mL, p = 0.045).
This distinctive β-TM cohort exhibited a high susceptibility to SARS-CoV-2 infection but mild disease course. Our findings support favourable serological responses to SARS-CoV-2 infection and to vaccination in patients with β-TM, indicating a potential interplay between iron availability and COVID-19-related immunity.
This study was funded by Mr. Hosam and Wasim s. El Helou.
由于合并症频繁、定期输血和铁过载，新冠病毒病（COVID-19）引起了重型β地中海贫血（β-TM）患者的特别关注。然而，COVID-19对β-TM患者的确切影响仍不确定。我们旨在探讨β-TM患者中COVID-19的发病率和严重程度，以及对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染和疫苗接种的血清学反应。
2021年1月1日至2021年12月31日，在加沙地带希法医院血液科前瞻性纳入了105例β-TM患者和年龄匹配的健康对照（所有对照组个体均为该医院医护人员）。分析了COVID-19的发病率和严重程度数据，当时阿尔法、贝塔和德尔塔SARS-CoV-2变异株占主导。测量并比较了研究组之间的抗SARS-CoV-2 IgG抗体水平。
β-TM患者的SARS-CoV-2感染率高于普通人群（61.9%对7.1%，p<0.0001）。大多数β-TM患者无症状（70.8%）或病情轻微（26.1%），无死亡记录。β-TM女性患者的COVID-19病情比男性更严重。有症状的β-TM患者感染后和接种疫苗后的抗SARS-CoV-2 IgG抗体显著高于对照组（几何均值÷几何标准差分别为1299.0÷3.3对555.7÷2.4 AU/mL，p=0.009）以及（8404.0÷3.9对2785.6÷5.0 AU/mL，p=0.015）。比较感染后（595.4÷3.9对280.7÷3.5 AU/mL，p=0.005）和接种疫苗后（13778.2÷3.2对4961.8÷4.1 AU/mL，p=0.045）的β-TM脾切除患者与非脾切除患者（包括无症状和有症状患者）时，观察到类似反应。
这一独特的β-TM队列对SARS-CoV-2感染表现出高易感性，但病程较轻。我们的研究结果支持β-TM患者对SARS-CoV-2感染和疫苗接种有良好的血清学反应，表明铁的可利用性与COVID-19相关免疫之间可能存在相互作用。
本研究由Hosam先生和Wasim s. El Helou资助。
