儿童自身免疫性风湿病患者感染 COVID-19 后的血清学反应与接种 COVID-19 疫苗的比较。
Serological response after COVID-19 infection compared to vaccination against COVID-19 in children with autoimmune rheumatic diseases.
机构信息
Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
出版信息
Pediatr Rheumatol Online J. 2024 Jul 25;22(1):68. doi: 10.1186/s12969-024-01003-0.
BACKGROUND
Paediatric patients with autoimmune rheumatic diseases (pARD) have a dysregulated immune system, so infections present a major threat to them. To prevent severe COVID-19 infections we aimed to vaccinate them as soon as possible. Studies have shown that the BNT162b2 vaccine is safe, effective, and immunogenic, however, in a short observation period, only.
METHODS
The main objective was to compare the serological response between three groups of pARD: after SARS-CoV-2 infection, after vaccination against COVID-19 with two doses of the BNT162b2 vaccine, and after experiencing both events. Data on demographics, diagnosis, therapy, and serology (anti-SARS-CoV-2 IgG/IgA) were collected from March 2020 to April 2022. For statistical analysis ANOVA, Mann-Whitney U test, Chi-square test and Fisher's exact test were applied. To compare adverse events (AE) after vaccination we included a control group of healthy adolescents.
RESULTS
We collected data from 115 pARD; from 92 after infection and 47 after vaccination. Twenty-four were included in both groups. Serological data were available for 47 pARD after infection, 25 after vaccination, and 21 after both events. Serological response was better after vaccination and after both events compared to after infection only. No effect of medication on the antibody levels was noted. The safety profile of the vaccine was good. Systemic AE after the first dose of the vaccine were more common in healthy adolescents compared to pARD. In the observation period of 41.3 weeks, 60% of vaccinated pARD did not experience a symptomatic COVID-19 infection.
CONCLUSIONS
IgG and IgA anti-SARS-CoV-2 levels were higher after vaccination and after both events compared to after infection only. Six months after vaccination we observed an increase in antibody levels, suggesting that pARD had been exposed to SARS-CoV-2 but remained asymptomatic.
TRIAL REGISTRATION
The study was approved by the Medical Ethics Committee of the Republic of Slovenia (document number: 0120-485/2021/6).
背景
患有自身免疫性风湿病（pARD）的儿科患者免疫系统失调，因此感染对他们构成重大威胁。为防止严重的 COVID-19 感染，我们旨在尽快为他们接种疫苗。研究表明，BNT162b2 疫苗是安全、有效和免疫原性的，但在短期观察期内，仅如此。
方法
主要目的是比较三组 pARD 的血清学反应：感染 SARS-CoV-2 后、接种两剂 BNT162b2 疫苗预防 COVID-19 后，以及同时经历这两种情况后。从 2020 年 3 月到 2022 年 4 月，收集了人口统计学、诊断、治疗和血清学（抗 SARS-CoV-2 IgG/IgA）的数据。为了进行统计学分析，应用了方差分析、Mann-Whitney U 检验、卡方检验和 Fisher 精确检验。为了比较接种疫苗后的不良事件（AE），我们纳入了一组健康青少年作为对照组。
结果
我们收集了 115 名 pARD 的数据；92 名感染后，47 名接种疫苗后。24 名患者同时在两组中。感染后有 47 名 pARD 有血清学数据，接种疫苗后有 25 名，同时有两组事件的有 21 名。与仅感染相比，接种疫苗和同时发生两种情况后血清学反应更好。药物对抗体水平没有影响。疫苗的安全性良好。与 pARD 相比，健康青少年在接种疫苗第一剂后更常出现全身性 AE。在 41.3 周的观察期内，60%的接种 pARD 未经历有症状的 COVID-19 感染。
结论
与仅感染相比，接种疫苗和同时发生两种情况后，IgG 和 IgA 抗 SARS-CoV-2 水平更高。接种疫苗 6 个月后，我们观察到抗体水平增加，这表明 pARD 曾接触过 SARS-CoV-2，但仍无症状。
试验注册
该研究得到了斯洛文尼亚共和国医学伦理委员会的批准（文件编号：0120-485/2021/6）。
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