Immunogenicity of COVID-19 Vaccination in Immunocompromised Patients: An Observational, Prospective Cohort Study Interim Analysis
Open accessPreprint — published as 10.1093/cid/ciac103
Abstract
Objectives: Immunocompromised patients were excluded from COVID-19 vaccine clinical trials. The objectives of the study were to measure antibody responses, levels, and neutralization capability after COVID-19 vaccination among immunocompromised patients and compare these variables to those of immunocompetent healthcare workers. Methods: This is an interim analysis of an ongoing observational, prospective cohort study which launched on April 14, 2021 across Western Pennsylvania. Participants were healthy healthcare workers (HCW) and immunocompromised patients who had completed their COVID-19 vaccination series. Individuals with a history of COVID-19 were not eligible. Serum was collected to measure for the presence of IgG against the SARS-CoV-2 Spike protein using a semi-quantitative assay; antibody levels were available for comparisons. A quasi-random subset of patients was selected for pseudovirus neutralization assays. Seropositivity with 95% Clopper-Pearson exact confidence intervals and distribution of antibody levels were measured. To identify risk factors for seronegativity, clinical characteristics were univariately compared between antibody reactive and non-reactive individuals within the immunocompromised group. Results: 107 HCW and 489 immunocompromised patients were enrolled. Compared to HCWs, seropositivity was significantly lower (p<.001) among immunocompromised patients with Solid organ transplant (SOT), autoimmune, hematological malignancies, and solid tumors (HCW=98.1%; SOT=37.2%; autoimmune=83.8%; hematological malignancies=54.7%; and solid tumor=82.4%, p < 0.05). Over 94% of patients with Human Immunodeficiency Virus were seropositive. Among seropositive patients, antibody levels were much lower among SOT (4.5 [2.1,13.1], p=.020). Neutralization titers tightly correlated with antibody levels (Spearman r = 0.91, p < 0.0001). Conclusion: Our findings demonstrate the heterogeneity of the humoral immune response to COVID-19 vaccines based on underlying immunosuppressive condition and highlight an urgent need to optimize and individualize COVID-19 prevention in these patients. These findings also have implications on public health guidance, particularly given revised Centers for Disease Control and Prevention recommendations permitting vaccinated individuals to abandon masking and social distancing in most settings. Future studies are warranted to determine assessment of cellular immunity, longitudinal measurement of immune responses, and the safety and efficacy of revaccination.
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Regardless of the vaccine received, reductions in vaccine-elicited humoral immunity is likely to be clinically significant for persons with impaired immunity as a result of underlying disease, immunosuppressive drugs or older age.
“Moreover, regardless of the vaccine received, reductions in vaccine-elicited humoral immunity is likely to be clinically significant for persons with impaired immunity as a result of underlying disease, immunosuppressive drugs or older age [241][242][243][244] .”
From The biological and clinical significance of emerging SARS-CoV-2 variants (2021) · cites this paper as [243]
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Method
- Authors
- Haidar, G., Agha, M., Lukanski, A., Linstrum, K., Troyan, R., Bilderback, A., Rothenberger, S., McMahon, D. K., Crandall, M., Enick, P. N., Sobolewksi, M., Collins, K., Schwartz, M. B., Dueker, J. M., Silveira, F. P., Keebler, M. E., Humar, A., Luketich, J. D., Morrell, M. R., Pilewski, J. M., McDyer, J. F., Pappu, B., Ferris, R. L., Marks, S. M., Klamar-Blain, C., Parikh, U. M., Heaps, A., Kip, P. L., Wells, A., Minnier, T., Angus, D., & Mellors, J. W.
- Affiliations
- University of Pittsburgh (US)
- UPMC Hillman Cancer Center (US)
- University of Pittsburgh Medical Center (US)
- University of Utah (US)
- Corresponding author
- Haidar, Ghady
- ORCID
- Haidar, Ghady
- Agha, Mounzer
- Lukanski, Amy
- Bilderback, Andrew
- Rothenberger, Scott
- McMahon, Deborah K.
- Crandall, Melissa
- Collins, Kevin
- Schwartz, Marc B.
- Silveira, Fernanda P.
- Keebler, Mary E.
- Humar, Abhinav
- Luketich, James D.
- Morrell, Matthew R.
- Pilewski, Joseph M.
- McDyer, John F.
- Ferris, Robert L.
- Parikh, Urvi M.
- Heaps, Amy
- Kip, Paula L.
- Wells, Alan
- Minnier, Tami
- Angus, Derek
- Mellors, John W.
- Venue
- Clinical Infectious Diseases
- Publisher
- openRxiv
- Published
- 2021-06-30
- Volume
- 75
- Issue
- 1
- Pages
- e630-e644
- ISSN
- 1058-4838 (ISSN-L)
- PMC
- PMC8903515
- OpenAlex
- W4210317504
- Cited by
- 126
- References
- 0
- Citations by year
- 2026: 5 · 2025: 14 · 2024: 26 · 2023: 34 · 2022: 34 · 2021: 13
- FWCI
- 13.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Infectious Diseases (publishedVersion)
- medRxiv (acceptedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- DSF Charitable Foundation
- Gilead Sciences (COVID-19)
- University of Pittsburgh
- National Institutes of Health (COVID-19)
- National Cancer Institute (P30CA047904)
- National Institute of Allergy and Infectious Diseases (COVID-19, K23AI154546)
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Life Sciences › Immunology and Microbiology › Immunology › Immune responses and vaccinations
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Keywords
- COVID-19 vaccines, immunocompromised patients, humoral immune response, seropositivity, antibody levels, neutralizing antibodies, solid organ transplant recipients, hematologic malignancies, autoimmune disease, solid tumors, HIV, anti-CD20 monoclonal antibody, BNT162b2, mRNA-1273, adenovirus vector vaccine
- MeSH terms
- COVID-19, SARS-CoV-2, COVID-19 Vaccines, BNT162 Vaccine, Adult, Antibodies, Viral, Humans, Prospective Studies, Vaccination, HIV Infections, Immunocompromised Host
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