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COVID-19 Vaccination in Patients with Inborn Errors of Immunity Reduces Hospitalization and Critical Care Needs
John McDonnell1, Kimberley Cousins2, M Elizabeth M Younger3
1Pediatric Allergy and Immunology, Cleveland Clinic Children's Hospital, 9500 Euclid Ave/R3, Cleveland, OH, 44195, USA. mcdonnj@ccf.org.
Insights
COVID-19 vaccination is safe for individuals with inborn errors of immunity (IEI). Vaccination also reduces the severity of COVID-19 infection in this vulnerable population.
Area of Science:
- Immunology
- Infectious Diseases
- Vaccinology
Background:
- Centers for Disease Control and Prevention (CDC) and Advisory Committee on Immunization Practices (ACIP) recommend COVID-19 vaccination for patients with inborn errors of immunity (IEI).
- Limited data exist on COVID-19 vaccine safety and effectiveness in IEI patients.
- The impact of vaccination on COVID-19 infection severity in IEI is not well understood.
Purpose of the Study:
- To assess the safety of COVID-19 vaccination in patients with IEI.
- To evaluate the effect of COVID-19 vaccination on infection outcomes in IEI patients.
Main Methods:
- A secure registry database was established in collaboration with the US Immunodeficiency Network.
- Data were collected from 1245 IEI patients across 24 countries between January 1, 2022, and August 19, 2022.
- Vaccination status, safety indicators, and COVID-19 infection outcomes were analyzed.
Main Results:
- Of 1245 patients, 806 (64.7%) received at least one COVID-19 vaccine, primarily mRNA-based vaccines.
- Seventeen patients reported vaccine-related complications; one required hospitalization for anemia.
- COVID-19 infection occurred in 823 patients (66.1%), with lower hospitalization (9.3% vs 24.4%), ICU admission (2.8% vs 7.6%), and mortality (2.3% vs 4.3%) rates in vaccinated individuals.
- Vaccination prior to infection significantly reduced the odds of hospitalization and ICU admission.
Conclusions:
- COVID-19 vaccination is deemed safe for the IEI population.
- Vaccination was found to attenuate the severity of COVID-19 infection in individuals with IEI.
Background:
The CDC and ACIP recommend COVID-19 vaccination for patients with inborn errors of immunity (IEI). Not much is known about vaccine safety in IEI, and whether vaccination attenuates infection severity in IEI.
Objective:
To estimate COVID-19 vaccination safety and examine effect on outcomes in patients with IEI.
Methods:
We built a secure registry database in conjunction with the US Immunodeficiency Network to examine vaccination frequency and indicators of safety and effectiveness in IEI patients. The registry opened on January 1, 2022, and closed on August 19, 2022.
Results:
Physicians entered data on 1245 patients from 24 countries. The most common diagnoses were antibody deficiencies (63.7%). At least one COVID-19 vaccine was administered to 806 patients (64.7%), and 216 patients received vaccination prior to the development of COVID-19. The most common vaccines administered were mRNA-based (84.0%). Seventeen patients were reported to seek outpatient clinic or emergency room care for a vaccine-related complication, and one patient was hospitalized for symptomatic anemia. Eight hundred twenty-three patients (66.1%) experienced COVID-19 infection. Of these, 156 patients required hospitalization (19.0%), 47 required ICU care (5.7%), and 28 died (3.4%). Rates of hospitalization (9.3% versus 24.4%, p < 0.001), ICU admission (2.8% versus 7.6%, p = 0.013), and death (2.3% versus 4.3%, p = 0.202) in patients who had COVID-19 were lower in patients who received vaccination prior to infection. In adjusted logistic regression analysis, not having at least one COVID-19 vaccine significantly increased the odds of hospitalization and ICU admission.
Conclusion:
Vaccination for COVID-19 in the IEI population appears safe and attenuates COVID-19 severity.
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