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Reduced durability of hybrid immunity to SARS-CoV-2 in immunocompromised children
Youjia Zhong1,2,3, Amuthavalli Kottaiswamy1, Chen Xiang Ang3
1Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
Insights
Immunocompromised children need a three-dose COVID-19 vaccine primary series for adequate protection. Their immunity wanes faster than in healthy children, requiring frequent booster shots.
Area of Science:
- Immunology
- Vaccinology
- Pediatrics
Background:
- Immunocompromised children face significant risks from endemic COVID-19.
- Optimal primary vaccination and booster schedules for this vulnerable group remain unclear.
Purpose of the Study:
- To evaluate the immunogenicity and durability of hybrid immunity following SARS-CoV-2 vaccination in immunocompromised children.
- To compare vaccine responses in immunocompromised children with those in healthy children.
Main Methods:
- Recruitment of 19 immunocompromised children (transplant recipients, autoimmune disease, leukemia patients).
- Primary vaccination with BNT162b2 mRNA SARS-CoV-2 vaccine.
- Longitudinal follow-up for 1 year post-vaccination, assessing T cell and memory B cell responses.
Main Results:
- Two vaccine doses were insufficient to elicit protective T cell and memory B cell responses in immunocompromised children.
- A third dose significantly enhanced both T cell and memory B cell responses.
- Hybrid immunity declined more rapidly in immunocompromised children, falling below protective levels by 12 months.
Conclusions:
- A three-dose primary vaccination regimen is recommended for immunocompromised children.
- Sustained immunity may necessitate yearly or twice-yearly booster doses in this population.
Background:
In endemic COVID-19, immunocompromised children are vulnerable until vaccinated but the optimal primary vaccination regime and need for booster doses remains uncertain.
Methods:
We recruited 19 immunocompromised children (post-solid organ transplantation, have autoimmune disease or were on current or recent chemotherapy for acute lymphoblastic leukemia), and followed them from the start of primary vaccination with BNT162b2 mRNA SARS-CoV-2 until 1-year post-vaccination. We investigated the quality of vaccine immunogenicity, and longevity of hybrid immunity, in comparison to healthy children.
Results:
Immunocompromised children failed to produce T cell and memory B cell (MBC) responses reaching thresholds of protection after 2 doses; a third dose however improved both responses. Initially robust hybrid immunity demonstrated significantly more decline in T cell and MBC responses in immunocompromised compared to healthy children, to levels below the protective threshold by month 12.
Discussion:
Immunocompromised children may benefit from a 3-dose primary vaccination regime, with yearly or twice-yearly booster doses for sustained immunity.
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