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SARS-CoV-2-specific immune responses and clinical outcomes after COVID-19 vaccination in patients with immune-suppressive disease

SARS-CoV-2-specific immune responses and clinical outcomes after COVID-19 vaccination in patients with immune-suppressive disease
SARS-CoV-2-specific immune responses and clinical outcomes after COVID-19 vaccination in patients with immune-suppressive disease

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immune responses and infection outcomes were evaluated in 2,686 patients with varying immune-suppressive disease states after administration of two Coronavirus Disease 2019 (COVID-19) vaccines. Overall, 255 of 2,204 (12%) patients failed to develop anti-spike antibodies, with an additional 600 of 2,204 (27%) patients generating low levels (<380 AU ml −1). Vaccine failure rates were highest in ANCA-associated vasculitis on rituximab (21/29, 72%), hemodialysis on immunosuppressive therapy (6/30, 20%) and solid organ transplant recipients (20/81, 25% and 141/458, 31%). SARS-CoV-2-specific T cell responses were detected in 513 of 580 (88%) patients, with lower T cell magnitude or proportion in hemodialysis, allogeneic hematopoietic stem cell transplantation and liver transplant recipients (versus healthy controls). Humoral responses against Omicron (BA.1) were reduced, although cross-reactive T cell responses were sustained in all participants for whom these data were available. BNT162b2 was associated with higher antibody but lower cellular responses compared to ChAdOx1 nCoV-19 vaccination. We report 474 SARS-CoV-2 infection episodes, including 48 individuals with hospitalization or death from COVID-19. Decreased magnitude of both the serological and the T cell response was associated with severe COVID-19. Overall, we identified clinical phenotypes that may benefit from targeted COVID-19 therapeutic strategies.

1078-8956
1760-1774
Barnes, Eleanor
2ccdaa43-22ce-4cb1-91ca-2abb35df1966
S. Goodyear, Carl
17522e02-a1bd-4dcb-b211-fd434a594151
Willicombe, Michelle
dabeda91-1229-4038-a95a-d238ea648572
Lim, Sean
1afe5aa1-61a4-4a7b-927f-5e671f885196
et al.
Barnes, Eleanor
2ccdaa43-22ce-4cb1-91ca-2abb35df1966
S. Goodyear, Carl
17522e02-a1bd-4dcb-b211-fd434a594151
Willicombe, Michelle
dabeda91-1229-4038-a95a-d238ea648572
Lim, Sean
1afe5aa1-61a4-4a7b-927f-5e671f885196

Barnes, Eleanor, S. Goodyear, Carl and Willicombe, Michelle , et al. (2023) SARS-CoV-2-specific immune responses and clinical outcomes after COVID-19 vaccination in patients with immune-suppressive disease. Nature Medicine, 29 (7), 1760-1774. (doi:10.1038/s41591-023-02414-4).

Record type: Article

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immune responses and infection outcomes were evaluated in 2,686 patients with varying immune-suppressive disease states after administration of two Coronavirus Disease 2019 (COVID-19) vaccines. Overall, 255 of 2,204 (12%) patients failed to develop anti-spike antibodies, with an additional 600 of 2,204 (27%) patients generating low levels (<380 AU ml −1). Vaccine failure rates were highest in ANCA-associated vasculitis on rituximab (21/29, 72%), hemodialysis on immunosuppressive therapy (6/30, 20%) and solid organ transplant recipients (20/81, 25% and 141/458, 31%). SARS-CoV-2-specific T cell responses were detected in 513 of 580 (88%) patients, with lower T cell magnitude or proportion in hemodialysis, allogeneic hematopoietic stem cell transplantation and liver transplant recipients (versus healthy controls). Humoral responses against Omicron (BA.1) were reduced, although cross-reactive T cell responses were sustained in all participants for whom these data were available. BNT162b2 was associated with higher antibody but lower cellular responses compared to ChAdOx1 nCoV-19 vaccination. We report 474 SARS-CoV-2 infection episodes, including 48 individuals with hospitalization or death from COVID-19. Decreased magnitude of both the serological and the T cell response was associated with severe COVID-19. Overall, we identified clinical phenotypes that may benefit from targeted COVID-19 therapeutic strategies.

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Accepted/In Press date: 23 May 2023
Published date: 6 July 2023
Additional Information: Funding Information: We thank the patients who took part in the trial; the 35 investigators from 11 recruiting centers and their research staff members; colleagues at UK Health Security Agency (UKHSA), including Bassam Hallis, Cathy Rowe and Sue Charlton; and the staff from the Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, including P. Boateng, H. Doyle and J. Mason. We also acknowledge the British Society of Blood and Marrow Transplantation and Cellular Therapy and associated centers in the IMPACT network that contributed to the recruitment of patients for the study. The OCTAVE trial was sponsored by the University of Birmingham and supported by the National Core Studies Immunology (NCSi) program and funded by a grant from UK Research and Innovation (UKRI) administered by the Medical Research Council (grant reference number MC_PC_20031). It was designated an Urgent Public Health study by the National Institute of Health Research (NIHR). The trial was designed, initiated and conducted independently by the trial investigators and delivered by the CRCTU, University of Birmingham. PITCH was funded by the UK Department of Health and Social Care as part of the PITCH (Protective Immunity from T cells to Covid-19 in Health workers) Consortium, by UKRI as part of ‘Investigation of proven vaccine breakthrough by SARS-CoV-2 variants in established UK healthcare worker cohorts: SIREN consortium & PITCH Plus Pathway’ MR/W02067X/1, and with contributions from UKRI/NIHR through the UK Coronavirus Immunology Consortium (UK-CIC), the Huo Family Foundation and the NIHR (UKRIDHSC COVID-19 Rapid Response Rolling Call, grant reference number COV19-RECPLAS). Staff at the CRCTU are supported by a core funding grant from Cancer Research UK (C22436/A25354) and the IMPACT consortium. E.B. is an NIHR Senior Investigator. D.T. receives funding from a Wellcome-Beit Clinical Research Career Development Fellowship. G.C. received support for the study from NIHR infrastructure at Leeds, UK. M.W. receives funding from the Sidharth and Indira Burman Donation/Imperial (NIHR) Biomedical Research Centre. S.J.D. is funded by an NIHR Global Research Professorship (NIHR300791). T.d.S. is funded by a Wellcome Trust Intermediate Clinical Fellowship (110058/Z/15/Z). We would like to acknowledge P. Moss, who led the NCSi program. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care, Public Health England or the US Food and Drug Administration. Funding Information: We thank the patients who took part in the trial; the 35 investigators from 11 recruiting centers and their research staff members; colleagues at UK Health Security Agency (UKHSA), including Bassam Hallis, Cathy Rowe and Sue Charlton; and the staff from the Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, including P. Boateng, H. Doyle and J. Mason. We also acknowledge the British Society of Blood and Marrow Transplantation and Cellular Therapy and associated centers in the IMPACT network that contributed to the recruitment of patients for the study. The OCTAVE trial was sponsored by the University of Birmingham and supported by the National Core Studies Immunology (NCSi) program and funded by a grant from UK Research and Innovation (UKRI) administered by the Medical Research Council (grant reference number MC_PC_20031). It was designated an Urgent Public Health study by the National Institute of Health Research (NIHR). The trial was designed, initiated and conducted independently by the trial investigators and delivered by the CRCTU, University of Birmingham. PITCH was funded by the UK Department of Health and Social Care as part of the PITCH (Protective Immunity from T cells to Covid-19 in Health workers) Consortium, by UKRI as part of ‘Investigation of proven vaccine breakthrough by SARS-CoV-2 variants in established UK healthcare worker cohorts: SIREN consortium & PITCH Plus Pathway’ MR/W02067X/1, and with contributions from UKRI/NIHR through the UK Coronavirus Immunology Consortium (UK-CIC), the Huo Family Foundation and the NIHR (UKRIDHSC COVID-19 Rapid Response Rolling Call, grant reference number COV19-RECPLAS). Staff at the CRCTU are supported by a core funding grant from Cancer Research UK (C22436/A25354) and the IMPACT consortium. E.B. is an NIHR Senior Investigator. D.T. receives funding from a Wellcome-Beit Clinical Research Career Development Fellowship. G.C. received support for the study from NIHR infrastructure at Leeds, UK. M.W. receives funding from the Sidharth and Indira Burman Donation/Imperial (NIHR) Biomedical Research Centre. S.J.D. is funded by an NIHR Global Research Professorship (NIHR300791). T.d.S. is funded by a Wellcome Trust Intermediate Clinical Fellowship (110058/Z/15/Z). We would like to acknowledge P. Moss, who led the NCSi program. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care, Public Health England or the US Food and Drug Administration. Publisher Copyright: © 2023, The Author(s).

Identifiers

Local EPrints ID: 482585
URI: http://eprints.soton.ac.uk/id/eprint/482585
ISSN: 1078-8956
PURE UUID: 01ef8986-5906-4eac-ada0-eeaeb18fdbd4
ORCID for Sean Lim: ORCID iD orcid.org/0000-0002-2768-4858

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Date deposited: 10 Oct 2023 16:59
Last modified: 12 Dec 2024 02:43

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Contributors

Author: Eleanor Barnes
Author: Carl S. Goodyear
Author: Michelle Willicombe
Author: Sean Lim ORCID iD
Corporate Author: et al.

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