SARS-CoV-2-specific immune responses and clinical outcomes after COVID-19 vaccination in patients with immune-suppressive disease
Eleanor Barnes(University of Oxford), Carl S. Goodyear(University of Glasgow), Michelle Willicombe(Imperial College London), Charlotte Gaskell(Cancer Research UK Clinical Trials Unit), Stefan Siebert(University of Glasgow), Thushan I. de Silva(University of Sheffield), Sam M. Murray(University of Oxford), Daniel Rea(Cancer Research UK Clinical Trials Unit), John A. Snowden(Royal Hallamshire Hospital), Miles W. Carroll(Centre for Human Genetics), Sarah Pirrie(Cancer Research UK Clinical Trials Unit), S. Bowden(Cancer Research UK Clinical Trials Unit), Susanna Dunachie(University of Oxford), Alex Richter(University of Birmingham), Zixiang Lim(University of Oxford), Jack Satsangi(University of Oxford), Gordon Cook(University of Leeds), Ann Pope(Cancer Research UK Clinical Trials Unit), Ana Hughes(Cancer Research UK Clinical Trials Unit), M. Harrison(Cancer Research UK Clinical Trials Unit), Sean H. Lim(University of Southampton), P.D. Miller(Guy's Hospital), Paul Klenerman(University of Oxford), Alex Richter(University of Birmingham), Alexander J. Mentzer(Centre for Human Genetics), Alexandra Deeks(University of Oxford), Anni Jämsén(University of Oxford), Anthony Brown(University of Oxford), Chris Conlon(University of Oxford), Christina Dold(University of Oxford), C.J. Duncan(Newcastle University), Donal Skelly(University of Oxford), Barbara Kronsteiner(University of Oxford), Priyanka Abraham(University of Oxford), Eloise Phillips(University of Oxford), Katie Jeffery(Oxford University Hospitals NHS Trust), Lance Turtle(University of Liverpool), Lisa Frending(University of Oxford), Lizzie Stafford(University of Oxford), Mohammad Ali(University of Oxford), Patpong Rongkard(University of Oxford), Rebecca Payne(Newcastle University), Sandra Adele(University of Oxford), Simon Travis(University of Oxford), Siobhan Gardiner(University of Oxford), Sue L. Dobson(University of Liverpool), Tom Malone(University of Oxford), Sagida Bibi(University of Oxford), Miles W. Carroll(Centre for Human Genetics), Sian Faustini(University of Birmingham), Sarah Foulkes(UK Health Security Agency), John Frater(University of Oxford), Victoria Hall(UK Health Security Agency), Susan Hopkins(UK Health Security Agency), Jasmin Islam(UK Health Security Agency), Teresa Lambe(University of Oxford), Stephanie Longet(Centre for Human Genetics), Shona C. Moore(University of Liverpool), Ashley Otter(UK Health Security Agency), Sarah Rowland‐Jones(University of Sheffield), James E. D. Thaventhir(University of Cambridge), Dan Wootton(University of Liverpool), Neil Basu(University of Glasgow), Ashley Gilmour(University of Glasgow), Sophie Irwin(University of Oxford), Georgina Meacham(University of Oxford), Thomas Marjot(University of Oxford), Stavros Dimitriadis(University of Oxford), Peter Kelleher(Chelsea and Westminster Hospital), Maria Prendecki(Imperial College London), Candice Clarke(Imperial College London), Paige M Mortimer(Imperial College London), Stacey McIntyre(Imperial College London), Rachael Selby(Royal Hallamshire Hospital), Naomi Meardon(University of Sheffield), Dung Nguyen(Centre for Human Genetics), Tom Tipton(Centre for Human Genetics), Stephanie Longet(Centre for Human Genetics), Stephen M. Laidlaw(Centre for Human Genetics), Kim Orchard(University Hospital Southampton NHS Foundation Trust), Georgina Ireland(UK Health Security Agency), CONSENSUS(UK Health Security Agency), Kevin Brown(UK Health Security Agency), Gayatri Amirthalingam(UK Health Security Agency), David Thomas(National Institute for Health and Care Research), Pamela Kearns(National Institute for Health and Care Research), Amanda Kirkham(Cancer Research UK Clinical Trials Unit), Iain B. McInnes(University of Glasgow), OCTAVE Collaborative Group, Richard Beesley, Vicky Churchill, Holly Loughton, Elspeth Insch(University Hospitals Birmingham NHS Foundation Trust), Eilean MacDonald(Cancer Research UK Clinical Trials Unit), Gary Middleton(University Hospitals Birmingham NHS Foundation Trust), Lucinda Billingham(Cancer Research UK Clinical Trials Unit), Faye Lowe(Cancer Research UK Clinical Trials Unit), Sophia Magwaro(Cancer Research UK Clinical Trials Unit), Saly Al‐Taei(University of Glasgow), Maxine Arnott(University of Glasgow), Louise Bennett(University of Glasgow), James B. Brock(University of Glasgow), Victora Keillor(University of Glasgow), Andrew Melville(University of Glasgow), Lisa Melville(University of Glasgow), Samantha Miller(University of Glasgow), Aurélie Najm(University of Glasgow), Caron Paterson(University of Glasgow), Lewis Rodgers(University of Glasgow), Matthew Rutherford(University of Glasgow), S Rundell(University of Glasgow), Emily Smith(University of Glasgow), Lynn Stewart(University of Glasgow), Flavia Sunzini(University of Glasgow), Andrew Tong(Cambridge University Hospitals NHS Foundation Trust), Kieran Woolcock(Cambridge University Hospitals NHS Foundation Trust), Faisal Basheer(Cambridge University Hospitals NHS Foundation Trust), Charles Crawley(Cambridge University Hospitals NHS Foundation Trust), Ram Malladi(Cambridge University Hospitals NHS Foundation Trust), Andrew P. King(Cambridge University Hospitals NHS Foundation Trust), Sophie Lockey(St George's, University of London), Ben Uttenthal(Cambridge University Hospitals NHS Foundation Trust), Mickey Koh(St George’s University Hospitals NHS Foundation Trust), Samantha E. Hansford(Churchill Hospital), Gurjinder Sandhar(Imperial College London), Murali Kesavan(Churchill Hospital), Celia Moore(Imperial College London), Pinelopi Manousou(Imperial College London), Gareth Hahn(Imperial College London), Benjamin H. Mullish(Imperial College Healthcare NHS Trust), Maria Atta(Imperial College Healthcare NHS Trust), Sarah Gleeson(Imperial College Healthcare NHS Trust), Liz Lightstone(Imperial College Healthcare NHS Trust), Paul Martin(Imperial College Healthcare NHS Trust), Stephen P. McAdoo(Imperial College Healthcare NHS Trust), Tina Thomson(Imperial College Healthcare NHS Trust), Daniele Avenoso(University of Leeds), Robin Sanderson(University Hospitals Birmingham NHS Foundation Trust), Claire Taylor(University of Leeds), Khushpreet Bhandal(University Hospitals Birmingham NHS Foundation Trust), Diana Hull(University Hospitals Birmingham NHS Foundation Trust), Palak Trivedi(Freeman Hospital), Andrew Filer(University Hospitals Birmingham NHS Foundation Trust), Erin Hurst(Freeman Hospital), Amy Publicover(Freeman Hospital), Katy Scouse(Freeman Hospital), Jem Chalk(University of Oxford), Daniel Hanke(Centre for Human Genetics), Josef Hanke(University of Oxford), Saoirse Healy(Centre for Human Genetics), Nicholas M. Provine(University of Oxford), Sarah Thomas(University of Oxford), Victoria Walker(Royal Hallamshire Hospital), Zay Win(St George’s University Hospitals NHS Foundation Trust), Doreen Trown(St George’s University Hospitals NHS Foundation Trust), Patricia Faria(St George’s University Hospitals NHS Foundation Trust), J. Chackathayil(St George’s University Hospitals NHS Foundation Trust), Clare Hutchison(Southampton General Hospital), Deborah Richardson(Southampton General Hospital)
Cited by 132Open Access
Abstract
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.