Post-vaccination SARS-CoV-2 infections and immune response in people with immune disorders

Authors

• ME Hackbarth
• JD Burke
• G Elliott
• L Garrett
• P Leoyklang
• P Zerfas
• D Springer
• MS Sabir
• L Pollard
• M Huizing
• WA Gahl
• MCV Malicdan

Abstract

While some immune-deficient persons (IDP) face higher risk for severe SARS-CoV-2 infection than the general population, little is known about their immune response to post-vaccination infections. A cohort of 217 IDP and 54 healthy volunteers (HV) were followed from April 2021 to April 2023. Blood was collected at baseline, 1-, and 6-months post vaccination. Anti-spike IgG response was assessed by ELISA. SARS-CoV-2 infection was actively monitored for 6 months post-vaccination; participants could self-report at any point. Thirty-six percent of IDP and 46% of healthy volunteers experienced a post-vaccination SARS-CoV-2 infection (p=0.21). Infections occurred from September 3, 2021 to March 25, 2023 and were primarily of the Omicron lineage. Clinical symptoms, severity, and time from last vaccination to infection (IDP: 140 days, HV: 161 days, p=0.28) did not significantly differ between groups. While ~50% of both groups received ≥3 doses, IDP received more doses pre-infection than HV. Of the 84 (39%) IDP and 19 (35%) HV who received a bivalent booster, 9 (11%) IDP and 2 (11%) HV later experienced an infection (p=1). Among the 50 IDP who received Evusheld, only 9 (18%) experienced an infection after its receipt. Infection increased anti-spike IgG relative to infection-naïve participants 6 months post-dose 3 (IDP and HV) and post-dose 4 only (IDP) (Figure). IDP experienced post-vaccination infections at a similar rate as HV, mostly during the Omicron period. Less than half of IDP have received a bivalent booster. Additional doses, especially the bivalent dose, enhances the immune response in this population.

Scientific Focus Area: ACI/IRS

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