News Scan for Aug 31, 2021

COVID vaccines in immune-compromised
MIS-C 1 year later

COVID vaccine doses may have weaker effect in immune-compromised

After two doses of an mRNA-based COVID-19 vaccine, nearly 90% of immunocompromised patients had an antibody response, but it was about as third as strong as those with healthy immune systems, according to data published in the Annals of Internal Medicine yesterday.

Researchers recruited 133 adults who were receiving immunosuppressive therapies for chronic inflammatory diseases (CIDs) plus 53 adults with healthy immune systems from the San Francisco and St. Louis areas. The most common CIDs were irritable bowel syndrome (31.6%) and rheumatoid arthritis (28.6%). All received two doses of the Pfizer/BioNTech or Moderna vaccine from Dec 1, 2020, to Mar 20, 2021, and they gave blood samples 2 weeks prior to their first dose and within 3 weeks after the second dose.

All 53 patients with non-compromised immune systems developed sufficient antibodies, whereas 88.7% of immunocompromised patients did. The researchers note, however, that the geometric mean titers at half-maximal neutralization were 6,261 in the healthy group, compared with 2,312 in the immunocompromised group.

Those who were on glucocorticoids (17) and B-cell depletion therapy (10) also showed lower anti-spike protein immunoglobulin G (Anti-S IgG) antibody titers. For instance, those on prednisone had a geometric mean titer of 357 anti-S IgG, compared with 2,190 in non-users, and only 65% were seropositive after vaccination. As for those on B-cell depleting therapies, only 60% appeared to have immunogenicity, with less likelihood if therapy occurred within 6 months.

"What we found here is that the vast majority of immunocompromised patients with autoimmune diseases are able to mount antibody responses following COVID-19 vaccination. There’s clearly a benefit for this population," said co-senior author Alfred Kim, MD, PhD, in a Washington University press release. The researchers plan to follow up with this cohort as some choose to get a third vaccine dose.
Aug 30 Ann Intern Med study
Aug 30 Washington University
press release


MIS-C mostly resolves 1 year later, study says

Of 68 UK patients with multisystem inflammatory syndrome in children (MIS-C) tied to COVID-19, most had resolved symptoms 1 year after hospitalization, according to a research letter yesterday in JAMA Pediatrics.

The cohort had been admitted to the hospital prior to May 10, 2020, and follow-ups in April 2021 showed that many symptoms resolved. While two patients (3%) had to be readmitted to critical care for a median hospitalization of 10 days, none needed respiratory support after discharge, and all instances were unrelated to MIS-C. No deaths occurred.

Of the inflammation biomarkers C-reactive protein, D-dimer, and troponin, 3%, 3%, and 2% of tests came back abnormal 50 days post-admission, respectively, although the researchers note that only 59 to 65 of the cohort were tested for each. Blood results for lymphocytes, neutrophils, platelets, creatinine, ferritin, and alanine transaminase were normal for all more than 50 days post-admission.

Aneurysms were resolved in 14 of 19 patients. All patients with impaired function without aneurysm recovered by day 74.

"While the majority of the units have established a consistent multidisciplinary follow-up protocol, this analysis is restricted to one of the earliest reported cohorts of patients worldwide, when the presence of such an entity was becoming apparent," write the researchers. "Although our data identify a group of patients with a risk of significant long-term morbidity, it is reassuring that the majority of patients had good outcomes with no significant medium- or long-term sequelae."
Aug 30 JAMA Pediatr study

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