Impact of vaccination on hospitalization and mortality from COVID-19 in patients with primary and secondary immunodeficiency: The United Kingdom experience

Adrian M. Shields, Susan Tadros, Adam Al-Hakim, Jeremy M. Nell, Me Me Nay Lin, Michele Chan, Sarah Goddard, John Dempster, Magdalena Dziadzio, Smita Y. Patel, Shuayb Elkalifa, Aarnoud Huissoon, Christopher J. A. Duncan, Archana Herwadkar, Sujoy Khan, Claire Bethune, Suzanne Elcombe, James Thaventhiran, Paul Klenerman, David M. LoweSinisa Savic, Siobhan O. Burns, Alex G. Richter

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Abstract

Background: Individuals with primary and secondary immunodeficiency (PID/SID) were shown to be at risk of poor outcomes during the early stages of the SARS-CoV-2 pandemic. SARS-CoV-2 vaccines demonstrate reduced immunogenicity in these patients.

Objectives: To understand whether the risk of severe COVID-19 in individuals with PID or SID has changed following the deployment of vaccination and therapeutics in the context of the emergence of novel viral variants of concern.

Methods: The outcomes of two cohorts of patients with PID and SID were compared: the first, infected between March and July 2020, prior to vaccination and treatments, the second after these intervention became available between January 2021 and April 2022.

Results: 22.7% of immunodeficient patients have been infected at least once with SARS-CoV-2 since the start of the pandemic, compared to over 70% of the general population. Immunodeficient patients were typically infected later in the pandemic when the B.1.1.529 (Omicron) variant was dominant. This delay was associated with receipt of more vaccine doses and higher pre-infection seroprevalence. Compared to March-July 2020, hospitalization rates (53.3% vs 17.9%, p
Conclusions: Most individuals with immunodeficiency in the United Kingdom remain SARS-CoV-2 infection naïve. Vaccination, widespread availability of outpatient treatments and, possibly, the emergence of the B.1.1.529 variant have led to significant improvements in morbidity and mortality followings SARS-CoV-2 infection since the start of the pandemic. However, individuals with PID and SID remain at significantly increased risk of poor outcomes compared to the general population; mitigation, vaccination and treatment strategies must be optimized to minimize the ongoing burden of the pandemic in these vulnerable cohorts.
Original languageEnglish
Article number984376
JournalFrontiers in immunology
Volume13
DOIs
Publication statusPublished - 23 Sept 2022

Keywords

  • COVID-19
  • CVID
  • SARS-CoV-2
  • inborn errors of immunity
  • primary immunodeficiency
  • secondary immunodeficiency
  • vaccination

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