Immunological and clinical efficacy of COVID-19 vaccines in immunocompromised populations: a systematic review.
Immunological and clinical efficacy of COVID-19 vaccines in immunocompromised populations: a systematic review.
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DOI：
10.1016/j.cmi.2021.09.036
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Launay O
中科院分区：
文献类型：
--
作者：
Galmiche S;Luong Nguyen LB;Tartour E;de Lamballerie X;Wittkop L;Loubet P;Launay O
现有数据显示，COVID-19疫苗在免疫功能低下的人群中可能不太有效，这些人群患严重COVID-19的风险增加。我们对文献进行了系统性综述，以评估COVID-19疫苗在免疫功能低下人群中的免疫原性、有效性和有效性。我们检索了Medline和Embase数据库。我们纳入了直至2021年8月31日免疫功能低下患者接种完COVID-19疫苗后的研究。排除了<10例患者的研究、仅安全性数据和突破性感染的病例系列。通过美国国立卫生研究院开发的干预性和观察性研究工具评估偏倚风险。通过无应答率（定义为无抗SARS-CoV-2刺突蛋白抗体）、疗效和有效性（定义为SARS-CoV-2感染或COVID-19风险的相对降低）评估免疫原性。我们收集了与无应答风险相关的因素。我们按免疫抑制类型列出了收集的数据。我们筛选了5917个结果，包括162个研究。在25209例受试者中，有157例免疫原性，包括7835例癌症或血液系统恶性肿瘤患者（31.1%），6302例透析患者（25.0%），5974例实体器官移植受者（23.7%）和4680例免疫介导疾病患者（18.6%）。实体器官移植受者（范围18-100%）和血液学恶性肿瘤患者（范围14-61%）的无应答者比例似乎较高，癌症患者（范围2-36%）和透析患者（范围2-30%）的无应答者比例较低。无应答的风险因素包括年龄较大、使用皮质类固醇、免疫抑制剂或抗CD 20药物。10项研究评价了额外剂量的免疫原性。五项研究评估了疫苗的有效性或有效性：三项关于SARS-CoV-2感染（范围71-81%），一项关于COVID-19相关住院（62.9%），一项样本量太小。本系统性综述强调了COVID-19疫苗在免疫功能低下人群中的低免疫原性风险，特别是实体器官移植受者和血液恶性肿瘤患者。尽管缺乏疫苗有效性数据，但可能需要加强疫苗方案。
Available data show that COVID-19 vaccines may be less effective in immunocompromised populations, who are at increased risk of severe COVID-19. We conducted a systematic review of literature to assess immunogenicity, efficacy and effectiveness of COVID-19 vaccines in immunocompromised populations. We searched Medline and Embase databases. We included studies of COVID-19 vaccines after complete vaccination in immunocompromised patients until 31 August 2021. Studies with <10 patients, safety data only and case series of breakthrough infections were excluded. Risk of bias was assessed via the tool developed by the National Institutes of Health on interventional and observational studies. Immunogenicity was assessed through non-response rate defined as no anti-SARS-CoV-2 spike protein antibodies, efficacy and effectiveness by the relative reduction in risk of SARS-CoV-2 infection or COVID-19. We collected factors associated with the risk of non-response. We presented collected data by immunosuppression type. We screened 5917 results, included 162 studies. There were 157 on immunogenicity in 25 209 participants, including 7835 cancer or haematological malignancy patients (31.1%), 6302 patients on dialysis (25.0%), 5974 solid organ transplant recipients (23.7%) and 4680 immune-mediated disease patients (18.6%). Proportion of non-responders seemed higher among solid organ transplant recipients (range 18–100%) and patients with haematological malignancy (range 14–61%), and lower in patients with cancer (range 2–36%) and patients on dialysis (range 2–30%). Risk factors for non-response included older age, use of corticosteroids, immunosuppressive or anti-CD20 agent. Ten studies evaluated immunogenicity of an additional dose. Five studies evaluated vaccine efficacy or effectiveness: three on SARS-CoV-2 infection (range 71–81%), one on COVID-19-related hospitalization (62.9%), one had a too small sample size. This systematic review highlights the risk of low immunogenicity of COVID-19 vaccines in immunocompromised populations, especially solid organ transplant recipients and patients with haematological malignancy. Despite lack of vaccine effectiveness data, enhanced vaccine regimens may be necessary.
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