SUMMARY
Background
Safety and immunogenicity of 3 doses of BNT162b2 and CoronaVac in adult
and pediatric patients with inborn errors of immunity (IEIs) remain
unknown. Intradermal vaccination may improve immunogenicity in
immunocompromised patients. Our study (NCT04800133) aimed to determine
the safety and immunogenicity in patients with IEIs receiving a 3-dose
primary series of mRNA vaccine BNT162b2 (age 12+) or inactivated
whole-virion vaccine CoronaVac (age 3+) in Hong Kong, including Omicron
BA.1 neutralization, in a nonrandomized manner. Intradermal vaccination
was also studied.
Methods
Thirty-nine patients were vaccinated, including 16 with homologous
intramuscular 0.3ml BNT162b2 and 17 with homologous intramuscular 0.5ml
CoronaVac. Two patients received 3 doses of intradermal 0.5ml CoronaVac,
and 4 patients received 2 doses of intramuscular BNT162b2 and the third
dose with intradermal BNT162b2. Adverse reactions and adverse events
were tracked for 7 and 28 days after each dose. Antibody responses
assessed included binding IgG antibody to wild-type (WT) spike
receptor-binding domain (S-RBD IgG) and surrogate neutralization
activity to WT and BA.1 viruses. T cell responses were examined by
intracellular cytokine staining following stimulation with SARS-CoV-2
peptide pool(s).
Results
No safety concerns were identified. Inadequate antibody responses were
found after 2 doses in patients with humoral immunodeficiencies and
especially so against BA.1. Dose 3 of either vaccine increased S-RBD IgG
response. T cell responses against SARS-CoV-2 antigens were detected in
vaccinated IEI patients. Intradermal third dose vaccine led to high
antibody response in 4 patients.
Conclusions
The primary vaccination series of BNT162b2 and CoronaVac in adults and
children with IEIs should include 3 doses for optimal immunogenicity.