Safety and Immunogenicity of 3 Doses of BNT162b2 and CoronaVac in
Children and Adults with Inborn Errors of Immunity
Abstract
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.