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Yu MKL, Chan SHS, Cheng S, Leung D, Chan SM, Yan ASK, Wong WHS, Peiris M, Lau YL, Rosa Duque JS. Hesitancy, reactogenicity and immunogenicity of the mRNA and whole-virus inactivated Covid-19 vaccines in pediatric neuromuscular diseases. Hum Vaccin Immunother 2023:2206278. [PMID: 37157992 DOI: 10.1080/21645515.2023.2206278] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
The mRNA-based BNT162b2 and inactivated whole-virus CoronaVac are two widely used COVID-19 vaccines that confer immune protection to healthy individuals. However, hesitancy toward COVID-19 vaccination appeared to be common for patients with neuromuscular diseases (NMDs) due to the paucity of data on the safety and efficacy in this high-risk patient population. Therefore, we examined the underlying factors associated with vaccine hesitancy across time for NMDs and assessed the reactogenicity and immunogenicity of these two vaccines. Patients aged 8-18 years with no cognitive delay were invited to complete surveys in January and April 2022. Patients aged 2-21 years were enrolled for COVID-19 vaccination between June 2021 and April 2022, and they recorded adverse reactions (ARs) for 7 days after vaccination. Peripheral blood was obtained before and within 49 days after vaccination to measure serological antibody responses compared to healthy children and adolescents. Forty-one patients completed vaccine hesitancy surveys for both timepoints, while 22 joined the reactogenicity and immunogenicity arm of the study. Two or more family members vaccinated against COVID-19 was positively associated with intention of vaccination (odds ratio 11.7, 95% CI 1.81-75.1, p = .010). Pain at the injection site, fatigue, and myalgia were the commonest ARs. Most ARs were mild (75.5%, n = 71/94). All 19 patients seroconverted against the wildtype SARS-CoV-2 after two doses of either vaccine, similar to 280 healthy counterparts. There was lower neutralization against the Omicron BA.1 variant. BNT162b2 and CoronaVac were safe and immunogenic for patients with NMDs, even in those on low-dose corticosteroids.
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Affiliation(s)
- Michael Kwan Leung Yu
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sophelia Hoi Shan Chan
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Samuel Cheng
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Daniel Leung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sau Man Chan
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Amy Suen Ka Yan
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Wilfred Hing Sang Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Malik Peiris
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yu Lung Lau
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jaime S Rosa Duque
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Saito T, Saito T, Hashimoto H, Ogata K, Kobayashi M, Takada H, Kuru S, Kimura T, Nakamura A, Matsumura T. Safety and immunogenicity of mRNA COVID-19 vaccine in inpatients with muscular dystrophy. Muscle Nerve 2023; 67:117-123. [PMID: 36478587 PMCID: PMC9878062 DOI: 10.1002/mus.27761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION/AIMS Due to muscular weakness and cardiopulmonary dysfunction, patients with muscular dystrophy (MD) have an increased risk of serious complications from coronavirus disease-2019 (COVID-19). Although vaccination is recommended, COVID-19 vaccination safety and immunogenicity in these patients are unknown. We investigated reaction frequency, post-vaccine antibody titers after two mRNA COVID-19 vaccine doses, and clinical predictors of antibody response among patients with MD. METHODS We recruited 171 inpatients with MD receiving two BNT162b2 mRNA COVID-19 vaccine doses from seven hospitals. Blood samples were obtained from 53 inpatients before the first dose and 28 to 30 days after the second dose, and antibody titers were measured. RESULTS Overall, 104 (60.8%) and 115 (67.6%) patients had side effects after the first and second doses, respectively. These were generally mild and self-limited. Multiple logistic regression analysis showed that a bedridden state was associated with reduced side effects (odds ratio [OR] = 0.29; 95% confidence interval [CI], 0.12 to 0.71). The antibody titers of all participants changed from negative to positive after two vaccine doses. The geometric mean titer (GMT) of the inpatients was 239 (95% CI, 159.3 to 358.7). Older age (relative risk [RR] = 0.97; 95% CI, 0.95 to 0.99) and bedridden state (RR = 0.27; 95% CI, 0.14 to 0.51) were associated with a lower antibody titer. Patients with myotonic dystrophy type 1 (DM1) had a lower GMT than patients with other MDs (RR = 0.42; 95% CI, 0.21 to 0.85). DISCUSSION COVID-19 vaccination is safe and immunogenic in inpatients with MD. Patients with DM1 appear to have a poorer COVID-19 antibody response than those with other MDs.
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Affiliation(s)
- Tomoko Saito
- Department of NeurologyNational Hospital Organization, Osaka Toneyama Medical CenterOsakaJapan
| | - Toshio Saito
- Division of Child Neurology, Department of NeurologyNational Hospital Organization, Toneyama Medical CenterOsakaJapan
| | - Hiroya Hashimoto
- Core Laboratory, Nagoya City University Graduate School of Medical SciencesClinical Research Management Center, Nagoya City University HospitalNagoyaJapan
| | - Katsuhisa Ogata
- Department of NeurologyNational Hospital Organization, Higashisaitama National HospitalSaitamaJapan
| | - Michio Kobayashi
- Department of NeurologyNational Hospital Organization, Akita National HospitalAkitaJapan
| | - Hiroto Takada
- Department of NeurologyNational Hospital Organization, Aomori National HospitalAomoriJapan
| | - Satoshi Kuru
- Department of NeurologyNational Hospital Organization, Suzuka National HospitalSuzukaJapan
| | - Takashi Kimura
- Department of NeurologyNational Hospital Organization, Asahikawa Medical CenterAsahikawaJapan
| | - Akinori Nakamura
- Department of Clinical ResearchNational Hospital Organization, Matsumoto Medical CenterNaganoJapan
| | - Tsuyoshi Matsumura
- Department of NeurologyNational Hospital Organization, Osaka Toneyama Medical CenterOsakaJapan
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Kasai R, Funato M, Maruta K, Yasuda K, Minatsu H, Ito J, Takahashi K. Immunogenicity of SARS-CoV-2 mRNA intramuscular vaccination in patients with muscular disorders. Front Immunol 2023; 14:1103196. [PMID: 36825020 PMCID: PMC9941142 DOI: 10.3389/fimmu.2023.1103196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
Backgrounds Little clinical data is available on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with muscular disorders (MDs). The immunogenicity of SARS-CoV-2 vaccines against MDs, in particular, remains unknown. Thus, this study aimed to confirm the immunogenicity and safety of the SARS-CoV-2 vaccine against MDs. Methods All participants were vaccinated with two doses of mRNA vaccines (BNT162b2, Pfizer-BioNTech). The serum samples were collected from each patient on the day of second dose of vaccination, and then, consecutively, after one month, three months, and six months. Anti-SARS-CoV-2 IgG levels were determined using the Abbott SARS-CoV-2 IgG II Quant assay. Results We evaluated 75 individuals, including 42 patients with MDs and 33 patients with non-muscular disorders (non-MDs). Non-MD patients primarily include those with severe motor and intellectual disabilities. The median age of the patients was 32 years (range 12-64 years). After one and three months following the second immunization, patients with MDs had lower antibody responses. Furthermore, three months following the second immunization, the proportion of high responders among patients with MDs decreased significantly compared to that among patients without MDs (p-value of less than 0.01). No serious adverse events were observed in patients with or without MDs. Conclusion Intensity and latency of antibody response were suppressed in patients with MDs. Although MDs may be a key contributor in predicting the antibody response to SARS-CoV-2 vaccination, SARS-CoV-2 immunization in MDs needs extensive research.
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Affiliation(s)
- Ryousuke Kasai
- Department of Pediatrics, National Hospital Organization Nagara Medical Center, Gifu, Japan
| | - Michinori Funato
- Department of Pediatric Neurology, National Hospital Organization Nagara Medical Center, Gifu, Japan
| | - Kanako Maruta
- Department of Pediatrics, National Hospital Organization Nagara Medical Center, Gifu, Japan
| | - Kunihiko Yasuda
- Department of Pediatric Surgery, National Hospital Organization Nagara Medical Center, Gifu, Japan
| | - Hiroshi Minatsu
- Department of Pediatric Surgery, National Hospital Organization Nagara Medical Center, Gifu, Japan
| | - Junji Ito
- Department of Clinical Examination, National Hospital Organization Nagara Medical Center, Gifu, Japan
| | - Kazuhiro Takahashi
- Department of Pediatrics, National Hospital Organization Nagara Medical Center, Gifu, Japan
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Iwayama H, Ishihara N, Kawahara K, Madokoro Y, Togawa Y, Muramatsu K, Murakami A, Kuru S, Kumagai T, Ohashi W, Nanya K, Hasegawa S, Katsuno M, Okumura A. Early immunological responses to the mRNA SARS-CoV-2 vaccine in patients with neuromuscular disorders. Front Immunol 2022; 13:996134. [PMID: 36248823 PMCID: PMC9558231 DOI: 10.3389/fimmu.2022.996134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Backgrounds Intramuscular injection of the SARS-CoV-2 vaccine has raised concerns about its use in patients with neuromuscular disorders (NMDs). We evaluated the response of patients with NMDs to the BNT162b2 vaccine. Methods Healthy subjects, patients with spinal muscular atrophy (SMA), and patients with Duchenne muscular dystrophy (DMD) were included. All participants received two BNT162b2 doses. SARS-CoV-2 antibody titers at baseline and 2 weeks after each vaccination were compared between groups. Residual muscle volume was evaluated in NMDs group. A questionnaire documented adverse reactions. Results Eleven patients with NMDs (9 with SMA, 2 with DMD; 7 males; aged 32.7 ± 19.3 years) and 346 healthy subjects (60 males, aged 40.0 ± 12.4 years) were included. Antibody titers (U/mL) were similar between groups (baseline: <0.40 vs. <0.40, first vaccination, 145 ± 258 vs. 103 ± 1192, and second vaccination, 1528 ± 1265 vs. 1429 ± 944; p = 1.000, 0.909, and 0.736, respectively). A negative correlation was found between antibody titers and residual muscle volume but was not significant (Mercuri scale, r = −0.429, p = 0.249; fat infiltration rate, r = −0.194, p = 0.618). The adverse reactions were comparable between groups. Conclusion The BNT162b2 vaccine is safe and effective in patients with NMDs.
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Affiliation(s)
- Hideyuki Iwayama
- Department of Pediatrics, Aichi Medical University School of Medicine, Nagakute, Japan
- *Correspondence: Hideyuki Iwayama,
| | - Naoko Ishihara
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kohei Kawahara
- Department of Pediatrics, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yuta Madokoro
- Department of Neurology, Nagoya City University Hospital, Nagoya, Japan
| | - Yasuko Togawa
- Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Kanji Muramatsu
- Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Ayuka Murakami
- Department of Neurology, National Hospital Organization Suzuka Hospital, Suzuka, Japan
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Kuru
- Department of Neurology, National Hospital Organization Suzuka Hospital, Suzuka, Japan
| | - Toshiyuki Kumagai
- Department of Pediatric Neurology, Aichi Prefectural Colony Central Hospital, Kasugai, Japan
- Kuma Home Medical Care Clinic, Nagoya, Japan
| | - Wataru Ohashi
- Division of Biostatistics, Clinical Research Center, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kengo Nanya
- Clinical Laboratory, Nagoya Memorial Hospital, Nagoya, Japan
| | - Shinji Hasegawa
- Department of Pediatrics, Nagoya Memorial Hospital, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University School of Medicine, Nagakute, Japan
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