SARS-CoV-2 vaccination and risk of severe COVID-19 outcomes in patients with autoimmune hepatitis

Background

Data regarding outcome of Coronavirus disease 2019 (COVID-19) in vaccinated patients with autoimmune hepatitis (AIH) are lacking. We evaluated the outcome of COVID-19 in AIH patients who received at least one dose of Pfizer- BioNTech (BNT162b2), Moderna (mRNA-1273) or AstraZeneca (ChAdOx1-S) vaccine.

Patients and methods

We performed a retrospective study on AIH patients with COVID-19. The outcomes of AIH patients who had acute respiratory syndrome coronavirus 2 (SARS-CoV-2) breakthrough infection after at least one dose of COVID-19 vaccine were compared to unvaccinated patients with AIH. COVID-19 outcome was classified according to clinical state during the disease course as: (i) no hospitalization, (ii) hospitalization without oxygen supplementation, (iii) hospitalization with oxygen supplementation by nasal cannula or mask, (iv) intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v) ICU admission with invasive mechanical ventilation or (vi) death, and data was analyzed using ordinal logistic regression.

Results

We included 413 (258 unvaccinated and 155 vaccinated) patients (81%, female) with a median age of 52 (range: 17–85) years at COVID-19 diagnosis. The rates of hospitalization were (36.4% vs. 14.2%), need for any supplemental oxygen (29.5% vs. 9%) and mortality (7% vs. 0.6%) in unvaccinated and vaccinated AIH patients with COVID-19. Having received at least one dose of SARS-CoV-2 vaccine was associated with a significantly lower risk of worse COVID-19 severity, after adjusting for age, sex, comorbidities and presence of cirrhosis (adjusted odds ratio [aOR] 0.18, 95% confidence interval [CI], 0.10–0.31). Overall, vaccination against SARS-CoV-2 was associated with a significantly lower risk of mortality from COVID-19 (aOR 0.20, 95% CI 0.11–0.35).

Conclusions

SARS-CoV-2 vaccination significantly reduced the risk of COVID-19 severity and mortality in patients with AIH.

[Comparison of two different vaccination schemes against Hepatitis A and B in Mexican children and adolescents]

BACKGROUND

Development of multiple antigens in combined vaccines offers the advantages of reducing costs, increasing compliance and provides dual protection. Hepatitis A is an endemic disease in Mexico and hepatitis B, notwithstanding low prevalence, confers risk of progression to cirrhosis, hepatocellular carcinoma, and high medical costs in consequence.

OBJECTIVE

Determine immunogenicity and reactogenicity of a combined vaccine when compared with use of conventional vaccines simultaneously.

METHODS

The present study was a prospective, open, and randomized trial; 73 healthy children and adolescents were included, all with negative serologic markers. They were assigned to one of the following groups: Group 1, combined vaccine (n = 49) Twinrix (HAV 720 UE/HBV 20 micrograms), and group 2, separate vaccines (n = 24) Engerix B 20 micrograms/Havrix 720 UE. Both groups were given two-dose series at months 0 and 6. Geometric titles of antibody production (GMT) anti-HAV and anti-HBV were determined in months 1, 2, 6 and 7. Adverse reactions were registered during the study.

RESULTS

No difference was observed between the two groups in age or gender. Immunogenicity anti-HAV: 100% of vaccines in both groups reached seroprotective levels (> or = 33 mUI/mL). Antibody titles in group 1 were three times higher than those in group 2 (9,696 mIU/mL vs. 3,940 mIU/mL [p = 0.003]) at the end of the study. Immunogenicity anti-HBV: All subjects in both groups reached seroprotective levels (> or = 10 mIU/mL) with similar antibody titles at the end of the study (group 1: 5,603 mIU/mL vs. group 2: 5,201 mIU/mL [p = 0.55 NS]). Reactogenicity: No serious adverse reactions were observed; main were local, and frequency and characteristics were similar in both groups.

CONCLUSIONS

Seroprotective levels and reactogenicity obtained from use of a combined vaccine against hepatitis A/B are acceptable when compared with use of conventional vaccines administered separately.