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. 2022 Aug 9;8(8):CD015021.
doi: 10.1002/14651858.CD015021.

Immunity after COVID-19 vaccination in people with higher risk of compromised immune status: a scoping review

Nina Kreuzberger  1 , Caroline Hirsch  1 , Marike Andreas  1 , Lena Böhm  2 , Paul J Bröckelmann  3   4 , Veronica Di Cristanziano  5 , Martin Golinski  6 , Renate Ilona Hausinger  7 , Sibylle Mellinghoff  3   8 , Berit Lange  9   10 , Tina Lischetzki  1 , Verena Kappler  7 , Agata Mikolajewska  11   12 , Ina Monsef  1 , Yun Soo Park  1 , Vanessa Piechotta  1 , Christoph Schmaderer  7 , Miriam Stegemann  11 , Kanika Vanshylla  5 , Florencia Weber  2 , Stephanie Weibel  2 , Caspar Stephani  6 , Nicole Skoetz  1
Affiliations

Immunity after COVID-19 vaccination in people with higher risk of compromised immune status: a scoping review

Nina Kreuzberger et al. Cochrane Database Syst Rev. .

Abstract

Background: High efficacy in terms of protection from severe COVID-19 has been demonstrated for several SARS-CoV-2 vaccines. However, patients with compromised immune status develop a weaker and less stable immune response to vaccination. Strong immune response may not always translate into clinical benefit, therefore it is important to synthesise evidence on modified schemes and types of vaccination in these population subgroups for guiding health decisions. As the literature on COVID-19 vaccines continues to expand, we aimed to scope the literature on multiple subgroups to subsequently decide on the most relevant research questions to be answered by systematic reviews.

Objectives: To provide an overview of the availability of existing literature on immune response and long-term clinical outcomes after COVID-19 vaccination, and to map this evidence according to the examined populations, specific vaccines, immunity parameters, and their way of determining relevant long-term outcomes and the availability of mapping between immune reactivity and relevant outcomes.

Search methods: We searched the Cochrane COVID-19 Study Register, the Web of Science Core Collection, and the World Health Organization COVID-19 Global literature on coronavirus disease on 6 December 2021. SELECTION CRITERIA: We included studies that published results on immunity outcomes after vaccination with BNT162b2, mRNA-1273, AZD1222, Ad26.COV2.S, Sputnik V or Sputnik Light, BBIBP-CorV, or CoronaVac on predefined vulnerable subgroups such as people with malignancies, transplant recipients, people undergoing renal replacement therapy, and people with immune disorders, as well as pregnant and breastfeeding women, and children. We included studies if they had at least 100 participants (not considering healthy control groups); we excluded case studies and case series.

Data collection and analysis: We extracted data independently and in duplicate onto an online data extraction form. Data were represented as tables and as online maps to show the frequency of studies for each item. We mapped the data according to study design, country of participant origin, patient comorbidity subgroup, intervention, outcome domains (clinical, safety, immunogenicity), and outcomes. MAIN RESULTS: Out of 25,452 identified records, 318 studies with a total of more than 5 million participants met our eligibility criteria and were included in the review. Participants were recruited mainly from high-income countries between January 2020 and 31 October 2021 (282/318); the majority of studies included adult participants (297/318). Haematological malignancies were the most commonly examined comorbidity group (N = 54), followed by solid tumours (N = 47), dialysis (N = 48), kidney transplant (N = 43), and rheumatic diseases (N = 28, 17, and 15 for mixed diseases, multiple sclerosis, and inflammatory bowel disease, respectively). Thirty-one studies included pregnant or breastfeeding women. The most commonly administered vaccine was BNT162b2 (N = 283), followed by mRNA-1273 (N = 153), AZD1222 (N = 66), Ad26.COV2.S (N = 42), BBIBP-CorV (N = 15), CoronaVac (N = 14), and Sputnik V (N = 5; no studies were identified for Sputnik Light). Most studies reported outcomes after regular vaccination scheme. The majority of studies focused on immunogenicity outcomes, especially seroconversion based on binding antibody measurements and immunoglobulin G (IgG) titres (N = 179 and 175, respectively). Adverse events and serious adverse events were reported in 126 and 54 studies, whilst SARS-CoV-2 infection irrespective of severity was reported in 80 studies. Mortality due to SARS-CoV-2 infection was reported in 36 studies. Please refer to our evidence gap maps for more detailed information.

Authors' conclusions: Up to 6 December 2021, the majority of studies examined data on mRNA vaccines administered as standard vaccination schemes (two doses approximately four to eight weeks apart) that report on immunogenicity parameters or adverse events. Clinical outcomes were less commonly reported, and if so, were often reported as a secondary outcome observed in seroconversion or immunoglobulin titre studies. As informed by this scoping review, two effectiveness reviews (on haematological malignancies and kidney transplant recipients) are currently being conducted.

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Conflict of interest statement

Nina Kreuzberger: no relevant interests; staff role at Cochrane Haematology, University Hospital Cologne, Germany; member of the prognosis methods group.

Caroline Hirsch: no relevant interests; Managing Editor at Cochrane Haematology, but was not involved in the editorial process for this review.

Marike Andreas: none known.

Lena Böhm: none known.

Paul Bröckelmann: BeiGene USA, Inc. (grant/contract), Bristol‐Myers Squibb Foundation (grant/contract), Celgene (travel), Takeda Oncology (consultant); consultant for internal medicine fellow in haematology/oncology, Department of Internal Medicine, University Hospital Cologne, Germany.

Veronica Di Cristanziano: no relevant interests; virologist at the Institute of Virology of the University Hospital Cologne, Germany; involved in the study 'Immune responses to SARS‐CoV‐2 infection and vaccination in dialysis patients and kidney transplant recipients'. The study at hand was supported by intramural funds.

Martin Golinski: no relevant interests; anesthesiologist consultant in intensive care medicine, Department of Anesthesiology, University Medicine Center Goettingen, Georg August University, Goettingen, Germany.

Renate Hausinger: no relevant interests; resident, Department of Nephrology at Klinikum rechts der Isar, University Hospital, Munich, Germany.

Verena Kappler: none known.

Berit Lange: Bundesministerium für Bildung und Forschung (grant/contract for MuSPAD seroprevalence study).

Tina Lischetzki: none known.

Sibylle Mellinghoff: Gilead Foundation (travel), Octapharma USA Inc (consultant).

Agata Mikolajewska: no relevant interests; co‐ordination of Section COVRIIN and Work in Office of STAKOB (Competence and Treatment Centres for high consequence infectious diseases) at Robert Koch Institute Centre for Biological Threats and Special Pathogens (ZBS), Section Clinical Management and Infection Control.

Ina Monsef: no relevant interests; Information Specialist, Cochrane Haematology.

Yun Soo Park: none known.

Vanessa Piechotta: none known.

Christoph Schmaderer: none known.

Miriam Stegemann: no relevant interests; medical doctor, Charité Universitätsmedizin Berlin, Germany.

Kanika Vanshylla: patent regarding SARS‐2 neutralising antibodies filed by the University of Cologne (pending); Tober‐Lau P, Gruell H, Vanshylla K, et al. doi:10.3201/eid2805.220271 COVIM: “NaFoUniMedCovid19” Bundesministerium für Bildung und Forschung Federal Institute for Drugs and Medical Devices German Center for Infection Research (DZIF); Vanshylla K, Tober‐Lau P, Gruell H, et al. doi:10.1016/S1473‐3099(22)00135‐9 COVIM: “NaFoUniMedCovid19” Bundesministerium für Bildung und Forschung Federal Institute for Drugs and Medical Devices German Center for Infection Research (DZIF) Deutsche Forschungsgemeinschaft (DFG); Gruell H, Vanshylla K, Tober‐Lau P, et al. doi:10.1038/s41591‐021‐01676‐0 COVIM: “NaFoUniMedCovid19” Bundesministerium für Bildung und Forschung Federal Institute for Drugs and Medical Devices German Center for Infection Research (DZIF) Deutsche Forschungsgemeinschaft (DFG); Mellinghoff SC, Robrecht S, Mayer L, et al. doi:10.1038/s41375‐021‐01500‐1 German Center for Infection Research (DZIF) Mildred Scheel School of Oncology German Cancer Aid; Müller L, Andrée M, Ostermann PN, et al. doi:10.3389/fmed.2021.746644 VIRus ALliance NRW (VIRAL) from the Ministry of Culture and Science NRW Jürgen Manchot Foundation; Tober‐Lau P, Schwarz T, Vanshylla K, et al. doi:10.1016/S2213‐2600(21)00456‐2 COVIM: “NaFoUniMedCovid19” Bundesministerium für Bildung und Forschung Berlin Institute of Health (BIH) and Berlin University Alliance Deutsche Forschungsgemeinschaft (DFG); Hillus D, Schwarz T, Tober‐Lau P, et al. doi:10.1016/S2213‐2600(21)00357‐X COVIM: “NaFoUniMedCovid19” Bundesministerium für Bildung und Forschung, Laboratory of Experimental Immunology, Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

Florencia Weber: no relevant interests; resident of anaesthesiology, Universitätsklinikum Würzburg, Germany.

Stephanie Weibel: no relevant interests; editor with Cochrane Anaesthesia.

Caspar Stephani: no relevant interests; medical doctor on an intensive care unit in Göttingen, Germany.

Nicole Skoetz: no relevant interests; editor with Cochrane Haematology, but was not involved in the editorial process for this review.

Figures

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PRISMA flow diagram. *Categories are mutually exclusive and sorted according to the online database. Numbers do not align with Table 4, as one study can include more than one comorbidity subgroup.
2
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Heat map: intervention ‐ outcome.
3
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Heat map: subgroup ‐ outcome.
See this image and copyright information in PMC

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