Durable Immune Response and Long-term Efficacy of COVID-19 Vaccination in Children With Inflammatory Bowel Disease

Arthur J Kastl¹, Erica J Brenner², Kimberly N Weaver³, Xian Zhang², Jennifer A Strople⁴, Jeremy Adler⁵, Marla C Dubinsky⁶, Athos Bousvaros⁷, Runa Watkins⁸, Xiangfeng Dai⁹, Wenli Chen⁹, Raymond K Cross¹⁰, Peter D R Higgins¹¹, Ryan C Ungaro¹², Meenakshi Bewtra¹³, Emanuelle A Bellaguarda¹⁴, Francis A Farraye¹⁵, Kelly Y Chun¹⁶, Michael Zikry¹⁶, Monique Bastidas¹⁶, Ann M Firestine¹⁷, Riley G Craig¹⁷, Margie E Boccieri², Millie D Long¹⁸, Michael D Kappelman²

Affiliations

¹ Division of Gastroenterology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
² Division of Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³ Division of Gastroenterology, Hepatology and Nutrition, Allegheny Health Network, Pittsburgh, PA, USA.
⁴ Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
⁵ Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
⁶ Dr. Henry D. Janowitz Division of Gastroenterology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁷ Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
⁸ Division of Pediatric Gastroenterology and Nutrition, University of Maryland School of Medicine, Baltimore, MD, USA.
⁹ Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁰ Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA.
¹¹ Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.
¹² Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹³ Division of Gastroenterology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
¹⁴ Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL, USA.
¹⁵ Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.
¹⁶ Esoterix LabCorp,Calabasas, CA, USA.
¹⁷ Division of Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁸ Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

PMID: 39412147
DOI: 10.1093/ibd/izae225

Durable Immune Response and Long-term Efficacy of COVID-19 Vaccination in Children With Inflammatory Bowel Disease

Arthur J Kastl et al. Inflamm Bowel Dis. 2025.

. 2025 Jul 7;31(7):1797-1805.

doi: 10.1093/ibd/izae225.

Authors

Affiliations

¹ Division of Gastroenterology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
² Division of Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³ Division of Gastroenterology, Hepatology and Nutrition, Allegheny Health Network, Pittsburgh, PA, USA.
⁴ Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
⁵ Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
⁶ Dr. Henry D. Janowitz Division of Gastroenterology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁷ Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
⁸ Division of Pediatric Gastroenterology and Nutrition, University of Maryland School of Medicine, Baltimore, MD, USA.
⁹ Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁰ Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA.
¹¹ Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.
¹² Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹³ Division of Gastroenterology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
¹⁴ Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL, USA.
¹⁵ Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.
¹⁶ Esoterix LabCorp,Calabasas, CA, USA.
¹⁷ Division of Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁸ Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

PMID: 39412147
DOI: 10.1093/ibd/izae225

Abstract

Background: Children with inflammatory bowel disease (IBD) may have diminished serologic response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination and increased risk for subsequent severe coronavirus disease 2019 (COVID-19) infection. We sought to describe outcomes among those who developed SARS-CoV-2 infection following vaccination, characterize SARS-CoV-2 antibodies 1 year post-vaccination, and identify factors associated with durable serologic response.

Methods: We recruited children with IBD who received ≥2 doses of SARS-CoV-2 vaccine and prospectively collected data on (1) demographics, IBD characteristics, and therapy and (2) SARS-CoV-2 vaccination, testing, and infection symptoms. Serum was obtained for measurement of anti-receptor-binding domain IgG antibodies following a 2-part immunization at 12 and 52 weeks.

Results: We enrolled 298 participants (mean age 11.9 ± 3.82, 50% female, 67% Crohn's disease). Symptomatic COVID-19 infection after vaccination occurred in half of the participants, although only 2 (1%) required hospitalization. Anti-tumor necrosis factor alpha (TNF-α) was associated with higher likelihood of symptomatic COVID-19 infection, with an adjusted hazard ratio of 2.7 (95% CI, 1.5-5.0; P = .001). Nearly all participants (99%) had detectable antibody at Week 52. Children aged 1-5 years had lower 52-week antibody level compared to older children (P = .04), as did those on anti-TNF-α therapy (P = .007) and those who received only 2 vaccine doses prior to Week 52 (P < .001).

Conclusions: SARS-CoV-2 vaccination provides lasting serologic response and protection against severe COVID-19 for most children with IBD, despite the use of lower vaccine doses in younger children and wide-ranging classes of immunosuppressive therapies.

Keywords: COVID-19; Crohn’s disease; humoral immune response; ulcerative colitis; vaccination.

Plain language summary

We demonstrate high rates of durable antibody response and low rates of coronavirus disease 2019-related hospitalization 1 year following severe acute respiratory syndrome coronavirus 2 vaccination in children with inflammatory bowel disease. Anti-tumor necrosis factor alpha therapy, young age, and fewer vaccine doses were associated with lower 52-week antibody level.

© The Author(s) 2024. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

PubMed Disclaimer

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Durable Immune Response and Long-term Efficacy of COVID-19 Vaccination in Children With Inflammatory Bowel Disease

Affiliations

Durable Immune Response and Long-term Efficacy of COVID-19 Vaccination in Children With Inflammatory Bowel Disease

Authors

Affiliations

Abstract

Plain language summary

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous