COVID-19 Vaccination in Patients with Inborn Errors of Immunity Reduces Hospitalization and Critical Care Needs Related to COVID-19: a USIDNET Report
Authors: McDonnell John , Cousins Kimberley , Younger M. Elizabeth M. , Lane Adam , Abolhassani Hassan , Abraham Roshini S. , Al-Tamemi Salem , Aldave-Becerra Juan Carlos , Al-Faris Eman Hesham , Alfaro-Murillo Alberto , AlKhater Suzan A. , Alsaati Nouf , Doss Alexa Michelle Altman , Anderson Melissa , Angarola Ernestina , Ariue Barbara , Arnold Danielle E. , Assa’ad Amal H. , Aytekin Caner , Bank Meaghan , Bergerson Jenna R. E. , Bleesing Jack , Boesing John , Bouso Carolina , Brodszki Nicholas , Cabanillas Diana , Cady Carol , Callahan Meghan A. , Caorsi Roberta , Carbone Javier , Carrabba Maria , Castagnoli Riccardo , Catanzaro Jason R. , Chan Samantha , Chandra Sharat , Chapdelaine Hugo , Chavoshzadeh Zahra , Chong Hey Jin , Connors Lori , Consonni Filippo , Correa-Jimenez Oscar , Cunningham-Rundles Charlotte , D’Astous-Gauthier Katherine , Delmonte Ottavia Maria , Demirdag Yesim Yilmaz , Deshpande Deepti R. , Diaz-Cabrera Natalie M. , Dimitriades Victoria R. , El-Owaidy Rasha , ElGhazali Gehad , Al-Hammadi Suleiman , Fabio Giovanna , Faure Astrid Schellnast , Feng Jin , Fernandez James M. , Fill Lauren , Franco Guacira R. , Frenck Robert W. , Fuleihan Ramsay L. , Giardino Giuliana , Galant-Swafford Jessica , Gambineri Eleonora , Garabedian Elizabeth K. , Geerlinks Ashley V. , Goudouris Ekaterini , Grecco Octavio , Pan-Hammarström Qiang , Khani Hedieh Haji Khodaverdi , Hammarström Lennart , Hartog Nicholas L. , Heimall Jennifer , Hernandez-Molina Gabriela , Horner Caroline C. , Hostoffer Robert W. , Hristova Nataliya , Hsiao Kuang-Chih , Ivankovich-Escoto Gabriela , Jaber Faris , Jalil Maaz , Jamee Mahnaz , Jean Tiffany , Jeong Stephanie , Jhaveri Devi , Jordan Michael B. , Joshi Avni Y. , Kalkat Amanpreet , Kanarek Henry J. , Kellner Erinn S. , Khojah Amer , Khoury Ruby , Kokron Cristina M. , Kumar Ashish , Lecerf Kelsey , Lehman Heather K. , Leiding Jennifer W. , Lesmana Harry , Lim Xin Rong , Lopes Joao Pedro , López Ana Laura , Tarquini Lucia , Lundgren Ingrid S. , Magnusson Julieann , Marinho Ana Karolina B. B. , Marseglia Gian Luigi , Martone Giulia M. , Mechtler Annamaria G. , Mendonca Leonardo , Milner Joshua D. , Mustillo Peter J. , Naderi Asal Gharib , Naviglio Samuele , Nell Jeremy , Niebur Hana B. , Notarangelo Luigi , Oleastro Matias , Ortega-López María Claudia , Patel Neil R. , Petrovic Gordana , Pignata Claudio , Porras Oscar , Prince Benjamin T. , Puck Jennifer M. , Qamar Nashmia , Rabusin Marco , Raje Nikita , Regairaz Lorena , Risma Kimberly A. , Ristagno Elizabeth H. , Routes John , Roxo-Junior Persio , Salemi Negin , Scalchunes Christopher , Schuval Susan J. , Seneviratne Suranjith L. , Shankar Ashwin , Sherkat Roya , Shin Junghee Jenny , Siddiqi Abeer , Signa Sara , Sobh Ali , Lima Fabiana Mascarenhas Souza , Stenehjem Kristen K. , Tam Jonathan S. , Tang Monica , Barros Myrthes Toledo , Verbsky James , Vergadi Eleni , Voelker Dayne H. , Volpi Stefano , Wall Luke A. , Wang Christine , Williams Kelli W. , Wu Eveline Y. , Wu Shan Shan , Zhou Jessie J. , Cook Alexandria , Sullivan Kathleen E. , Marsh Rebecca 
Published: April 2024

Abstract
Background
The CDC and ACIP recommend COVID-19 vaccination for patients with inborn errors of immunity (IEI). Not much is known about vaccine safety in IEI, and whether vaccination attenuates infection severity in IEI.

Objective
To estimate COVID-19 vaccination safety and examine effect on outcomes in patients with IEI.

Methods
We built a secure registry database in conjunction with the US Immunodeficiency Network to examine vaccination frequency and indicators of safety and effectiveness in IEI patients. The registry opened on January 1, 2022, and closed on August 19, 2022.

Results
Physicians entered data on 1245 patients from 24 countries. The most common diagnoses were antibody deficiencies (63.7%). At least one COVID-19 vaccine was administered to 806 patients (64.7%), and 216 patients received vaccination prior to the development of COVID-19. The most common vaccines administered were mRNA-based (84.0%). Seventeen patients were reported to seek outpatient clinic or emergency room care for a vaccine-related complication, and one patient was hospitalized for symptomatic anemia. Eight hundred twenty-three patients (66.1%) experienced COVID-19 infection. Of these, 156 patients required hospitalization (19.0%), 47 required ICU care (5.7%), and 28 died (3.4%). Rates of hospitalization (9.3% versus 24.4%, p < 0.001), ICU admission (2.8% versus 7.6%, p = 0.013), and death (2.3% versus 4.3%, p = 0.202) in patients who had COVID-19 were lower in patients who received vaccination prior to infection. In adjusted logistic regression analysis, not having at least one COVID-19 vaccine significantly increased the odds of hospitalization and ICU admission.

Conclusion
Vaccination for COVID-19 in the IEI population appears safe and attenuates COVID-19 severity.