|Title:||“IS IMMUNOSUPPRESSION TRIGGERING mRNA BNT162b2 VACCINE BREAKTHROUGH INFECTION? – CASE SERIES”|
|Author(s):||N Rajendran E Moore A Houston B Kent B Kennedy B Crowley|
|Institution:||St. James's Hospital, Dublin|
|Poster:||Click to view poster|
|Abstract:||SARS-CoV-2 vaccines have played a significant role in reducing mortality and morbidity from Covid-19. However, concern remains that immunosuppressed individuals may develop breakthrough infection despite full vaccination, resulting in severe Covid pneumonia. |
We assessed vaccinated patients admitted with Covid pneumonia between 09 July 2021 – 09 August 2021. We measured Anti-SARS-CoV-2 spike (anti-S IgG) and nucleocapsid (anti-N IgG) antibodies, clinical severity, imaging, immunosuppressant drugs and oxygen requirements.
Three fully vaccinated patients developed severe Covid pneumonia. All were male, with an average age 53 years (range 51-59). Two had haematological malignancies, one had systemic sclerosis associated interstitial lung disease, and all were on B-cell depleting immunosuppression therapy. One patient had detectable anti-S IgG, compatible with a humoral response, another had both anti-S and anti-N IgG, compatible with a serological response to SARS-CoV-2 infection, the third was seronegative. Peak CRP was 146±92. All three required high flow nasal oxygen therapy, prolonged self-proning and high dose corticosteroids, two receiving Tocilizumab.
Immunosuppressed patients may remain at risk of severe Covid pneumonia despite full vaccination. This may be particularly the case in patients receiving B cell depleting therapies, even in the presence of apparent humoral response to vaccination and/or infection.