J Pediatr. 2025 Oct 23:114873. doi: 10.1016/j.jpeds.2025.114873. Online ahead of print.
ABSTRACT
OBJECTIVE: To investigate the concern that children and young people (CYP) receiving immune-suppressing treatments mount impaired responses to vaccines, in CYP compared with healthy controls.
STUDY DESIGN: We prospectively enrolled CYP aged 5-17 years who are receiving we measured humoral and cellular biological response modifying (BRM) therapies for rheumatologic inflammatory conditions (RIC), or post solid organ transplant (PSOT), or cancer chemotherapy before and/or after routine vaccinations with BNT162b2 vaccine. Responses to SARS-CoV-2 vaccination were assessed by anti-SARS-CoV-2 spike antibodies (Roche Diagnostics) and T-cell responses (Oxford Immunotec). Response to wild-type and SARS-CoV-2 variants (BA.5, XBB1.5) was assessed by microneutralization assay. Control data were from ComCOV3.
RESULTS: 125 eligible participants enrolled (RIC n=54 [43·2%], PSOT n=49 [39·2%], cancer n=22 [17·6%]); 58 (46·4%) female; mean (SD) age 12·9 (2·9) years. 79 (63·2%) participants had prior COVID-19 and 28 (22·4%) were unvaccinated prior to study; 97 (77·6%) participants received one or more vaccines; 13 (10·4%) reported COVID-19 infection during follow up. CYP receiving chemotherapy for cancer had lower antibody responses post vaccine: anti-SARS-CoV-2 spike antibodies (median [IQR], AU/mL) = 26·7 [2·3-1088·0] compared with RIC = 6970·0 [1417·0-18163·0] and PSOT = 7899·0 [1711·0-19201·0]), both p values <0·0001. T-cell responses (median [IQR] SFC/106 PBMCs) were also reduced in the cancer group (8.0 [0·0-48.0]) compared with RIC (110.0 [44.0-260.0]) p=0.009 and PSOT (74.0 [32·0-160·0]), p=0·003.
CONCLUSIONS: Children receiving immune-suppressing therapies for RIC and PSOT had antibody and T-cell responses after the third vaccine dose that approached levels reported in healthy controls. Children who were receiving cancer chemotherapy, however, showed substantially reduced humoral and T-cell responses.
PMID:41139014 | DOI:10.1016/j.jpeds.2025.114873
