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Background: Patients with inborn errors of immunity (IEI) have high risks of severe complications after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Although vaccination is effective in preventing severe coronavirus disease 2019 (COVID-19), boosters are required as the protection provided wanes over time. A greater number of boosters may be required in IEI patients compared to healthy individuals because of their immunodeficient state, but no such data are available. Objective: We investigated and compared the immunogenicity between 4 doses of COVID-19 vaccination for patients with IEI and 3 doses for healthy individuals. Methods: In the current study (NCT04800133), either BNT162b2 or CoronaVac was administered as dose 4. Healthy individuals who received 3 doses were included for comparison. Humoral and cellular immunogenicity against wild-type and JN.1 SARS-CoV-2 was assessed between IEI patients and healthy individuals. Results: IEI patients had lower humoral and cellular immunogenicity than healthy individuals after 3 doses of COVID-19 vaccination. After dose 4, IEI patients obtained immunogenicity similar to that of healthy individuals who received 3 doses. A fourth dose of BNT162b2 significantly enhanced humoral and cellular immunogenicity against wild-type SARS-CoV-2 and humoral responses against JN.1 SARS-CoV-2. In contrast, CoronaVac had minimal effect on humoral responses to wild-type and JN.1 SARS-CoV-2. Six patients experienced breakthrough infections, which did not result in hospitalization or death. Conclusion: A fourth dose of BNT162b2 was immunogenic and safe for most IEI patients. The fourth dose of vaccination is recommended for IEI patients to improve protection against COVID-19, particularly before travel to areas with high endemic transmission.
Chan et al. (Wed,) studied this question.