Rituximab‐to‐vaccine interval on SARS‐CoV‐2 immunogenicity in children: The potential role of prior natural infection

Author:

Gualtieri Renato1,Yerly Sabine2,Garcia‐Tarodo Stephanie3,Parvex Paloma4,Rock Nathalie56,Posfay‐Barbe Klara17,Didierlaurent Arnaud M.8,Eberhardt Christiane Sigrid89ORCID,Blanchard‐Rohner Geraldine10ORCID

Affiliation:

1. Pediatric Platform for Clinical Research, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine University of Geneva Geneva Switzerland

2. Laboratory of Virology, Diagnostic Department Geneva University Hospitals Geneva Switzerland

3. Unit of Pediatric Neurology, Division of Pediatric Specialties, Department of Pediatrics, Gynecology and Obstetrics Geneva University Hospitals Geneva Switzerland

4. Unit of Pediatric Nephrology, Division of Pediatric Specialties, Department of Pediatrics, Gynecology and Obstetrics Geneva University Hospitals Geneva Switzerland

5. Pediatric Gastroenterology, Hepatology and Nutrition Unit, Department of Pediatrics, Gynecology and Obstetrics, Swiss Pediatric Liver Center Geneva University Hospitals Geneva Switzerland

6. Department of Pediatrics, Gynecology, and Obstetrics, Swiss Pediatric Liver Center University of Geneva, University Hospitals of Geneva Geneva Switzerland

7. Unit of Infectious Diseases, Division of General Pediatrics, Department of Pediatrics, Gynecology and Obstetrics Geneva University Hospitals Geneva Switzerland

8. Department of Pathology and Immunology, Center for Vaccinology University of Geneva Geneva Switzerland

9. Center for Vaccinology University Hospitals of Geneva Geneva Switzerland

10. Unit of Immunology, Vaccinology and Rheumatology, Division of General Pediatrics, Department of Pediatrics, Gynecology and Obstetrics Geneva University Hospitals Geneva Switzerland

Abstract

AbstractBackgroundTreatment with anti‐CD20 antibodies (rituximab) is used in both adults and children to treat various autoimmune and oncological diseases. Rituximab depletes B CD20+ cells and, thereby, antibody response to vaccines. This study aimed to examine the antibody response to mRNA‐based COVID‐19 vaccines in children aged 5–18 years undergoing rituximab treatment compared to healthy matched children.MethodsBetween 31 January and 18 July 2022, we conducted a prospective observational study at the Geneva University Hospitals, enrolling children aged 5–18 years under rituximab treatment who had received two mRNA‐based SARS‐CoV‐2 vaccine doses. Controls were healthy volunteers with no significant medical conditions. Exclusion criteria included a recent SARS‐CoV‐2 infection. Blood samples were collected at day 60 (±30) and day 270 (±90) after the second vaccination.ResultsThe rituximab‐treated group exhibited significantly lower levels of antibodies specific to the anti‐receptor binding domain (RBD) of the SARS‐CoV‐2 spike (S) protein than healthy controls at 60 (±30) days after the second vaccine dose (geometric mean concentration: 868.3 IU/mL in patients and 11,393 IU/mL in controls; p = .008). However, patients with a rituximab‐to‐vaccine interval shorter than 6 months and with evidence of a past infection (based on positive anti‐N antibody levels) had a high level of anti‐RBD antibodies.ConclusionA past infection with SARS‐CoV‐2 may induce anti‐RBD‐specific memory B cells that can be re‐activated by SARS‐CoV‐2 vaccination, even after rituximab‐induced B‐cell depletion. This suggests that it is possible to vaccinate earlier than 6 months after rituximab to develop a good antibody response, especially in the case of past SARS‐CoV‐2 infection.

Publisher

Wiley

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