New Study Supports COVID-19 Vaccination in Patients with Cystic Fibrosis

In a recent study, COVID-19 vaccination in patients with cystic fibrosis (CF) appeared to induce antibody responses comparable with those observed in the general population. The results of the research supported vaccination in this population and called for further efforts in the CF community.¹

The lungs, liver, pancreas, kidney, and intestines can be impacted in patients with CF, which makes them more vulnerable to infection than the general population.² Therefore, higher risk of experiencing severe complications associated with COVID-19 could be exhibited by patients with CF.

Investigators led by Georgene Hergenroeder MD, Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, aimed to examine the seroprevalence and clinical characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children with cystic fibrosis, as well as to assess the antibody responses following SARS-CoV-2 infection or vaccination.

COVID-19 and Cystic Fibrosis

The investigation enrolled children and adolescents with CF who were receiving care at Seattle Children's Hospital from July 2020 and February 2021. Patient information was provided through intake and weekly surveys regarding SARS-CoV-2 exposures, viral/respiratory illnesses, and symptoms.

The team used nucleocapsid and spike IgG tests to determine SARS-CoV-2 serostatus at enrollment and at 6 and 11 months (±2 months). Specifically, the spike IgG measurements were adjusted by adding 1 AU to ensure values above 0 for analysis.

For comparison to vaccine responses, the values were converted to Binding Antibody Units (BAU). Investigators compared demographic and clinical variables between seronegative and seropositive patients using statistical tests.

Survival analysis estimated the proportion of participants with SARS-CoV-2 infection over time, and CDC seroprevalence data were used for assessment and adjusted to represent the population based on US census data.

Analyzing Seroprevalence and Antibody Responses

Of the 125 patients enrolled in the study, 14 (11%) had positive SARS-CoV-2 antibodies indicating recent or past infection. The data analysis revealed several notable findings.

Patients who were seropositive were more likely to identify as Hispanic (29% vs 8%, P = 0.04). These patients also had a higher incidence of pulmonary exacerbations requiring oral antibiotics in the year prior to the study when compared with seronegative participants (71% vs 41%, P = 0.04).

The data demonstrated 35.7% of the seropositive patients were asymptomatic, while 42.9% reported mild symptoms, including cough and nasal congestion. Investigators noted this finding suggests distinguishing SARS-CoV-2 infection from baseline respiratory symptoms in this population may be challenging, as a majority of cases exhibited mild or no symptoms.

When analyzing antibody responses, the study observed that patients who received vaccination showed approximately 10-fold higher levels of antispike protein IgG compared with those who had natural infection alone (P < 0.0001). These antibody levels resembled those previously reported in the general population, indicating vaccination can generate a strong immune response similar to that seen in individuals without CF.

The study highlighted the seroprevalence and clinical characteristics of SARS-CoV-2 infection in children with CF. Additionally, the data indicated a significant proportion experience mild or no symptoms when infected, presenting a potential challenge in distinguishing infectious symptoms from their baseline respiratory symptoms.

“Prior studies suggested that people with CF exhibit impaired antibody responses to influenza and pneumococcal vaccination,” investigators wrote. “In contrast, our findings suggest that COVID-19 vaccines responses in children and young adults with CF are similar to those of the general population.”

References:

1. Hergenroeder GE, Faino AV, Cogen JD, Genatossio A, McNamara S, Pascual M, Hernandez RE. Seroprevalence and clinical characteristics of SARS-CoV-2 infection in children with cystic fibrosis. Pediatr Pulmonol. 2023 Jun 14. doi: 10.1002/ppul.26528. Epub ahead of print. PMID: 37314149.
2. Alicea J. The Rare Disease Report Podcast: Cystic Fibrosis. HCPLive. May 28, 2021. https://www.hcplive.com/view/rare-disease-report-podcast-cystic-fibrosis