背景:COVID-19大流行不成比例地影响了患有潜在疾病的人。儿科血液肿瘤患者的SARS-CoV-2感染易感性和疫苗有效性未知。
方法:从2022年2月至7月,在354名儿科血液学-肿瘤学受试者中测定了抗刺药和抗核衣壳Ig,包括53名接受化疗(癌症)的肿瘤患者,150例镰状细胞病(SCD)患者,和151名良性咨询和长期随访患者(对照)。参与者填写了一份问卷。
结果:COVID-19感染的频率,通过阳性PCR/抗原测试或抗核衣壳Ig定义,62%的人患有癌症,71%的SCD,52%的控制,SCD与对照组有统计学差异(p=.001)。感染与COVID-19暴露有关,西班牙裔/拉丁裔或黑人/非裔美国人种族,多户住宅,运动参与;COVID-19助推器降低与感染的相关性。在COVID-19阳性癌症患者中,58%的抗核衣壳阳性,76%的抗刺药阳性(≥10U/mL),与SCD和对照中的基本上100%血清转化相比(分别为p<0.0001,p=.01)。感染导致12%癌症的高抗尖峰(≥2500U/mL),14%SCD,和15%的对照(p=0.93)。疫苗接种导致90%癌症的抗峰值阳性,100%SCD,和100%控制(p=.06),在20%的癌症中,47%SCD,和41%的对照(p=0.36)。在被提升的科目中,两种癌症之一,6/6SCD,19/19对照组表现出高抗尖峰。
结论:癌症患者表现出与对照组相似的SARS-CoV-2感染频率,但对感染和疫苗接种的抗体反应减弱。SCD患者表现出与对照组没有区别的血清转换。与感染相比,疫苗接种与高抗尖峰的频率相关;疫苗接种加加强剂在引发90天以上可检测到的高抗尖峰抗体方面最有效。
BACKGROUND: The COVID-19 pandemic disproportionately affected persons with underlying medical conditions. SARS-CoV-2 infection susceptibility and vaccine effectiveness in pediatric hematology-oncology patients were unknown.
METHODS: From February to July 2022, anti-spike and anti-nucleocapsid Ig were assayed in 354 pediatric hematology-oncology subjects, including 53 oncology patients receiving chemotherapy (cancer), 150 patients with sickle cell disease (SCD), and 151 benign consult and long-term follow-up patients (controls). Participants completed a questionnaire.
RESULTS: Frequencies of COVID-19 infection, defined by positive PCR/antigen test or anti-nucleocapsid Ig, were 62% in cancer, 71% in SCD, 52% in controls, with SCD statistically different than controls (p = .001). Infection was associated with COVID-19 exposure, Hispanic/Latino or Black/African American ethnicity, multi-family dwelling, sports participation; COVID-19 booster decreased association with infection. In COVID-19-positive cancer patients, 58% had positive anti-nucleocapsid and 76% had positive anti-spike (≥10 U/mL), compared to essentially 100% seroconversion in SCD and controls (p < .0001, p = .01, respectively). Infection led to high anti-spike (≥2500 U/mL) in 12% cancer, 14% SCD, and 15% controls (p = .93). Vaccination resulted in anti-spike positivity in 90% cancer, 100% SCD, and 100% controls (p = .06), and in high anti-spike in 20% cancer, 47% SCD, and 41% controls (p = .36). Of boosted subjects, one of two cancer, 6/6 SCD, and 19/19 controls exhibited high anti-spike.
CONCLUSIONS: Cancer patients demonstrated similar SARS-CoV-2 infection frequency as controls, but diminished antibody response to infection and vaccination. SCD patients exhibited seroconversion indistinguishable from controls. Vaccination was associated with higher frequency of high anti-spike than infection; vaccination plus booster was most effective in eliciting high anti-spike antibody detectable beyond 90 days.