tetano
Editor, Senior Moderator
J Allergy Clin Immunol Glob
. 2026 Mar 25;5(4):100694.
doi: 10.1016/j.jacig.2026.100694. eCollection 2026 Jul.
Four doses of coronavirus disease 2019 vaccination for patients with inborn errors of immunity compared to 3 doses for healthy individuals
Jeffery C H Chan[SUP] 1 [/SUP], Samuel M S Cheng[SUP] 2 [/SUP], Daniel Leung[SUP] 1 [/SUP], Xiwei Wang[SUP] 1 [/SUP], Manni Wang[SUP] 1 [/SUP], Yin Celeste Cheuk[SUP] 1 [/SUP], Cyrus Ho[SUP] 1 [/SUP], Leo C H Tsang[SUP] 2 [/SUP], Tsz Chun Kwan[SUP] 2 [/SUP], Amos M T Lee[SUP] 1 [/SUP], Wing Yan Li[SUP] 1 [/SUP], Jennifer H Y Lam[SUP] 1 [/SUP], Kaiyue Zhang[SUP] 1 [/SUP], Issan Y S Tam[SUP] 1 [/SUP], Sau Man Chan[SUP] 1 [/SUP], Koon Wing Chan[SUP] 1 [/SUP], Malik Peiris[SUP] 2 3 [/SUP], Wenwei Tu[SUP] 1 [/SUP], Yu Lung Lau[SUP] 1 [/SUP], Jaime S Rosa Duque[SUP] 1 [/SUP]
Affiliations
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.
Keywords: COVID-19; inborn errors of immunity; vaccine.
. 2026 Mar 25;5(4):100694.
doi: 10.1016/j.jacig.2026.100694. eCollection 2026 Jul.
Four doses of coronavirus disease 2019 vaccination for patients with inborn errors of immunity compared to 3 doses for healthy individuals
Jeffery C H Chan[SUP] 1 [/SUP], Samuel M S Cheng[SUP] 2 [/SUP], Daniel Leung[SUP] 1 [/SUP], Xiwei Wang[SUP] 1 [/SUP], Manni Wang[SUP] 1 [/SUP], Yin Celeste Cheuk[SUP] 1 [/SUP], Cyrus Ho[SUP] 1 [/SUP], Leo C H Tsang[SUP] 2 [/SUP], Tsz Chun Kwan[SUP] 2 [/SUP], Amos M T Lee[SUP] 1 [/SUP], Wing Yan Li[SUP] 1 [/SUP], Jennifer H Y Lam[SUP] 1 [/SUP], Kaiyue Zhang[SUP] 1 [/SUP], Issan Y S Tam[SUP] 1 [/SUP], Sau Man Chan[SUP] 1 [/SUP], Koon Wing Chan[SUP] 1 [/SUP], Malik Peiris[SUP] 2 3 [/SUP], Wenwei Tu[SUP] 1 [/SUP], Yu Lung Lau[SUP] 1 [/SUP], Jaime S Rosa Duque[SUP] 1 [/SUP]
Affiliations
- PMID: 42022223
- PMCID: PMC13098406
- DOI: 10.1016/j.jacig.2026.100694
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.
Keywords: COVID-19; inborn errors of immunity; vaccine.