Vaccines (Apr 2024)

Lack of Specific Immune Response after Five Doses of mRNA SARS-CoV-2 Vaccine in a Patient with CD4<sup>+</sup> T-Cell Lymphopenia but Preserved Responses to CMV

  • Trinidad Alba-Cano,
  • Eduardo Fernández-Cruz,
  • Roberto Alonso,
  • Sara Muñoz-Gómez,
  • Rebeca Pérez de Diego,
  • Elena García Martínez,
  • Paloma Sánchez-Mateos,
  • Joaquín Navarro Caspistegui,
  • Mónica Martín López,
  • Juana Gil-Herrera

DOI
https://doi.org/10.3390/vaccines12040386
Journal volume & issue
Vol. 12, no. 4
p. 386

Abstract

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Immunogenicity of SARS-CoV-2 mRNA vaccines is highly heterogeneous in patients with inborn errors of immunity (IEIs). This case report analyzes the immune response to mRNA COVID-19 two-dose primary vaccination followed by three boosters in an IEI patient with marked CD4+ T-cell cytopenia and diminished thymic output, in comparison with that raised against latent, chronic cytomegalovirus (CMV) infection. Serum IgG antibodies anti-spike (S) protein of SARS-CoV-2 and anti-CMV were both determined by chemiluminescent microparticle immunoassays (CMIAs). SARS-CoV-2 and CMV memory CD4+ T-cell responses were simultaneously evaluated in vitro using an activation-induced marker (AIM) assay via multicolor flow cytometry. Throughout the 2-year follow-up that included the administration of five doses of SARS-CoV-2 mRNA vaccines, cellular anti-SARS-CoV-2-specific responses remained consistently negative, with extremely weak humoral responses, while the patient showed in vitro persistent CD4+ T-cell reactivity to CMV peptides and high-IgG CMV-specific titers. The assessment of immune responses to vaccines and prevalent viruses is essential in IEI patients in order to take adequate preventive measures.

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