Inflamm Bowel Dis. 2024 Oct 16:izae225. doi: 10.1093/ibd/izae225. Online ahead of print.

Arthur J Kastl ¹, Erica J Brenner ², Kimberly N Weaver ³, Xian Zhang ², Jennifer A Strople ⁴, Jeremy Adler ⁵, Marla C Dubinsky ⁶, Athos Bousvaros ⁷, Runa Watkins ⁸, Xiangfeng Dai ⁹, Wenli Chen ⁹, Raymond K Cross ¹⁰, Peter D R Higgins ¹¹, Ryan C Ungaro ¹², Meenakshi Bewtra ¹³, Emanuelle A Bellaguarda ¹⁴, Francis A Farraye ¹⁵, Kelly Y Chun ¹⁶, Michael Zikry ¹⁶, Monique Bastidas ¹⁶, Ann M Firestine ¹⁷, Riley G Craig ¹⁷, Margie E Boccieri ², Millie D Long ¹⁸, Michael D Kappelman ²

Author information

¹Division of Gastroenterology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

²Division of Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

³Division of Gastroenterology, Hepatology and Nutrition, Allegheny Health Network, Pittsburgh, PA, USA.

⁴Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.

⁵Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.

⁶Dr. Henry D. Janowitz Division of Gastroenterology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

⁷Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.

⁸Division of Pediatric Gastroenterology and Nutrition, University of Maryland School of Medicine, Baltimore, MD, USA.

⁹Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

¹⁰Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA.

¹¹Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.

¹²Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

¹³Division of Gastroenterology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.

¹⁴Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL, USA.

¹⁵Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.

¹⁶Esoterix LabCorp,Calabasas, CA, USA.

¹⁷Division of Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

¹⁸Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Abstract

Background: Children with inflammatory bowel disease (IBD) may have diminished serologic response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination and increased risk for subsequent severe coronavirus disease 2019 (COVID-19) infection. We sought to describe outcomes among those who developed SARS-CoV-2 infection following vaccination, characterize SARS-CoV-2 antibodies 1 year post-vaccination, and identify factors associated with durable serologic response.

Methods: We recruited children with IBD who received ≥2 doses of SARS-CoV-2 vaccine and prospectively collected data on (1) demographics, IBD characteristics, and therapy and (2) SARS-CoV-2 vaccination, testing, and infection symptoms. Serum was obtained for measurement of anti-receptor-binding domain IgG antibodies following a 2-part immunization at 12 and 52 weeks.

Results: We enrolled 298 participants (mean age 11.9 ± 3.82, 50% female, 67% Crohn's disease). Symptomatic COVID-19 infection after vaccination occurred in half of the participants, although only 2 (1%) required hospitalization. Anti-tumor necrosis factor alpha (TNF-α) was associated with higher likelihood of symptomatic COVID-19 infection, with an adjusted hazard ratio of 2.7 (95% CI, 1.5-5.0; P = .001). Nearly all participants (99%) had detectable antibody at Week 52. Children aged 1-5 years had lower 52-week antibody level compared to older children (P = .04), as did those on anti-TNF-α therapy (P = .007) and those who received only 2 vaccine doses prior to Week 52 (P < .001).

Conclusions: SARS-CoV-2 vaccination provides lasting serologic response and protection against severe COVID-19 for most children with IBD, despite the use of lower vaccine doses in younger children and wide-ranging classes of immunosuppressive therapies.