Humoral Immune Response and Safety of SARS-CoV-2 Vaccination in Pediatric Inflammatory Bowel Disease

Arthur J. Kastl*, Kimberly N. Weaver, Xian Zhang, Jennifer A Strople, Jeremy Adler, Marla C. Dubinsky, Athos Bousvaros, Runa Watkins, Xiangfeng Dai, Wenli Chen, Raymond K. Cross, Peter D.R. Higgins, Ryan C. Ungaro, Meenakshi Bewtra, Emanuelle A. Bellaguarda, Francis A. Farraye, Kelly Y. Chun, Michael Zikry, Manory Fernando, Monique BastidasCristian G. Hernandez, Riley G. Craig, Margie E. Boccieri, Anne Firestine, Millie D. Long, Michael D. Kappelman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


INTRODUCTION:Children with inflammatory bowel disease (IBD) may respond differently to COVID-19 immunization as compared with healthy children or adults with IBD. Those younger than 12 years receive a lower vaccine dose than adults. We sought to describe the safety and humoral immune response to COVID-19 vaccine in children with IBD.METHODS:We recruited children with IBD, ages 5-17 years, who received ≥ 2 doses of the BNT162b2 vaccine by a direct-to-patient outreach and at select sites. Patient demographics, IBD characteristics, medication use, and vaccine adverse events were collected. A subset of participants had quantitative measurement of anti-receptor binding domain IgG antibodies after 2-part immunization.RESULTS:Our study population included 280 participants. Only 1 participant required an ED visit or hospitalization because of an adverse event. Of 99 participants who underwent anti-receptor binding domain IgG antibody measurement, 98 had a detectable antibody, with a mean antibody level of 43.0 g/mL (SD 67) and a median of 22 g/mL (interquartile range 12-38). In adjusted analyses, older age (P = 0.028) and antitumor necrosis factor monotherapy compared with immunomodulators alone (P = 0.005) were associated with a decreased antibody level. Antibody response in patients treated with antitumor necrosis factor combination vs monotherapy was numerically lower but not significant.DISCUSSION:Humoral immune response to COVID-19 immunization in children with IBD was robust, despite a high proportion of this pediatric cohort being treated with immunosuppressive agents. Severe vaccine-related AEs were rare. Overall, these findings provide a high level of reassurance that pediatric patients with IBD respond well and safely to SARS-CoV-2 vaccination.

Original languageEnglish (US)
Pages (from-to)129-137
Number of pages9
JournalAmerican Journal of Gastroenterology
Issue number1
StatePublished - Jan 1 2023

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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