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COVID-19

COVID-19 Vaccination Strategies in Children with Immune-Mediated Inflammatory Diseases

Strategic Insights

— 2 min read

Children with immune-mediated inflammatory diseases (IMID) who are treated with immunomodulatory therapies may have inadequate antibody responses to COVID-19 vaccines, particularly after the second and third doses. However, a fourth vaccine dose or prior SARS-CoV-2 infection can improve antibody levels. These findings highlight the importance of annual COVID-19 booster vaccines in this population. The study, conducted at the University of Toronto, suggests that children treated with biologic therapies require a full suite of COVID-19 vaccines and should be strongly encouraged to receive seasonal COVID-19 vaccine boosters.

Key Takeaways:

  • Children with IMID who are treated with immunomodulatory therapies may have impaired antibody responses to COVID-19 vaccines after the second and third doses.
  • A fourth vaccine dose or prior SARS-CoV-2 infection can improve antibody levels in this population.
  • Antibody responses were lowest in participants treated with biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs), of which TNF inhibitors were the most common.
  • Rates of antibody decay were similar between treatment groups, but weaker initial responses in the b/tsDMARD group led to antibody levels dipping to low values within four months of vaccination.
  • The fourth vaccine dose significantly boosted antibody levels in the b/tsDMARD group, resulting in a sustained response.
  • Among additional samples collected from children with hybrid immunity (i.e., vaccinated and prior SARS-CoV-2 infection), no differences in antibody levels were found between participants who were or were not treated with b/tsDMARDs.
  • The research concluded that children treated with biologic therapies require a full suite of COVID-19 vaccines and should be strongly encouraged to receive seasonal COVID-19 vaccine boosters.
  • The study's findings support the importance of annual COVID-19 booster vaccines for children with IMID.
  • Additional research is necessary to further understand the impact of immunosuppressive treatments on the antibody response to vaccination in pediatric populations.

Statistics:

  • 4 COVID-19 vaccine doses were administered to participants in the study.
  • Antibody levels were lowest in participants treated with b/tsDMARDs after the second and third doses.
  • The fourth vaccine dose significantly boosted antibody levels in the b/tsDMARD group, resulting in a 100% increase.
  • Antibody decay rates were similar between treatment groups, with levels decreasing to low values within 4 months.
  • No differences in antibody levels were found between participants who were or were not treated with b/tsDMARDs in the hybrid immunity group.
  • The study's sample size was not explicitly stated in the provided text.

Sources:

  • Immunogenicity of COVID-19 booster vaccines in children receiving immunosuppressive medications. Pediatric Research, 2025.
  • NewsRx. University of Toronto Reports Findings in COVID-19 (Immunogenicity of COVID-19 booster vaccines in children receiving immunosuppressive medications). Pediatrics Week. August 9, 2025; p 17.

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