Personalising risk from COVID-19 key to protecting immunosuppressed people
The research, published in The Lancet, reveals how a simple blood test can predict the severity of COVID-19 infection, paving the way for personalised approaches to vaccination and better protection for those most at risk.
The MELODY Study explored how well at-risk individuals develop antibodies after at least three COVID-19 vaccinations. Antibodies are crucial for the body to fight off infection, but patients on immunosuppressive medications – common after organ transplants – may respond less effectively to vaccines.
Led by Dr Michelle Willicombe, clinical reader at Imperial College London and consultant nephrologist at Imperial College Healthcare NHS Trust, the MELODY (Mass Evaluation of Lateral Flow Immunoassays for the Detection of SARS-CoV-2 Antibody in Immunosuppressed People) Study is the largest of its kind, involving over 28,000 participants.
Dr Willicombe said: “Although it is really reassuring to see that most patients in this group responded well to vaccination, we know this approach can be less effective in some patients treated with certain immunosuppressive medication, and careful consideration in any protective strategies is required.
“MELODY has shown it is possible to individually assess vaccine response and the risk of severe outcomes following COVID-19 infection in this group. This information has the potential to support personalised approaches to COVID-19 prevention, such as individualised vaccination schedules or treatments, helping at-risk patients to benefit more equally from available public health measures.”
Between December 2021 and June 2022, participants used home-testing kits that involved a simple finger-prick blood test to measure long-lasting antibody levels, employing methods pioneered through the REACT Study, one of the world’s largest and most comprehensive coronavirus monitoring studies. Unlike standard COVID-19 tests, these tests checked for immune protection.
The study found that 82% of the patients developed antibodies after vaccination. Those with detectable antibodies were less likely to contract the virus or require hospital care if infected.
Professor Graham Cooke, co-author and Deputy Dean of the Faculty of Medicine, added: “Many of us used self-reported home testing for the first time during the COVID pandemic. This study, focused on vulnerable patient groups, is a great demonstration of the potential for self-testing approaches in routine clinical settings as we look to shift NHS care towards prevention in the community.”
The study also revealed broader patterns affecting COVID-19 risks. Patients who continued shielding had higher infection rates once restrictions eased, possibly due to a lack of prior exposure to the virus. Living in a household with children was another factor linked to increased infection rates, highlighting the challenges of preventing household transmission.
Dr Willicombe emphasised: “MELODY has provided valuable information on how best to protect at-risk populations both in terms of behavioural changes, such as shielding, and vaccinating, based on personal circumstances. This knowledge can be applied to inform ongoing COVID-19 risk and also outbreaks of new viruses, should they occur.”
The findings underscore the importance of adapting health measures to meet the needs of vulnerable patients, ensuring everyone benefits from advances in medicine and public health.
The research was supported by Kidney Research UK, UK Research and Innovation (UKRI), Blood Cancer UK, Vasculitis UK, and Cystic Fibrosis Trust.
This news story was adapted from a press release by Imperial College London.
