Coronavirus disease 2019 (COVID-19) which is caused by the virus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has resulted in an ongoing global pandemic. It is unclear whether the relatively low number of reported cases of COVID-19 in people with CF (pwCF) is due to enhanced infection prevention practices or whether pwCF have protective genetic/immune factors. This study aims to prospectively assess the proportion of pwCF, including both adults and children with CF who have evidence of SARS-CoV-2 antibodies over a two-year period. This study will also examine whether pwCF who have antibodies for SARS-CoV-2 have a different clinical presentation and what impact this has on their CF disease. The proposed study will recruit pwCF from paediatric and adult CF centres throughout the United Kingdom. Serological testing to detect antibodies will be performed on blood samples taken at month 0, 6, 12, 18 and 24 with additional time-points if bloodwork is available via normal clinical care. Clinical data on, lung function, CF-related medical history, pulmonary exacerbations, antibiotic use, and microbiology and vaccination receipt, will be collected during routine clinical assessments. Associations will be examined between socio-demographic and clinical variables and serologic testing. The investigators will also examine the effects of SARS-CoV-2 infection on clinical outcomes and analyse end-points to explore any age-related or gender-based differences, as well as subgroup analysis of outcomes in lung-transplant recipients and pwCF receiving cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies. As pwCF receive COVID-19 vaccination the investigators will perform a comparison of the development and progression of anti-SARS-CoV-2 antibodies in pwCF following natural infection and vaccination SARS-CoV-2 over time.
This is a prospective, longitudinal cohort study in people with Cystic Fibrosis (pwCF) that
involves repeated serial sampling of participants. This study design was chosen to provide
comprehensive information on SARS-CoV-2 seroprevalence changes over time and the subsequent
clinical impact on pwCF. The study will be conducted at participating CF centres over a
3-year period. Study participants will include paediatric and adult pwCF. For the United
Kingdom (UK) section of the study, UK investigators in the European Cystic Fibrosis
Society-Clinical Trials Network (ECFS-CTN) will be invited to participate. Participating
investigators can enrol all eligible pwCF over a 12-month period. Participants are then
followed up for 24 months. Participants will donate blood samples at their routine clinic
visits. Blood samples will be collected at Day 0 (baseline), at Months 6, 12, 18 and 24 (to
coincide with routine clinical reviews). Additional blood samples will be taken
opportunistically every time the participant visits the clinic for blood draws. These blood
samples could be related to, routine care, annual review visits, pulmonary exacerbations
(PEx), CF complications or when initiating new treatments (e.g. CFTR modulators).
Serum from blood samples will be shipped to a central laboratory (Queen's University Belfast)
for standardized measurement of SARS-CoV-2 antibodies.
Alongside the blood samples the investigator will also collect clinical data from the
patient's health records and will input this data into the case report form (CRF). Clinical
data will be collected in conjunction with routine care visits, according to local clinical
practice. Investigators will collect data elements from information routinely recorded in the
patients' medical records. Data will be collected at baseline, month 6, 12, 18 and 24 as per
the study schedule, and at additional blood sampling timepoints as previously explained
above. Data collection will include routine data available from CF clinic follow-ups
including background demographic information, CF medical history, medications, exacerbation
information, sputum microbiology and clinical and lung function parameters. Information on
SARS-CoV-2 infection history and vaccine receipt will also be collected.
The maximum follow-up duration of participation in the study for each patient will be 24
months. This study duration (24-month follow-up) is justified as it provides sufficient time
to observe changes in antibody prevalence over the course of the COVID-19 pandemic as well as
sufficient time to determine long term clinical outcomes for pwCF who are SARS-CoV-2
seropositive. Furthermore, the investigators anticipate the 2-year study follow-up period
will provide sufficient time to observe the impact of vaccination on antibody levels given
that a number of vaccines are now commercially available.
The investigators will compare the level of antibody responses between natural COVID-19
infection and vaccination in pwCF and how this varies over time. This will be achieved by
analyzing seroprevalence and antibody levels according to natural infection and vaccination
status and according to time of sample post infection or post vaccination, if known.
Optional Study sample collection:
For participants who consent, a second blood sample will also be drawn into Ethylenediamine
tetraacetic acid (EDTA) tubes (plasma). Consent to this optional study sample would allow
this sample and any remaining serum (following antibody testing) to be stored for future
analysis and allow further research to be carried out on related studies to COVID-19 and CF.
Inclusion Criteria:
Consenting people with cystic fibrosis of any age, genotype, transplant status and disease
severity will be eligible to participate in the study. The study population is expected to
be representative of the general CF population.
Exclusion Criteria:
There are no specific exclusion criteria other than refusal to give informed consent, or
contraindication to venepuncture.
Hannover Medical School, Clinic for Pediatric Pneumology, Allergology and Neonatology & Clinic for Pneumology, Hannover
Hannover, Lower Saxony, Germany
University Children's Hospital Bochum, Paediatric Pneumology and CF Center
Bochum, Germany
CF Center, University Hospital Cologne
Cologne, Germany
Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children's Hospital, University of Duisburg-Essen
Essen, Germany
Ruhrlandklinik, Westdeutsches Lungenzentrum gGmbH
Essen, Germany
Universitätsklinikum Frankfurt a.M., Allergologie, Pneumologie & Mukoviszidose
Frankfurt am Main, Germany
University of Jena, Cystic Fibrosis Centre for children and adults
Jena, Germany
Cystic Fibrosis Center for Adults, Department of Pneumology
München, Germany
Silke van Koningsbruggen-Rietschel, MD, PhD
+49-221-478-4492
Silke.vanKoningsbruggen@uk-koeln.de
Meike Meyer, MD
+49-221-478-42128
Meike.Meyer@uk-koeln.de
Silke van Koningsbruggen-Rietschel, MD, PhD, Principal Investigator
CF Center, University Hospital, University of Cologne, Faculty of Medicine