Impact of immune enhancement on Covid-19 polyclonal hyperimmune globulin therapy and vaccine development Ruklanthi de Alwis,a,b Shiwei Chen,a Esther S. Gan,a and Eng Eong Ooia,b,c,d,?
While development of both hyperimmune globulin therapy and vaccine against SARS-CoV-2 are promising, they both pose a common theoretical safety concern [11].
Experimental studies have suggested the possibility of immune-enhanced disease of SARS-CoV and MERS-CoV infections, which may thus similarly occur with SARS-CoV-2 infection
Indeed, vaccines that produce low titers of neutralizing antibodies elicited more severe peritonitis and higher mortality rates in vaccinated kittens [13].
Concerns were also raised on the possibility of ADE for SARS-CoV and MERS-CoV infections [14].
Besides dengue, several other viruses have shown clinical or epidemiological evidence to support the notion of ADE. Two notable examples of vaccine-induced ADE are respiratory syncytial virus (RSV) [26], [27], [28], [29] and atypical measles [30,31], where severe disease was more prevalent following vaccination with inactivated virions.