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Sam R, Rankin L, Ulasi I, Frantzen L, Nitsch D, Henner D, Molony D, Wagner J, Chen J, Agarwal SK, Howard A, Atkinson R, Landry D, Pastan SO, Kalantar-Zadeh K. Vaccination for Patients Receiving Dialysis. Kidney Med 2024; 6:100775. [PMID: 38435066 PMCID: PMC10906410 DOI: 10.1016/j.xkme.2023.100775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Vaccinating patients receiving dialysis may prevent morbidity and mortality in this vulnerable population. The National Forum of End-Stage Renal Disease Networks (the Forum) published a revised vaccination toolkit in 2021 to update evidence and recommendations on vaccination for patients receiving dialysis. Significant changes in the last 10 years include more data supporting the use of a high-dose influenza vaccine, the introduction of the Heplisav-B vaccine for hepatitis B, and changes in pneumococcal vaccines, including the approval of the PCV15 and PCV20 to replace the PCV13 and PPSV23 vaccines. Additional key items include the introduction of vaccines against severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID-19), and a new vaccine to prevent respiratory syncytial virus disease. Historically, influenza and pneumococcal vaccinations were routinely administered by dialysis facilities, and because of possible risks of hematogenous spread of hepatitis B, dialysis providers often have detailed hepatitis B vaccine protocols. In March 2021, COVID-19 vaccines were made available for dialysis facilities to administer, although with the end of the public health emergency, vaccine policies by dialysis facilities against COVID-19 remains uncertain. The respiratory syncytial virus vaccine was authorized in 2023, and how dialysis facilities will approach this vaccine also remains uncertain. This review summarizes the Forum's vaccination toolkit and discusses the role of the dialysis facility in vaccinating patients to reduce the risk of severe infections.
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Affiliation(s)
- Ramin Sam
- Division of Nephrology, Zuckerberg San Francisco General Hospital, University of California, San Francisco
| | - Laura Rankin
- Kidney Specialists of Central Oklahoma, Oklahoma City, Oklahoma
| | - Ifeoma Ulasi
- Division of Nephrology, University of Nigeria, Enugu, Nigeria
- College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
| | - Luc Frantzen
- Service de Nephrologie, Hopital Saint Joseph, Marseilles, France
| | - Dorothea Nitsch
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Henner
- Division of Nephrology, Berkshire Medical Center, Pittsfield, Massachusetts
| | - Donald Molony
- Division of Nephrology, University of Texas McGovern Medical School, Houston, Texas
- Division of Renal Diseases and Hypertension, McGovern Medical School, University of Texas Health, Houston, Texas
| | - John Wagner
- Division of Nephrology, New York City Health + Hospitals/Kings County, Brooklyn, New York
| | - Jing Chen
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Sanjay Kumar Agarwal
- Division of Nephrology, All India Institute of Medical Sciences, New Delhi, India
- Nephrology and Renal Transplant Medicine, Marengo Asia Hospital, Gurugram and Faridabad, Haryana, India
| | - Andrew Howard
- Metropolitan Nephrology Associates PC, Clinton, Maryland
| | | | - Daniel Landry
- Division of Nephrology, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
| | - Stephen O. Pastan
- Division of Nephrology, Emory University School of Medicine, Atlanta, Georgia
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, University of California, School of Medicine, Los Angeles, California
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Senthilkumaran G, Rajarathinam VD, Govindarajan S, V. S. J, Balasubramanian CM, Devaraju PK, Murugesan V, P. S, Lamech TM, Arumugam V, Gopalakrishnan N. SARS-CoV-2 Antibody Seroprevalence and Humoral Response to Vaccination in Patients Undergoing Maintenance Hemodialysis: A Prospective Cohort Study. Indian J Nephrol 2024; 34:129-133. [PMID: 38681012 PMCID: PMC11044672 DOI: 10.4103/ijn.ijn_7_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/17/2023] [Indexed: 05/01/2024] Open
Abstract
Introduction COVID-19, caused by SARS-CoV-2, has resulted in significant mortality and morbidity worldwide. Patients of chronic kidney disease who are on maintenance hemodialysis represent a vulnerable population cohort that is susceptible to severe disease. Hence, it is of utmost importance to prioritize vaccination in this population and to assess their response to said vaccination. Methods This prospective analytical study was conducted at the Institute of Nephrology, Madras Medical College, between August 2021 and February 2022. Patients of chronic kidney disease stage 5 dialysis (CKD5D) who were on maintenance hemodialysis and who consented to receive COVID-19 vaccine were studied. Serum samples were obtained before vaccination, ≥28 days after receiving the first dose of the vaccine, and ≥28 days after receiving the second dose. Antibody titers against the spike protein were estimated using the Roche chemiluminescent immunosorbent assay. Patients were grouped into non-responders/seronegative (<0.8 U/ml) and responders/seropositive (≥0.8 U/ml), with a value ≥250 U/ml considered as robust response. Results A total of 96 patients were included. The mean age was 36.70 (±11.53) years and 77.1% of them were male. The median dialysis vintage was 2 (IQR: 0.95-5) years. Twelve patients (9.9%) had a prior COVID-19 infection. Sixty-seven (69.8%) patients had received Covaxin and 29 (30.2%) had received Covishield vaccines. Among the 17 patients who were seronegative at baseline, 4 (23.52%) became seropositive after the first dose of the vaccine, and 11 (64.7%) were seropositive after the second dose, with high titers ("robust response") achieved in two patients (11.76%). No antibody response, despite two doses of the vaccine, was noted in six patients (35.29%). Conclusion Our study showed a high baseline seropositivity rate, even prior to vaccination, which indicated a high rate of subclinical COVID infection. Among those who were seronegative at baseline, the seroconversion rate after two doses of Covaxin or Covishield was 64.70%.
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Affiliation(s)
| | | | | | - Jibia V. S.
- Institute of Nephrology, Madras Medical College, Chennai, Tamil Nadu, India
| | | | - Prem K. Devaraju
- Institute of Nephrology, Madras Medical College, Chennai, Tamil Nadu, India
| | - Vinoj Murugesan
- Institute of Nephrology, Madras Medical College, Chennai, Tamil Nadu, India
| | - Shankar P.
- Institute of Nephrology, Madras Medical College, Chennai, Tamil Nadu, India
| | - Tanuj M. Lamech
- Institute of Nephrology, Madras Medical College, Chennai, Tamil Nadu, India
| | - Venkatesh Arumugam
- Institute of Nephrology, Madras Medical College, Chennai, Tamil Nadu, India
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Di Meo A, Ma L, Yau K, Abe KT, Colwill K, Gingras AC, Kozak R, Hladunewich MA, Yip PM. Evaluation of commercial assays for the assessment of SARS-CoV-2 antibody response in hemodialysis patients. Clin Biochem 2023; 121-122:110681. [PMID: 37913837 DOI: 10.1016/j.clinbiochem.2023.110681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Hemodialysis patients exhibit variable immunogenicity following administration of the SARS-CoV-2 mRNA vaccine. The aim of the current study was to evaluate the use of two commercial assays in the assessment of SARS-CoV-2 antibody response in hemodialysis patients and to compare their utility to commonly used SARS-CoV-2 serological assays developed in Canada. METHODS We evaluated serologic antibody response in 85 hemodialysis patients up to 6 months after receiving both doses of the Pfizer-BioNTech BNT162b2 COVID-19 mRNA vaccine. In addition, antibody response was assessed in 46 chronic kidney disease patients and 40 COVID-19 naïve health care workers (HCW) up to 3 months and 9 months, respectively. Anti-spike (S) and anti-nucleocapsid (N) levels were measured using Elecsys anti-SARS-CoV-2 immunoassays on the Roche analyzer and compared to ELISA-based detection of anti-S, anti-receptor binding domain (RBD), and anti-N. RESULTS The Elecsys anti-N immunoassay showed 93 % concordance with the anti-N ELISA. The Elecsys anti-S immunoassay showed 97 % concordance with the anti-S ELISA and 89 % concordance with the anti-RBD ELISA. HCWs exhibited significantly higher anti-S levels relative to hemodialysis patients. Anti-S levels decreased significantly over a 6-month period (p < 0.001) in patients receiving maintenance hemodialysis. In addition, anti-S levels decreased significantly over a 9-month (p < 0.001) and 3-month period (p < 0.001) in HCWs and CKD patients, respectively. CONCLUSIONS There is high concordance between commercial SARS-CoV-2 serological assays and SARS-CoV-2 serological assays developed in Canada. Hemodialysis patients exhibited varying immunogenicity following two doses of the COVID-19 mRNA vaccine with anti-S levels decreasing over time.
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Affiliation(s)
- Ashley Di Meo
- Department of Clinical Biochemistry, University Health Network, Toronto, ON, Canada; Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Liyan Ma
- Precision Medicine & Therapeutics Program (Laboratory Medicine), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kevin Yau
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kento T Abe
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Karen Colwill
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Robert Kozak
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada; Precision Medicine & Therapeutics Program (Laboratory Medicine), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michelle A Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Paul M Yip
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada; Precision Medicine & Therapeutics Program (Laboratory Medicine), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Beilhack G, Monteforte R, Frommlet F, Reindl-Schwaighofer R, Strassl R, Vychytil A. Durable Anti-SARS-CoV-2 Antibody Response after mRNA-1273 Booster in Peritoneal Dialysis Patients during the Omicron Wave. Vaccines (Basel) 2023; 11:1121. [PMID: 37376510 DOI: 10.3390/vaccines11061121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Anti-SARS-CoV-2 vaccination of dialysis patients has been proven to be safe and effective to reduce COVID-19-related morbidity and mortality. However, data on the durability of anti-SARS-CoV-2 antibodies post-vaccination in peritoneal dialysis (PD) patients are scarce. In this prospective single-center cohort study we measured anti-SARS-CoV-2 RBD antibodies 3 and 6 months after the 3rd dose of the mRNA-1273 vaccine in 27 adult PD patients and recorded breakthrough infections. Furthermore, in a mixed model analysis, we analyzed potential factors influencing the humoral response following vaccination. Anti-SARS-CoV-2 RBD antibody levels declined from 21,424 BAU/mL at 1 month to 8397 BAU/mL at 3 months and to 5120 BAU/mL at 6 months after the 3rd dose, but remained higher than pre-3rd dose levels (212 BAU/mL). Eight patients (29.6%) were infected with SARS-CoV-2 within six months from the 3rd dose during the Omicron wave. Previous high antibody levels, high glomerular filtration rate (GFR) and low Davies Comorbidity Score were associated with higher anti-SARS-CoV-2 antibody levels after the booster. In conclusion, PD patients exhibited a robust and durable humoral response after a third dose of the mRNA-1273 vaccine. A high GFR and low comorbidity as well as previous high antibody levels predicted a better humoral response to vaccination.
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Affiliation(s)
- Georg Beilhack
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Rossella Monteforte
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Florian Frommlet
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, 1090 Vienna, Austria
| | - Roman Reindl-Schwaighofer
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Robert Strassl
- Division of Clinical Virology, Medical University of Vienna, 1090 Vienna, Austria
| | - Andreas Vychytil
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, 1090 Vienna, Austria
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Kawashima M, Saito H, Nishiuchi T, Yoshimura H, Wakui M, Tani Y, Nishikawa Y, Omata F, Takita M, Zhao T, Yamamoto C, Kobashi Y, Kawamura T, Sugiyama A, Nakayama A, Kaneko Y, Sawano T, Shibuya K, Kazama J, Shineha R, Tsubokura M. Antibody and T-Cell Responses against SARS-CoV-2 after Booster Vaccination in Patients on Dialysis: A Prospective Observational Study. Vaccines (Basel) 2023; 11:vaccines11020260. [PMID: 36851137 PMCID: PMC9962042 DOI: 10.3390/vaccines11020260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/13/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
Intensive vaccination is recommended for populations more vulnerable to COVID-19 infection, although data regarding the built of immunity after vaccination for dialysis patients are lacking. This prospective, observational cohort study of maintenance hemodialysis patients examined IgG antibody levels against the SARS-CoV-2 spike (S1) protein, neutralizing activity, and interferon gamma levels after the third dose of the BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine. Humoral immunity was repeatedly measured for up to two months. The study includes 58 patients on hemodialysis. Median neutralizing antibodies reached a maximum at 56 and 9 days after booster vaccination with BNT162b2 and mRNA-1273, respectively. The median IgG antibody titer reached a maximum of 3104.38 and 7209.13 AU/mL after 16 days of booster dose, and cellular immunity was positive in 61.9% and 100% of patients with BNT162b2 and mRNA-1273 vaccination, respectively. By repeating the measurements over a period of two months, we clarified the chronological aspects of the acquisition of humoral immunity in dialysis patients after a booster COVID-19 vaccination; most dialysis patients acquired not only humoral immunity, but also cellular immunity against SARS-CoV-2. Future research should investigate the continued long-term dynamics of antibody titers and cellular immunity after the third or further vaccinations, evaluating the need for additional vaccinations for hemodialysis patients.
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Affiliation(s)
- Moe Kawashima
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan
| | - Hiroaki Saito
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan
- Soma Central Hospital, Fukushima 976-0016, Japan
| | | | - Hiroki Yoshimura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan
- School of Medicine, Hiroshima University, Hiroshima 739-8511, Japan
| | - Masatoshi Wakui
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo 108-8345, Japan
| | - Yuta Tani
- Medical Governance Research Institute, Tokyo 1080074, Japan
| | - Yoshitaka Nishikawa
- Soma Central Hospital, Fukushima 976-0016, Japan
- Department of General Internal Medicine, Hirata Central Hospital, Fukushima 963-8202, Japan
| | - Fumiya Omata
- Department of General Internal Medicine, Hirata Central Hospital, Fukushima 963-8202, Japan
| | - Morihito Takita
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan
| | - Tianchen Zhao
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan
| | - Chika Yamamoto
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan
| | - Yurie Kobashi
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan
- Department of General Internal Medicine, Hirata Central Hospital, Fukushima 963-8202, Japan
| | - Takeshi Kawamura
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo 153-8904, Japan
- Isotope Science Center, The University of Tokyo, Tokyo 113-0032, Japan
| | - Akira Sugiyama
- Isotope Science Center, The University of Tokyo, Tokyo 113-0032, Japan
| | - Aya Nakayama
- Isotope Science Center, The University of Tokyo, Tokyo 113-0032, Japan
| | - Yudai Kaneko
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo 153-8904, Japan
- Medical & Biological Laboratories Co., Ltd., Tokyo 105-0012, Japan
| | - Toyoaki Sawano
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima 972-8322, Japan
| | - Kenji Shibuya
- Tokyo Foundation for Policy Research, Tokyo 106-6234, Japan
| | - Junichiro Kazama
- Department of Nephrology, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan
| | | | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan
- Correspondence: ; Tel.: +81-245471891
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Balčiuvienė V, Burčiuvienė A, Haarhaus M, Uogintaitė J, Janavičienė A, Santockienė L, Mitrikevičienė J, Aleknienė L, Keinaitė D. Waning Humoral Response 6 Month after Double Vaccination with the mRNA-BNT162b2 Vaccine in Hemodialysis Patients. Acta Med Litu 2023; 30:26-38. [PMID: 37575375 PMCID: PMC10417014 DOI: 10.15388/amed.2023.30.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/10/2022] [Accepted: 12/21/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction Although most hemodialysis patients (HDP) exhibit an initial seroresponse to vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), studies have shown this response to be lower compared to healthy subjects. This fact raised concerns regarding the durability of the immune response and effective protection against severe Coronavirus disease 2019 (COVID-19) in this vulnerable population. The aim of our study was to evaluate the change in antibody levels over time in HDP population. Materials and Methods We performed a prospective multicenter study, evaluating antibody response among HDP at 2 and at 6 months after complete two-dose vaccination course with the mRNA-BNT162b2 (Pfizer-BioNTech) vaccine. The study was performed in 14 hemodialysis units of a private dialysis provider in Lithuania. The serum samples of 189 HDP were tested for SARS-CoV-2 IgG against the Spike glycoprotein. Results 189 HDP participated in the study. Patients were 64.3±15.7 years of age, 116 (61.4%) were males and 73 (38.6%) were females. Among them, 183 (96.8%) were seropositive for anti-S IgG at 2 months after the second immunization dose. Six months after the second dose only 145 (76.7%) of study participants had positive anti-S IgG titers. The median level of anti-S IgG titers after 2 months was 383.1 BAU/mL (166.2-995.6) and after 6 months this level significantly decreased to 51.4 BAU/mL (22.0-104.0) (p<0.001). Seroresponses at both time points inversely correlated with increasing patient's age. Risk factor for absent response after 2 months included oncologic disease. Systemic autoimmune disease and a history of myocardial infarction increased risk to be seronegative 6 months after the second vaccine dose. Conclusions The majority of hemodialysis patients seroresponded after BNT162b2/Pfizer vaccination, but vaccine-induced humoral immunity wanes over time.
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Affiliation(s)
- Vilma Balčiuvienė
- Diaverum dialysis unit, Diaverum Lithuania, Josvainių 36, LT-57275 Kėdainiai, Lithuania
| | - Asta Burčiuvienė
- Diaverum dialysis unit, Diaverum Lithuania, Savanorių 68, LT-44147 Kaunas, Lithuania
| | | | | | - Asta Janavičienė
- Diaverum dialysis unit, Diaverum Lithuania, Žeimių 19, LT-55134 Jonava, Lithuania
| | - Lina Santockienė
- Diaverum dialysis unit, Diaverum Lithuania, Beržyno 27, LT-56172 Kaišiadorys, Lithuania
| | | | - Loreta Aleknienė
- Diaverum dialysis unit, Diaverum Lithuania, Savanorių 68, LT-44147 Kaunas, Lithuania
| | - Danutė Keinaitė
- Diaverum Lithuania, Mindaugo 23, LT-3214, Vilnius, Lithuania
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Zhao T, Nishi-Uchi T, Omata F, Takita M, Kawashima M, Nishikawa Y, Yamamoto C, Kobashi Y, Kawamura T, Shibuya K, Kazama J, Shineha R, Tsubokura M. Humoral response to SARS-CoV-2 vaccination in haemodialysis patients and a matched cohort. BMJ Open 2022; 12:e065741. [PMID: 36351730 PMCID: PMC9644083 DOI: 10.1136/bmjopen-2022-065741] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES SARS-CoV-2 vaccination is a crucial intervention for infection control; however, the immune response to vaccination in dialysis patients has been reported to be moderate compared with healthy adults. There are few studies available on humoral response in immunised dialysis patients compared with well-matched control group, we conducted a prospective cohort study measuring SARS-CoV-2 antibody titres in Fukushima Prefecture, Japan since September 2021. PARTICIPANTS We compared the titres of both anti-SARS-CoV-2 S1 IgG and neutralising antibodies of 65 haemodialysis patients (dialysis group) with 500 residents in Soma, Fukushima (control group). METHODS Coarsened exact matching was used to balance sex, age and days from the second dose between dialysis and control groups. RESULTS Significant differences in the titres of anti-SARS-CoV-2 S1 IgG and neutralising antibodies were observed between the dialysis and control groups; anti-SARS-CoV-2 S1 IgG: 168.35 (4.48-1074.29) AU/mL and 269.81 (4.72-945.96) AU/mL in dialysis and control groups, p=0.02, neutralising antibodies: 35.77 (2.94-826.06) AU/mL and 62.22 (0.00-535.57) AU/mL, p=0.007, respectively). CONCLUSIONS We observed significantly reduced anti-SARS-CoV-2 S1 antibody and neutralising antibodies in haemodialysis patients compared with cohorts matched for duration after vaccination. Patients receiving haemodialysis should be carefully monitored for immunological responses to the vaccination and COVID-19 infection.
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Affiliation(s)
- Tianchen Zhao
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | | | - Fumiya Omata
- Department of General Internal Medicine, Hirata Central Hospital, Fukushima, Japan
| | - Morihito Takita
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Moe Kawashima
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshitaka Nishikawa
- Soma Central Hospital, Fukushima, Japan
- Department of General Internal Medicine, Hirata Central Hospital, Fukushima, Japan
| | - Chika Yamamoto
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yurie Kobashi
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of General Internal Medicine, Hirata Central Hospital, Fukushima, Japan
| | - Takeshi Kawamura
- Proteomics Laboratory, Isotope Science Center, The University of Tokyo, Tokyo, Japan
| | | | - Junichiro Kazama
- Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine, Fukushima, Japan
| | | | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
- Soma Central Hospital, Fukushima, Japan
- Department of General Internal Medicine, Hirata Central Hospital, Fukushima, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
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8
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Babel N, Hugo C, Westhoff TH. Vaccination in patients with kidney failure: lessons from COVID-19. Nat Rev Nephrol 2022; 18:708-723. [PMID: 35999285 PMCID: PMC9397175 DOI: 10.1038/s41581-022-00617-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 02/06/2023]
Abstract
Infection is the second leading cause of death in patients with chronic kidney disease (CKD). Adequate humoral (antibody) and cellular (T cell-driven) immunity are required to minimize pathogen entry and promote pathogen clearance to enable infection control. Vaccination can generate cellular and humoral immunity against specific pathogens and is used to prevent many life-threatening infectious diseases. However, vaccination efficacy is diminished in patients with CKD. Premature ageing of the immune system and chronic systemic low-grade inflammation are the main causes of immune alteration in these patients. In the case of SARS-CoV-2 infection, COVID-19 can have considerable detrimental effects in patients with CKD, especially in those with kidney failure. COVID-19 prevention through successful vaccination is therefore paramount in this vulnerable population. Although patients receiving dialysis have seroconversion rates comparable to those of patients with normal kidney function, most kidney transplant recipients could not generate humoral immunity after two doses of the COVID-19 vaccine. Importantly, some patients who were not able to produce antibodies still had a detectable vaccine-specific T cell response, which might be sufficient to prevent severe COVID-19. Correlates of protection against SARS-CoV-2 have not been established for patients with kidney failure, but they are urgently needed to enable personalized vaccination regimens.
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Affiliation(s)
- Nina Babel
- Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany.
- Center for Translational Medicine and Immune Diagnostics Laboratory, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany.
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Center for Advanced Therapies (BeCAT) and Berlin Institute of Health, Berlin, Germany.
| | - Christian Hugo
- Medizinische Klinik und Poliklinik III, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timm H Westhoff
- Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany
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El-Menyar A, Khan NA, Mekkodathil A, Rizoli S, Consunji R, Elmenyar E, Galwankar S, Al-Thani H. A quick scoping review of the first year of vaccination against the COVID-19 pandemic: Do we need more shots or time? Medicine (Baltimore) 2022; 101:e30609. [PMID: 36123868 PMCID: PMC9477714 DOI: 10.1097/md.0000000000030609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/16/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The emergence of new severe acute respiratory syndrome coronavirus 2 variants, along with the waning of vaccine-induced immunity, has increased breakthrough infections and urged booster jabs and debates. In the short term, the administration of booster doses has been reported to be safe and enhance severe acute respiratory syndrome coronavirus 2-specific neutralizing antibody levels. However, the effects of these doses on the pandemic trajectory and herd immunity are unclear. There is insufficient evidence that a third booster shot of the coronavirus disease 2019 (COVID-19) vaccine maintains longer immunity and covers new viral variants. The lack of sufficient evidence, combined with the fact that millions of people have not yet received 1 or 2 jabs of the COVID-19 vaccine, has raised concerns regarding the call for booster vaccinations. METHODS We conducted a quick scoping review to explore the literature on the need for a booster COVID-19 vaccination from January 1, 2021, to April 30, 2022. RESULTS Sixty-one relevant publications were identified, of which 17 were related to waning immunity after 2 doses of the vaccine among the general population or healthcare workers, 19 were related to the third or booster dose of vaccination after the second dose among the general population or healthcare workers, and 25 were related to booster dose among immunocompromised patient. CONCLUSIONS Initially, the need for a booster dose was equivocal; however, several studies demonstrated the benefit of the booster dose over time. Adequate scientific information is required regarding the administration of booster doses to the general population as well as the high-risk individuals.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery, Trauma and Vascular Surgery Clinical Research, Hamad Medical Corporation, Qatar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Naushad Ahmad Khan
- Department of Surgery, Trauma and Vascular Surgery Clinical Research, Hamad Medical Corporation, Qatar
| | - Ahammed Mekkodathil
- Department of Surgery, Trauma and Vascular Surgery Clinical Research, Hamad Medical Corporation, Qatar
| | - Sandro Rizoli
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Qatar
| | - Rafael Consunji
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Qatar
| | | | - Sagar Galwankar
- Department of Emergency Medicine, Sarasota Memorial Hospital, Sarasota, FL
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Qatar
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10
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Glowinska I, Labij-Reduta B, Juzwiuk J, Lukaszewicz M, Pietruczuk A, Poplawska A, Daniluk-Jamro A, Kakareko K, Rydzewska-Rosolowska A, Naumnik B, Koc-Zorawska E, Zorawski M, Hryszko T. Factors Influencing Longevity of Humoral Response to SARS-CoV-2 Vaccination in Patients with End Stage Kidney Disease Receiving Renal Replacement Therapy. J Clin Med 2022; 11:jcm11174984. [PMID: 36078913 PMCID: PMC9457318 DOI: 10.3390/jcm11174984] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/02/2022] [Accepted: 08/23/2022] [Indexed: 01/14/2023] Open
Abstract
COVID-19 has severely affected the population of patients with end stage renal disease. Current data have proved a two-dose vaccination schedule against SARS-CoV-2 to be effective among dialyzed patients. There are limited data on the longevity and modulating factors of humoral response after vaccination. We performed a prospective longitudinal cohort study to determine longevity of the humoral response after SARS-CoV-2 vaccine. The study included 191 adult patients on hemodialysis and peritoneal dialysis. All participants had been vaccinated with three doses, either with BNT162b2 (Pfizer-BioNTech) (n = 109) or mRNA-1273 (Moderna) (n = 82). Anti-spike protein receptor-binding domain antibodies (anti-S IgG) were assessed using SARS-CoV-2 (RBD) IgG ELISA EIA-6150 IVD assay at baseline, on the 21st day and 43rd day, before a booster dose and two weeks thereafter. We found that before vaccination, 37.7% of the cohort had anti-S IgG titres concordant with seroconversion. After two-dose vaccination, seroconversion occurred in 97% of patients. The booster dose evoked a ~12-fold increase in antibody level. Obesity increased more than two-fold the odds for a decrease in anti-S IgG. Previous COVID-19 infection enhanced longevity of the humoral response following vaccination. In patients with previous COVID-19 infection, the BNT162b2 vaccine was associated with a higher odds of anti-S IgG waning compared to the mRNA-1273 vaccine. In conclusion, we report that obesity predisposes patients to protective antibody waning, hybrid immunity enhances odds for higher anti-S IgG concentrations and vaccine efficacy may be influenced by previous SARS-CoV-2 infection. The results might provide a rationale for vaccination protocol design.
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Affiliation(s)
- Irena Glowinska
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, ul. M. Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland
- Correspondence:
| | - Barbara Labij-Reduta
- 1st Department of Nephrology and Transplantation with Dialysis Unit, Medical University of Bialystok, ul. Zurawia 14, 15-540 Bialystok, Poland
| | - Jerzy Juzwiuk
- Dialysis Unit, SPZOZ in Hajnowka, ul. A. Dowgirda 9, 17-200 Hajnowka, Poland
| | - Magdalena Lukaszewicz
- Nephrology and Dialysis Unit, Regional Specialist Hospital in Suwalki, ul. Szpitalna 60, 16-400 Suwalki, Poland
| | - Adam Pietruczuk
- Dialysis Unit, SPZOZ in Sokolka, ul. W. Sikorskiego 40, 16-100 Sokolka, Poland
| | - Agata Poplawska
- Nephrology and Dialysis Unit, Regional Specialist Hospital in Lomza, Al. J. Piłsudskiego 11, 18-404 Lomza, Poland
| | | | - Katarzyna Kakareko
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, ul. M. Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland
| | - Alicja Rydzewska-Rosolowska
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, ul. M. Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland
| | - Beata Naumnik
- 1st Department of Nephrology and Transplantation with Dialysis Unit, Medical University of Bialystok, ul. Zurawia 14, 15-540 Bialystok, Poland
| | - Ewa Koc-Zorawska
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, ul. M. Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland
| | - Marcin Zorawski
- Department of Clinical Medicine, Medical University of Bialystok, 15-254 Bialystok, Poland
| | - Tomasz Hryszko
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, ul. M. Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland
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11
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Yoshifuji A, Toda M, Ryuzaki M, Kikuchi K, Kawai T, Sakai K, Oyama E, Koinuma M, Katayama K, Uehara Y, Ohmagari N, Kanno Y, Kon H, Shinoda T, Takano Y, Tanaka J, Hora K, Nakazawa Y, Hasegawa N, Hanafusa N, Hinoshita F, Morikane K, Wakino S, Nakamoto H, Takemoto Y. Investigation for the efficacy of COVID-19 vaccine in Japanese CKD patients treated with hemodialysis. RENAL REPLACEMENT THERAPY 2022; 8:39. [PMID: 35999867 PMCID: PMC9388964 DOI: 10.1186/s41100-022-00427-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/02/2022] [Indexed: 11/12/2022] Open
Abstract
Background Dialysis patients are predisposed to severe disease and have a high mortality rate in coronavirus disease 2019 (COVID-19) due to their comorbidities and immunocompromised conditions. Therefore, dialysis patients should be prioritized for vaccination. This study aimed to examine how long the effects of the vaccine are maintained and what factors affect antibody titers. Methods Hemodialysis patients (HD group) and age- and sex-matched non-dialysis individuals (Control group), receiving two doses of BNT162b2 vaccine, were recruited through the Japanese Society for Dialysis Therapy (JSDT) Web site in July 2021. Anti-SARS-CoV-2 immunoglobulin (IgG) (SARS-CoV-2 IgG titers) was measured before vaccination, 3 weeks after the first vaccination, 2 weeks after the second vaccination, and 3 months after the second vaccination, and was compared between Control group and HD group. Factors affecting SARS-CoV-2 IgG titers were also examined using multivariable regression analysis and stepwise regression analysis (least AIC). In addition, we compared adverse reactions in Control and HD groups and examined the relationship between adverse reactions and SARS-CoV-2 IgG titers. Results Our study enrolled 123 participants in the Control group (62.6% men, median age 67.0 years) and 206 patients in the HD group (64.1% men, median age 66.4 years). HD group had significantly lower SARS-CoV-2 IgG titers at 3 weeks after the first vaccination (p < 0.0001), 2 weeks after second vaccination (p = 0.0002), and 3 months after the second vaccination (p = 0.045) than Control group. However, the reduction rate of SARS-CoV-2 IgG titers between 2 weeks and 3 months after the second vaccination was significantly smaller in HD group than in Control (p = 0.048). Stepwise regression analysis revealed that dialysis time was identified as the significant independent factors for SARS-CoV-2 IgG titers at 2 weeks after the second vaccination in HD group (p = 0.002) and longer dialysis time resulted in higher maximum antibody titers. The incidences of fever and nausea after the second vaccination were significantly higher in the HD group (p = 0.039 and p = 0.020). Antibody titers in those with fever were significantly higher than those without fever in both groups (HD: p = 0.0383, Control: p = 0.0096). Conclusion HD patients had significantly lower antibody titers than age- and sex-matched non-dialysis individuals over 3 months after vaccination. Dialysis time was identified as a factor affecting SARS-CoV-2 IgG titers in HD group, with longer dialysis time resulting in higher maximum SARS-CoV-2 IgG titers.
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12
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Ponce P, Peralta R, Felix C, Pinto C, Pinto B, Matos JF. Vaccination against SARS-CoV-2 in Haemodialysis Patients: Spike's Ab Response and the Influence of BMI and Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10091. [PMID: 36011725 PMCID: PMC9408116 DOI: 10.3390/ijerph191610091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/07/2022] [Accepted: 08/12/2022] [Indexed: 05/12/2023]
Abstract
Patients with chronic kidney disease (CKD-5D) in dialysis have been associated with higher rates of SARS-CoV-2 infection. Objective: To identify the CKD-5D patients’ immune system behavior regarding the Pfizer-BioNTech (BNT162b2 mRNA) vaccine (Comirnaty©). This was a multicenter study carried out in 38 dialysis units in NephroCare Portugal. Eligible patients from two cohorts—one composed of completely vaccinated patients with Comirnaty© (vaccinated group) against a second cohort of patients who recovered from SARS-CoV-2 infection (control group)—were selected through representative sampling for each cohort. Humoral response was assessed at 3 (t0) and 6 months (t1) after complete vaccination and, in the control group, 6 months after COVID-19 recovery. In the vaccinated group, at t0, the median anti-Spike IgG level was 1120 AU/mL and, at t1, all participants’ antibody level decreased to a median of 455 AU/mL. In the control group, the median serum SARS-CoV-2 antibodies level was 1836 AU/mL. In the vaccinated group, at t0, patients < 70 years presented a significantly (p = 0.002) higher level of anti-Spike IgG titres. In contrast, older patients from the control group presented a significantly (p = 0.038) higher IgG. No correlation was found between age and anti-Spike IgG antibodies level in any of the studied groups. Patients with a higher body mass index showed a greater immune response in both the vaccinated and control group, although without significance. We concluded that, in the vaccinated group, elderly patients developed a lower immune response than younger patients and the levels of anti-Spike IgG antibodies declined faster between t0 and t1, while in the control group, the oldest and overweight patients developed the best humoral response.
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Affiliation(s)
- Pedro Ponce
- Country Medical, NephroCare Portugal, Fresenius Medical Care Portugal, 1750-233 Lisboa, Portugal
| | - Ricardo Peralta
- Direção de Enfermagem, NephroCare Portugal, Fresenius Medical Care Portugal, 4470-573 Porto, Portugal
| | - Carla Felix
- Direção de Enfermagem, NephroCare Portugal, Fresenius Medical Care Portugal, 4470-573 Porto, Portugal
| | - Carla Pinto
- Country Medical, NephroCare Portugal, Fresenius Medical Care Portugal, 1750-233 Lisboa, Portugal
| | - Bruno Pinto
- Direção de Enfermagem, NephroCare Portugal, Fresenius Medical Care Portugal, 4470-573 Porto, Portugal
| | - João Fazendeiro Matos
- Direção de Enfermagem, NephroCare Portugal, Fresenius Medical Care Portugal, 4470-573 Porto, Portugal
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13
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Gallego-Valcarce E, Shabaka A, Leon-Poo M, Gruss E, Acedo-Sanz JM, Cordón A, Cases-Corona C, Fernandez-Juarez G. Humoral Response Following Triple Dose of mRNA Vaccines Against SARS-CoV-2 in Hemodialysis Patients: Results After 1 Year of Follow-Up. Front Med (Lausanne) 2022; 9:927546. [PMID: 35903310 PMCID: PMC9314744 DOI: 10.3389/fmed.2022.927546] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/21/2022] [Indexed: 12/11/2022] Open
Abstract
Introduction COVID-19 is associated with an increased mortality in hemodialysis patients. Therefore, achieving a long-lasting effective immune response to SARS-CoV-2 vaccines is essential. This study describes the humoral immune response in hemodialysis patients following three doses of mRNA vaccines against SARS-CoV-2, and explores the factors associated with a sustained immune response. Materials and Methods We analyzed the monthly serological evolution of SARS-CoV-2 anti-S(RBD) antibodies for 1 year in 178 chronic hemodialysis patients who received three doses of SARS-CoV-2 mRNA vaccines. The primary outcome was sustained effective humoral response defined as anti-S(RBD) levels > 1,000 AU/ml after 4 months from the third dose. Multivariate logistic regression analyses were used to identify features associated with a sustained humoral immune response. Results After the initial two SARS-CoV-2 mRNA vaccine doses, 77.8% of patients showed an immediate effective humoral response, decreasing to 52.5% after 4 months. Antibody levels were significantly higher in COVID-exposed patients and HBV vaccine responders. After the third dose, 97% of patients showed an effective humoral response, and remained in 91.7% after 4 months. The mean monthly rate of antibody titer decline decreased from 33 ± 14.5 to 25 ± 16.7%. Multivariate regression analysis showed that previous exposure to COVID-19 and response to HBV vaccines were associated with an effective sustained humoral immune response. Conclusion Immunization with SARS-CoV-2 mRNA vaccines elicits an effective immediate humoral immune response in hemodialysis patients, with a progressive waning in antibody levels. A third booster dose enhances the immune response with significantly higher antibody levels and more sustained humoral immune response. COVID-naïve patients and patients without previous response to HBV vaccines are likely to benefit from receiving more booster doses to maintain an effective immune response.
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Affiliation(s)
| | - Amir Shabaka
- Department of Nephrology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Mariana Leon-Poo
- Department of Nephrology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Enrique Gruss
- Department of Nephrology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Juan Manuel Acedo-Sanz
- Department of Clinical Analysis, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Alfredo Cordón
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo, Móstoles, Spain
| | - Clara Cases-Corona
- Department of Nephrology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Gema Fernandez-Juarez
- Department of Nephrology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
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14
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Notarte KI, Guerrero‐Arguero I, Velasco JV, Ver AT, Santos de Oliveira MH, Catahay JA, Khan MSR, Pastrana A, Juszczyk G, Torrelles JB, Lippi G, Martinez‐Sobrido L, Henry BM. Characterization of the significant decline in humoral immune response six months post-SARS-CoV-2 mRNA vaccination: A systematic review. J Med Virol 2022; 94:2939-2961. [PMID: 35229324 PMCID: PMC9088566 DOI: 10.1002/jmv.27688] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/16/2022] [Accepted: 02/27/2022] [Indexed: 11/11/2022]
Abstract
Accumulating evidence shows a progressive decline in the efficacy of coronavirus disease 2019 (COVID-19) (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) messenger RNA (mRNA) vaccines such as Pfizer-BioNTech (mRNA BNT161b2) and Moderna (mRNA-1273) in preventing breakthrough infections due to diminishing humoral immunity over time. Thus, this review characterizes the kinetics of anti-SARS-CoV-2 antibodies after the second dose of a primary cycle of COVID-19 mRNA vaccination. A systematic search of the literature was performed and a total of 18 articles (N = 15 980 participants) were identified and reviewed. The percent difference of means of reported antibody titers was then calculated to determine the decline in humoral response after the peak levels postvaccination. Findings revealed that the peak humoral response was reached at 21-28 days after the second dose, after which serum levels progressively diminished at 4-6-month postvaccination. Additionally, results showed that regardless of age, sex, serostatus, and presence of comorbidities, longitudinal data reporting antibody measurement exhibited a decline of both anti-receptor binding domain immunoglobulin G (IgG) and anti-spike IgG, ranging from 94% to 95% at 90-180 days and 55%-85% at 140-160 days, respectively, after the peak antibody response. This suggests that the rate of antibody decline may be independent of patient-related factors and peak antibody titers but mainly a function of time and antibody class/molecular target. Hence, this study highlights the necessity of more efficient vaccination strategies to provide booster administration in attenuating the effects of waning immunity, especially in the appearance of new variants of concerns.
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Affiliation(s)
- Kin Israel Notarte
- Faculty of Medicine and SurgeryUniversity of Santo TomasManilaPhilippines
| | - Israel Guerrero‐Arguero
- Disease Intervention & Prevention and Population Health ProgramsTexas Biomedical Research InstituteSan AntonioTexasUSA
| | | | | | | | | | - Md. Siddiqur Rahman Khan
- Disease Intervention & Prevention and Population Health ProgramsTexas Biomedical Research InstituteSan AntonioTexasUSA
| | - Adriel Pastrana
- Faculty of Medicine and SurgeryUniversity of Santo TomasManilaPhilippines
| | | | - Jordi B. Torrelles
- Disease Intervention & Prevention and Population Health ProgramsTexas Biomedical Research InstituteSan AntonioTexasUSA
| | - Giuseppe Lippi
- Section of Clinical BiochemistryUniversity of VeronaVeronaItaly
| | - Luis Martinez‐Sobrido
- Disease Intervention & Prevention and Population Health ProgramsTexas Biomedical Research InstituteSan AntonioTexasUSA
| | - Brandon Michael Henry
- Disease Intervention & Prevention and Population Health ProgramsTexas Biomedical Research InstituteSan AntonioTexasUSA
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15
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Boongird S, Setthaudom C, Kitpermkiat R, Prasongtanakij S, Srisala S, Chuengsaman P, Nongnuch A, Assanatham M, Kiertiburanakul S, Malathum K, Phuphuakrat A, Bruminhent J. Durability of Humoral and Cellular Immunity after an Extended Primary Series with Heterologous Inactivated SARS-CoV-2 Prime-Boost and ChAdOx1 nCoV-19 in Dialysis Patients (ICON3). Vaccines (Basel) 2022; 10:vaccines10071064. [PMID: 35891228 PMCID: PMC9323398 DOI: 10.3390/vaccines10071064] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/14/2022] [Accepted: 06/18/2022] [Indexed: 01/03/2023] Open
Abstract
The durability of a three-dose extended primary series of COVID-19 vaccine in dialysis patients remains unknown. Here, we assessed dynamic changes in SARS-CoV-2-specific humoral and cell-mediated immunity at baseline, 3 months, and 6 months after the extended primary series in 29 hemodialyzed (HD), 28 peritoneal dialyzed (PD) patients, and 14 healthy controls. Participants received two doses of inactivated SARS-CoV-2 vaccine followed by a dose of ChAdOx1 nCoV-19 vaccine. At 6 months, median anti-RBD IgG titers (IQR) significantly declined from baseline in the HD (1741 (1136−3083) BAU/mL vs. 373 (188−607) BAU/mL) and PD (1093 (617−1911) BAU/mL vs. 180 (126−320) BAU/mL) groups, as did the mean percent inhibition of neutralizing antibodies (HD: 96% vs. 81%; PD: 95% vs. 73%) (all p < 0.01). Age and post-vaccination serological response intensity were predictors of early humoral seroprotection loss. In contrast, cell-mediated immunity remained unchanged. In conclusion, humoral immunity declined substantially in dialysis patients, while cell-mediated immunity remained stable 6 months after the extended heterologous primary series of two inactivated SARS-CoV-2/ChAdOx1 nCoV-19 vaccine. A booster dose could be considered in dialysis patients 3 months after this unique regimen, particularly in the elderly or those with a modest initial humoral response.
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Affiliation(s)
- Sarinya Boongird
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (S.B.); (R.K.); (A.N.); (M.A.)
| | - Chavachol Setthaudom
- Immunology Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Rungthiwa Kitpermkiat
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (S.B.); (R.K.); (A.N.); (M.A.)
| | - Somsak Prasongtanakij
- Office of Research, Academic Affairs and Innovation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (S.P.); (S.S.)
| | - Supanart Srisala
- Office of Research, Academic Affairs and Innovation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (S.P.); (S.S.)
| | - Piyatida Chuengsaman
- Banphaeo-Charoenkrung Peritoneal Dialysis Center, Banphaeo Dialysis Group, Banphaeo Hospital, Bangkok 10120, Thailand;
| | - Arkom Nongnuch
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (S.B.); (R.K.); (A.N.); (M.A.)
| | - Montira Assanatham
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (S.B.); (R.K.); (A.N.); (M.A.)
| | - Sasisopin Kiertiburanakul
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (S.K.); (K.M.); (A.P.)
| | - Kumthorn Malathum
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (S.K.); (K.M.); (A.P.)
| | - Angsana Phuphuakrat
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (S.K.); (K.M.); (A.P.)
| | - Jackrapong Bruminhent
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (S.K.); (K.M.); (A.P.)
- Correspondence: ; Tel.: +66-2201-1581
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16
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Beilhack G, Monteforte R, Frommlet F, Reindl-Schwaighofer R, Strassl R, Vychytil A. Humoral Response to mRNA-1273 SARS-CoV-2 Vaccine in Peritoneal Dialysis Patients: Is Boostering After Six Months Adequate? Front Med (Lausanne) 2022; 9:905798. [PMID: 35814775 PMCID: PMC9263093 DOI: 10.3389/fmed.2022.905798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/23/2022] [Indexed: 12/28/2022] Open
Abstract
In dialysis patients the humoral response to anti-SARS-CoV-2 vaccines is attenuated and rapidly declines over time. However, data on the persistence of the immune response in peritoneal dialysis (PD) patients are scarce, particularly after a third (booster) dose with mRNA-1273 vaccine. In this prospective cohort study, we report anti-SARS-CoV-2 antibody levels in PD patients before and after the third dose of mRNA-1273 vaccine. Six months after the second dose, anti-SARS-CoV-2 antibodies were detected in all patients (n = 34). However, within this time period antibodies substantially declined in 31 of 34 patients (4.5-fold, median = 192 BAU/mL, p = 1.27 × 10–9) and increased in three patients. In accordance with government regulations, a third dose of mRNA-1273 vaccine (50 μg) was given to 27 PD patients 6 months after the second dose which induced a significant increase of anti-SARS-CoV-2 antibody titers (58.6-fold, median = 19405 BAU/mL, p = 1.24 × 10–29). A mixed model analysis showed that a lower Davies Comorbidity Score and a higher GFR were associated with higher antibody titers (p = 0.03 and p = 0.02). The most common adverse events after the third dose were pain at the injection site (77.8%) and fatigue (51.9%). No hospitalizations were reported. In conclusion, 6 months after the second dose of mRNA-1273 vaccine, anti-SARS-CoV-2 antibodies substantially decreased in PD patients, whereas a well-tolerated third dose induced a robust humoral response. Our data suggest that the administration of a booster dose within a shorter interval than 6 months should be considered in PD patients in order to maintain high anti-SARS-CoV-2 antibody levels and assure protection from severe COVID-19 disease.
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Affiliation(s)
- Georg Beilhack
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Rossella Monteforte
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Florian Frommlet
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Roman Reindl-Schwaighofer
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Robert Strassl
- Division of Clinical Virology, Medical University of Vienna, Vienna, Austria
| | - Andreas Vychytil
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- *Correspondence: Andreas Vychytil,
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17
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Davidovic T, Schimpf J, Abbassi-Nik A, Stockinger R, Sprenger-Mähr H, Lhotta K, Zitt E. Humoral and Cellular Immune Response After a 3-Dose Heterologous SARS-CoV-2 Vaccination Using the mRNA-BNT162b2 and Viral Vector Ad26COVS1 Vaccine in Hemodialysis Patients. Front Immunol 2022; 13:907615. [PMID: 35812459 PMCID: PMC9261096 DOI: 10.3389/fimmu.2022.907615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/30/2022] [Indexed: 12/01/2022] Open
Abstract
Background Due to the waning humoral response after a two-dose SARS-CoV-2 mRNA vaccination, a third booster was recommended in hemodialyis patients. Data on a heterologous mRNA-vector regimen, which might improve immunogenicity, are very limited. Methods In this observational study 36 chronic hemodialysis patients (mean (SD) age 66.9 (15.9) years, 33.3% females) were followed up for 13 months. All patients were vaccinated twice using the mRNA-BNT162b2 vaccine, followed by a 3rd dose of the vector vaccine Ad26COVS1 eight months later. We assessed the humoral response by quantifying the anti-SARS-CoV-2 spike IgG antibody and neutralizing antibody concentrations. The cellular immune response was evaluated via SARS-CoV-2 spike protein-specific interferon-γ release assay. Results The seroconversion rate was 47.2%, 100%, 69.4% and 100% one month after the 1st dose, one and six months after the 2nd dose and four months after the heterologous 3rd dose. The median (Q1, Q3) anti-SARS-CoV-2 spike IgG concentrations at the same time were 28.7 (13.2, 69.4) BAU/ml, 1130.0 (594.5, 1735.0) BAU/ml, 89.7 (26.4, 203.8) BAU/ml, and 2080.0 (1062.5, 2080.0) BAU/ml. The percentage of patients with neutralizing antibodies was 58.3% after the 2nd dose and improved to 100% after the 3rd dose (P <0.001). A positive T-cell response was found in 50% of patients after the 3rd dose. Conclusions A third heterologous booster dose helped to sustain humoral immunity in almost all hemodialysis patients and induced a significant T-cellular response in half of them. Stimulating the immune response against SARS-CoV-2 by two different vaccine platforms seems to be a promising approach.
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Affiliation(s)
- Tamara Davidovic
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Judith Schimpf
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Armin Abbassi-Nik
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Richard Stockinger
- Institute of Pathology, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Hannelore Sprenger-Mähr
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Karl Lhotta
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Emanuel Zitt
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
- *Correspondence: Emanuel Zitt,
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Haase M, Lesny P, Anderson M, Cloherty G, Stec M, Haase-Fielitz A, Haarhaus M, Santos-Araújo C, Veiga PM, Macario F. Humoral immunogenicity and tolerability of heterologous ChAd/BNT compared with homologous BNT/BNT and ChAd/ChAd SARS-CoV-2 vaccination in hemodialysis patients : A multicenter prospective observational study. J Nephrol 2022; 35:1467-1478. [PMID: 35084719 PMCID: PMC8792133 DOI: 10.1007/s40620-022-01247-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/01/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND After the reports of severe adverse reactions to the AstraZeneca ChAdOx1-S-nCoV-19 vaccine, patients who had received one dose of ChAdOx1-S-nCoV-19 vaccine were recommended a second dose of Pfizer's BNT162b2 vaccine. In hemodialysis patients, we compared the humoral immunogenicity and tolerability of homologous vaccination with ChAdOx1-nCoV-19/ChAdOx1-nCoV-19 (ChAd/ChAd) and BNT162b2/BNT162b2 (BNT/BNT) with heterologous vaccination of first dose of ChAdOx1-nCoV-19 and a second dose with BNT162b2 (ChAd/BNT). METHODS In a multicenter prospective observational study, SARS-CoV-2 spike-IgG antibody levels, Nucleocapsid-protein-IgG-antibodies, and vaccine tolerability were assessed 6 weeks after second SARS-CoV-2 vaccination in 137 hemodialysis patients and 24 immunocompetent medical personnel. RESULTS In COVID-19-naïve hemodialysis patients, significantly higher median SARS-CoV-2-spike IgG levels were found after ChAd/BNT (N = 16) compared to BNT/BNT (N = 100) or ChAd/ChAd (N = 10) (1744 [25th-75th percentile 276-2840] BAU/mL versus 361 [25th-75th percentile 120-936] BAU/mL; p = 0.009; 1744 [25th-75th percentile 276-2840] BAU/mL versus 100 [25th-75th percentile 41-346] BAU/mL; p = 0.017, respectively). Vaccinated, COVID-19-naïve medical personnel had median SARS-CoV-2 spike-IgG levels of 650 (25th-75th percentile 217-1402) BAU/mL and vaccinated hemodialysis patients with prior COVID-19 7047 (25th-75th percentile 685-10,794) BAU/mL (N = 11). In multivariable regression analysis, heterologous vaccination (ChAd/BNT) of COVID-19-naïve hemodialysis patients was independently associated with SARS-CoV-2 spike-IgG levels. The first dose of ChAd and the second dose of BNT after the first vaccination with ChAd (heterologous vaccination, ChAd/BNT) were associated with more frequent but manageable side effects compared with homologous BNT. CONCLUSIONS Within the limitations of this study, heterologous vaccination with ChAd/BNT appears to induce stronger humoral immunity and more frequent but manageable side effects than homologous vaccination with BNT/BNT or with ChAd/ChAd in COVID-19-naïve hemodialysis patients.
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Affiliation(s)
- Michael Haase
- Diaverum Renal Care Center, Potsdam, Germany.
- Diaverum AB, Hyllie Boulevard 39, 215 37, Malmö, Sweden.
- Medical Faculty, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Paul Lesny
- Diaverum Renal Care Center, Potsdam, Germany
| | - Mark Anderson
- Abbott Infectious Disease Research, Chicago, IL, 60064-3500, USA
| | - Gavin Cloherty
- Abbott Infectious Disease Research, Chicago, IL, 60064-3500, USA
| | - Michael Stec
- Abbott Infectious Disease Research, Chicago, IL, 60064-3500, USA
| | - Anja Haase-Fielitz
- Brandenburg Medical School Theodor Fontane, 16816, Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, 14469, Potsdam, Germany
- Institute of Integrated Health Care Systems Research & Social Medicine, Otto-Von-Guericke-University Magdeburg, 39120, Magdeburg, Germany
- Department of Cardiology, Brandenburg Heart Center, Immanuel Hospital, 16321, Bernau, Germany
| | - Mathias Haarhaus
- Diaverum AB, Hyllie Boulevard 39, 215 37, Malmö, Sweden
- Division of Renal Medicine, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Carla Santos-Araújo
- Institute of Integrated Health Care Systems Research & Social Medicine, Otto-Von-Guericke-University Magdeburg, 39120, Magdeburg, Germany
- Division of Renal Medicine, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Pedro Mota Veiga
- School of Education, Polytechnic Institute of Viseu, Viseu, Portugal
- NECE Research Unit in Business Sciences, University of Beira Interior, Covilhã, Portugal
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Füessl L, Lau T, Rau S, Regenauer R, Paal M, Hasmann S, Arend FM, Bruegel M, Teupser D, Fischereder M, Schönermarck U. Humoral response after SARS-CoV-2 booster vaccination in hemodialysis patients with and without prior infection. Clin Kidney J 2022; 15:1633-1635. [PMID: 35892016 PMCID: PMC9308091 DOI: 10.1093/ckj/sfac148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Louise Füessl
- Department of Medicine IV, University Hospital, LMU Munich, Germany
| | - Tobias Lau
- Dialysezentrum Bad Tölz und Wolfratshausen, Germany
| | - Simon Rau
- Dialysezentrum Bad Tölz und Wolfratshausen, Germany
| | - Ron Regenauer
- Department of Medicine IV, University Hospital, LMU Munich, Germany
| | - Michael Paal
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Germany
| | - Sandra Hasmann
- Department of Medicine IV, University Hospital, LMU Munich, Germany
| | - Florian M Arend
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Germany
| | - Mathias Bruegel
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Germany
| | - Daniel Teupser
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Germany
| | | | - Ulf Schönermarck
- Department of Medicine IV, University Hospital, LMU Munich, Germany
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20
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Evaluation of the correlation between responders and non-responders to the second coronavirus disease vaccination in kidney transplant recipients: A retrospective single-center cohort study. Transplant Proc 2022; 54:1483-1488. [PMID: 35868872 PMCID: PMC9151524 DOI: 10.1016/j.transproceed.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/04/2022] [Indexed: 11/22/2022]
Abstract
Background The immune response to COVID-19 vaccination in kidney transplant (KTx) recipients is significantly lower than that in healthy controls. We evaluated immune responses after the COVID-19 vaccine and their possible relationship with other cofactors in KTx recipients. Methods This retrospective single-center cohort study included 29 KTx recipients 2-8 weeks after receiving 2 doses of the Pfizer-BioNTech SARS-CoV-2 messenger RNA vaccine. Anti-SARS-CoV-2 spike (S) immunoglobulin (Ig)-G levels were evaluated to define cofactors influencing the immune response between the responder (anti-SARS-CoV-2 IgG level ≥0.8 U/mL) (n = 16) and nonresponder groups (anti-SARS-CoV-2 IgG level <0.8 U/mL) (n = 13). The kinetics of antibodies between 2 and 6 months after the second vaccination was also compared between the groups. Results KTx recipients with IgG levels ≥0.8 U/mL were younger (54 [interquartile range {IQR}, 46.5-61] years vs 65 [IQR, 55-71.5] years; P = .01), had been transplanted for a longer median time (1588 [IQR, 1382-4751] days vs 1034 [IQR, 548.5-1833] days; P = .02), and were more often treated with a lower mycophenolate mofetil dosage (765.6 ± 119.6 vs 1077 ± 76.9 mg; P = .04) than KTx recipients with IgG levels <0.8 U/mL. There was no significant difference in antibody titers between time periods after the second dose in the responder group. At the 6-month follow-up, a serologic response against the SARS-CoV-2 S was observed in 44.4% of KTx recipients in the nonresponder group. Conclusions More than 50% of KTx recipients developed a higher antibody response after the second dose of COVID-19 vaccination.
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21
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El Karoui K, De Vriese AS. COVID-19 in dialysis: clinical impact, immune response, prevention, and treatment. Kidney Int 2022; 101:883-894. [PMID: 35176326 PMCID: PMC8842412 DOI: 10.1016/j.kint.2022.01.022] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/01/2022] [Accepted: 01/20/2022] [Indexed: 01/07/2023]
Abstract
The COVID-19 pandemic has profound adverse effects on the population on dialysis. Patients requiring dialysis are at an increased risk of SARS-CoV-2 infection and mortality, and many have experienced psychological distress as well as delayed or suboptimal care. COVID-19 survivors have prolonged viral shedding, but generally develop a robust and long-lasting humoral immune response that correlates with initial disease severity. However, protection against reinfection is incomplete. A growing body of evidence reveals delayed and blunted immune responses to SARS-CoV-2 vaccination. Administration of a third dose within 1 to 2 months of prime-boost vaccination significantly increases antibody levels, in particular in patients with poor initial responses. Patients on dialysis have inferior immune responses to adenoviral vector vaccines than to mRNA vaccines. The immunogenicity of the mRNA-1273 vaccine is markedly better than that of the BNT162b2 vaccine, most likely by virtue of its higher mRNA content. Despite suboptimal immune responses in patients on dialysis, preliminary data suggest that vaccination partially protects against infection and severe disease requiring hospitalization. However, progressive waning of immunity and emergence of SARS-CoV-2 variants with a high potential of immune escape call for a booster dose in all patients on dialysis 4 to 6 months after prime-boost vaccination. Patients with persistent poor vaccine responses may be candidates for primary prophylaxis strategies. In the absence of specific data in patients on dialysis, therapeutic strategies in the event of established COVID-19 must be extrapolated from evidence obtained in the population not on dialysis. Neutralizing monoclonal antibodies may be an attractive option after a high-risk exposure or during the early course of infection.
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Affiliation(s)
- Khalil El Karoui
- Department of Nephrology and Transplantation, Hôpitaux Universitaires Henri Mondor, Fédération Hospitalo-Universitaire TRUE, Université Paris Est, Créteil, France
| | - An S De Vriese
- Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium.
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22
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Füessl L, Lau T, Lean I, Hasmann S, Riedl B, Arend FM, Sorodoc-Otto J, Soreth-Rieke D, Toepfer M, Rau S, Salihi-Halimi H, Paal M, Beuthien W, Thaller N, Suttmann Y, von Gersdorff G, Regenauer R, von Bergwelt-Baildon A, Teupser D, Bruegel M, Fischereder M, Schönermarck U. Diminished Short- and Long-Term Antibody Response after SARS-CoV-2 Vaccination in Hemodialysis Patients. Vaccines (Basel) 2022; 10:vaccines10040605. [PMID: 35455353 PMCID: PMC9031197 DOI: 10.3390/vaccines10040605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/04/2022] [Accepted: 04/12/2022] [Indexed: 12/19/2022] Open
Abstract
Short-term studies have shown an attenuated immune response in hemodialysis patients after COVID-19-vaccination. The present study examines how antibody response is maintained after vaccination against SARS-CoV-2 in a large population of hemodialysis patients from six outpatient dialysis centers. We retrospectively assessed serum antibody levels against SARS-CoV-2 spike protein and nucleocapsid protein (electrochemiluminescence immunoassays, Roche Diagnostics) after COVID-19-vaccination in 298 hemodialysis and 103 non-dialysis patients (controls), comparing early and late antibody response. Compared to a non-dialysis cohort hemodialysis patients showed a favorable but profoundly lower early antibody response, which decreased substantially during follow-up measurement (median 6 months after vaccination). Significantly more hemodialysis patients had anti-SARS-CoV-2-S antibody titers below 100 U/mL (p < 0.001), which increased during follow-up from 23% to 45% but remained low in the control group (3% vs. 7%). In multivariate analysis, previous COVID-19 infections (p < 0.001) and female gender (p < 0.05) were significantly associated with higher early as well as late antibody vaccine response in hemodialysis patients, while there was a significant inverse correlation between patient age and systemic immunosuppression (p < 0.001). The early and late antibody responses were significantly higher in patients receiving vaccination after a SARS-CoV-2 infection compared to uninfected patients in both groups (p < 0.05). We also note that a higher titer after complete immunization positively affected late antibody response. The observation, that hemodialysis patients showed a significantly stronger decline of SARS-CoV-2 vaccination antibody titers within 6 months, compared to controls, supports the need for booster vaccinations to foster a stronger and more persistent antibody response.
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Affiliation(s)
- Louise Füessl
- Department of Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (L.F.); (I.L.); (S.H.); (R.R.); (A.v.B.-B.); (M.F.)
| | - Tobias Lau
- Dialysezentrum Bad Tölz und Wolfratshausen, 83646 Bad Tölz, Germany; (T.L.); (S.R.)
| | - Isaac Lean
- Department of Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (L.F.); (I.L.); (S.H.); (R.R.); (A.v.B.-B.); (M.F.)
| | - Sandra Hasmann
- Department of Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (L.F.); (I.L.); (S.H.); (R.R.); (A.v.B.-B.); (M.F.)
| | - Bernhard Riedl
- KfH-Nierenzentrum Bayreuth, 95445 Bayreuth, Germany; (B.R.); (H.S.-H.)
| | - Florian M. Arend
- Institute of Laboratory Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.M.A.); (M.P.); (D.T.); (M.B.)
| | - Johanna Sorodoc-Otto
- KfH-Nierenzentrum Germering, 82110 Germering, Germany; (J.S.-O.); (W.B.); (Y.S.)
| | | | - Marcell Toepfer
- Dialysezentrum Garmisch-Partenkirchen-Murnau-Weilheim, 82418 Murnau, Germany;
| | - Simon Rau
- Dialysezentrum Bad Tölz und Wolfratshausen, 83646 Bad Tölz, Germany; (T.L.); (S.R.)
| | | | - Michael Paal
- Institute of Laboratory Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.M.A.); (M.P.); (D.T.); (M.B.)
| | - Wilke Beuthien
- KfH-Nierenzentrum Germering, 82110 Germering, Germany; (J.S.-O.); (W.B.); (Y.S.)
| | - Norbert Thaller
- KfH-Nierenzentrum Miesbach, 83714 Miesbach, Germany; (D.S.-R.); (N.T.)
| | - Yana Suttmann
- KfH-Nierenzentrum Germering, 82110 Germering, Germany; (J.S.-O.); (W.B.); (Y.S.)
| | - Gero von Gersdorff
- QiN-Group, Department II of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany;
| | - Ron Regenauer
- Department of Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (L.F.); (I.L.); (S.H.); (R.R.); (A.v.B.-B.); (M.F.)
| | - Anke von Bergwelt-Baildon
- Department of Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (L.F.); (I.L.); (S.H.); (R.R.); (A.v.B.-B.); (M.F.)
| | - Daniel Teupser
- Institute of Laboratory Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.M.A.); (M.P.); (D.T.); (M.B.)
| | - Mathias Bruegel
- Institute of Laboratory Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.M.A.); (M.P.); (D.T.); (M.B.)
| | - Michael Fischereder
- Department of Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (L.F.); (I.L.); (S.H.); (R.R.); (A.v.B.-B.); (M.F.)
| | - Ulf Schönermarck
- Department of Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (L.F.); (I.L.); (S.H.); (R.R.); (A.v.B.-B.); (M.F.)
- Correspondence: ; Fax: +49-89-4400-72362
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Kitamura M, Takazono T, Yamaguchi K, Tomura H, Yamamoto K, Harada T, Funakoshi S, Mukae H, Nishino T. Favorable Humoral Response to Third Dose of BNT162b2 in Patients Undergoing Hemodialysis. J Clin Med 2022; 11:jcm11082090. [PMID: 35456182 PMCID: PMC9024432 DOI: 10.3390/jcm11082090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 02/01/2023] Open
Abstract
Patients undergoing hemodialysis are known to exhibit low humoral responses to vaccines against severe acute respiratory syndrome coronavirus 2. In this study, we aimed to elucidate the humoral response to the third dose of BNT162b2 (Pfizer) in patients undergoing hemodialysis. We included 279 patients undergoing hemodialysis (69 ± 11 years, 65% male, median dialysis vintage: 69 months) and 189 healthcare workers (45 ± 13 years, 30% male) who received the third dose of BNT162b2. Anti-spike immunoglobulin G (anti-S IgG) antibody levels were measured 3−4.5 months after the second dose and 3 weeks after the third dose and were compared. Despite a significant difference in anti-S IgG antibody levels after the second dose between the two groups (patients: median 215 U/mL and healthcare workers: median 589 U/mL; p < 0.001), no significant difference in anti-S IgG antibody levels after the third dose was observed (patients: median 19,000 U/mL, healthcare workers: median 21,000 U/mL). Except for dialysis vintage (ρ = 0.209, p < 0.001), no other factors correlated with anti-S IgG antibody levels after the third vaccine dose in patients undergoing hemodialysis. Therefore, a favorable response to the third dose of BNT162b2 was observed in patients undergoing hemodialysis, irrespective of their backgrounds.
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Affiliation(s)
- Mineaki Kitamura
- Nagasaki Renal Center, Nagasaki 850-0032, Japan; (K.Y.); (H.T.); (T.H.); (S.F.)
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan;
- Correspondence: ; Tel.: +81-95-819-7282; Fax: +81-95-849-7274
| | - Takahiro Takazono
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan; (T.T.); (K.Y.)
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan;
| | - Kosei Yamaguchi
- Nagasaki Renal Center, Nagasaki 850-0032, Japan; (K.Y.); (H.T.); (T.H.); (S.F.)
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan;
| | - Hideshi Tomura
- Nagasaki Renal Center, Nagasaki 850-0032, Japan; (K.Y.); (H.T.); (T.H.); (S.F.)
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan;
| | - Kazuko Yamamoto
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan; (T.T.); (K.Y.)
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan;
| | - Takashi Harada
- Nagasaki Renal Center, Nagasaki 850-0032, Japan; (K.Y.); (H.T.); (T.H.); (S.F.)
| | - Satoshi Funakoshi
- Nagasaki Renal Center, Nagasaki 850-0032, Japan; (K.Y.); (H.T.); (T.H.); (S.F.)
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan;
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan;
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Matsunami M, Suzuki T, Fukuda J, Terao T, Ukai K, Sugihara S, Toishi T, Nagaoka K, Nakata M, Ohara M, Yashima J, Kuji H, Matsue K. Comparison of antibody response following the second dose of SARS-CoV-2 mRNA vaccine in elderly patients with late-stage chronic kidney disease. RENAL REPLACEMENT THERAPY 2022; 8:13. [PMID: 35402003 PMCID: PMC8980785 DOI: 10.1186/s41100-022-00402-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/23/2022] [Indexed: 01/12/2023] Open
Abstract
Background Currently, it is unclear whether the progression of chronic kidney disease (CKD) could be an independent predictor of antibody response after administration of a COVID-19 vaccine. This study aimed to investigate the immune response to COVID-19 vaccination in patients with CKD stage G4 to G5 without renal replacement therapy and G5D using the recommended dose and schedule. Methods This retrospective single-center cohort study evaluated immunogenicity regarding antibody response after COVID-19 vaccination in our hospital for late-stage CKD patients aged ≥ 60 years. We evaluated antibody responses in 48 patients with CKD G4, 35 patients with CKD G5, and 70 patients undergoing hemodialysis (HD; CKD G5D). Results After the second vaccination, anti-SARS-CoV-2-S (Spike) IgG levels were found to be positive (> 0.8 U/mL) in all CKD G4 and G5 patients (100%), and 69 of 70 HD patients (98.5%). The median (interquartile range [IQR] S-IgG level (Ab titers) was 358 [130.2–639.2], 218 [117–377], and 185.5 [95.1–323.5] U/mL in the CKD G4, G5, and HD groups, respectively. The median S-IgG levels were significantly lower in the HD group than in the CKD G4 group (p < 0.01). However, there was no significant difference in the antibody titers between the CKD G4 and G5 groups. To further analyze the decline in S-IgG levels after 6 months, we additionally assessed and compared antibody titers at 1 month and 6 months after the second vaccination in the HD group. Compared with the median S-IgG levels of 185.5 [95.1–323.5] U/mL 1 month after the second dose, the median S-IgG level 6 months thereafter was significantly decreased at 97.4 [62.5–205.5] U/mL (p < 0.05). Conclusions We highlight two major factors of variability in the vaccine response. First, in elderly patients with late-stage CKD, antibody titers tended to be lower in the G5D group than in the G4 and G5 groups despite the shorter time since vaccination; therefore, CKD stage progression might cause a decline in antibody titers. Second, waning immune responses were observed 6 months after second dose administration in HD patients advocating a potential need for a third booster dose vaccine after 6 months.
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Humoral Response after Three Doses of mRNA-1273 or BNT162b2 SARS-CoV-2 Vaccines in Hemodialysis Patients. Vaccines (Basel) 2022; 10:vaccines10040522. [PMID: 35455271 PMCID: PMC9030003 DOI: 10.3390/vaccines10040522] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/11/2022] [Accepted: 03/25/2022] [Indexed: 12/10/2022] Open
Abstract
The COVID-19 pandemic continues to be a worldwide health issue. Among hemodialysis (HD) patients, two-dose immunization schemes with mRNA vaccines have contributed to preventing severe COVID-19 cases; however, some have not produced a sufficient humoral response, and most have developed a rapid decline in antibody levels over the months following vaccination. This observational, prospective, multi-center study evaluated the humoral response in terms of presence and levels of IgG antibodies to the receptor-binding domain of the S1 spike antigen of SARS-CoV-2 (anti-S1-RBD IgG) to the third dose of SARS-CoV-2 mRNA vaccines, either the mRNA-1273 (Moderna) or BNT162b2 (Pfizer), in 153 patients from three dialysis units affiliated to Hospital Clínic of Barcelona (Spain). Most hemodialysis patients responded intensely to this third vaccine dose, achieving the seroconversion in three out of four non- or weak responders to two doses. Moreover, 96.1% maintained the upper limit or generated higher titers than after the second. BNT162b2 vaccine, active cancer, and immunosuppressive treatment were related to a worse humoral response. Every hemodialysis patient should be administered a third vaccine dose six months after receiving the second one. Despite the lack of data, immunosuppressed patients and those with active cancer may benefit from more frequent vaccine boosters.
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Li T, Gandra S, Reske KA, Olsen MA, Bommarito S, Miller C, Hock KG, Ballman CA, Su C, Le Dang N, Kwon JH, Warren DK, Fraser VJ, Farnsworth CW. Predictors of humoral response to SARS-CoV-2 mRNA vaccine BNT162b2 in patients receiving maintenance dialysis. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e48. [PMID: 36310813 PMCID: PMC9615013 DOI: 10.1017/ash.2022.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/07/2022] [Indexed: 06/16/2023]
Abstract
Objective Patients on dialysis are at high risk for severe COVID-19 and associated morbidity and mortality. We examined the humoral response to SARS-CoV-2 mRNA vaccine BNT162b2 in a maintenance dialysis population. Design Single-center cohort study. Setting and participants Adult maintenance dialysis patients at 3 outpatient dialysis units of a large academic center. Methods Participants were vaccinated with 2 doses of BNT162b2, 3 weeks apart. We assessed anti-SARS-CoV-2 spike antibodies (anti-S) ∼4-7 weeks after the second dose and evaluated risk factors associated with insufficient response. Definitions of antibody response are as follows: nonresponse (anti-S level, <50 AU/mL), low response (anti-S level, 50-839 AU/mL), and sufficient response (anti-S level, ≥840 AU/mL). Results Among the 173 participants who received 2 vaccine doses, the median age was 60 years (range, 28-88), 53.2% were men, 85% were of Black race, 86% were on in-center hemodialysis and 14% were on peritoneal dialysis. Also, 7 participants (4%) had no response, 27 (15.6%) had a low response, and 139 (80.3%) had a sufficient antibody response. In multivariable analysis, factors significantly associated with insufficient antibody response included end-stage renal disease comorbidity index score ≥5 and absence of prior hepatitis B vaccination response. Conclusions Although most of our study participants seroconverted after 2 doses of BNT162b2, 20% of our cohort did not achieve sufficient humoral response. Our findings demonstrate the urgent need for a more effective vaccine strategy in this high-risk patient population and highlight the importance of ongoing preventative measures until protective immunity is achieved.
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Affiliation(s)
- Tingting Li
- Division of Nephrology, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Sumanth Gandra
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Kimberly A. Reske
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Margaret A. Olsen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Silvana Bommarito
- Division of Nephrology, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Candace Miller
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Karl G. Hock
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Claire A. Ballman
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Christina Su
- Division of Nephrology, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Na Le Dang
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jennie H. Kwon
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - David K. Warren
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Victoria J. Fraser
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Christopher W. Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
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Biedunkiewicz B, Tylicki L, Ślizień W, Lichodziejewska-Niemierko M, Dąbrowska M, Kubanek A, Rodak S, Polewska K, Tylicki P, Renke M, Dębska-Ślizień A. Waning Humoral Response after COVID-19 mRNA Vaccination in Maintenance Dialysis Patients and Recovery after a Complementary Third Dose. Vaccines (Basel) 2022; 10:vaccines10030433. [PMID: 35335065 PMCID: PMC8950255 DOI: 10.3390/vaccines10030433] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to analyze the waning of anti-spike (S) antibodies after mRNA vaccination against COVID-19 in maintenance dialysis patients, and to assess the safety and effectiveness of the complementary third dose. This was a prospective, longitudinal study in which we analyzed the kinetics of antibodies up to six months after a two-dose vaccination (first protocol) in infection-naïve dialysis patients (IN-Ds), previously infected dialysis patients (PI-Ds) and subjects without chronic kidney disease (the controls), as well as their humoral response to the third dose of the same mRNA vaccine (second protocol). The respective reduction in antibody titer after 3 and 6 months by 82.9% and 93.03% in IN-Ds (n = 109), 73.4% and 93.36% in PI-Ds (n = 32) and 75.5% and 88.8% in the controls (n = 20) was demonstrated. Consequently, a protective antibody titer above 141 BAU/mL was found in only 47.7% and 23.8% of IN-Ds after 3 and 6 months, respectively. After the third vaccine dose, a significant increase in antibody titer was observed in all groups, with increases by a factor of ×51.6 in IN-Ds, ×30.1 in the controls and ×8.4 in PI-Ds. The median antibody titer after the third dose differed significantly between groups, and was the highest in PI-Ds: PI-Ds, 9090 (3300−15,000) BAU/mL; the controls, 6945 (2130−11,800); IN-Ds, 3715 (1470−7325) (p < 0.001). In conclusion, we observed similar degrees of antibody waning in all patients. After 3 months, over half of the infection-naïve dialysis patients had a very low antibody titer, and almost twenty percent of them had no antibodies at all. The humoral response to the third dose was very good, raising their titer of antibodies to a higher level than those in the general population who have received the primary two-dose scheme. The results support the administration of a complementary third dose of the mRNA vaccine for dialysis patients as soon as possible.
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Affiliation(s)
- Bogdan Biedunkiewicz
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (B.B.); (M.L.-N.); (K.P.); (P.T.); (A.D.-Ś.)
| | - Leszek Tylicki
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (B.B.); (M.L.-N.); (K.P.); (P.T.); (A.D.-Ś.)
- Correspondence: ; Tel.: +48-58-5844700
| | | | - Monika Lichodziejewska-Niemierko
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (B.B.); (M.L.-N.); (K.P.); (P.T.); (A.D.-Ś.)
| | | | - Alicja Kubanek
- Department of Occupational, Metabolic and Internal Diseases, Medical University of Gdańsk, 81-519 Gdynia, Poland; (A.K.); (M.R.)
| | - Sylwia Rodak
- NZOZ Diaverum, 81-519 Gdynia, Poland; (W.Ś.); (S.R.)
| | - Karolina Polewska
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (B.B.); (M.L.-N.); (K.P.); (P.T.); (A.D.-Ś.)
| | - Piotr Tylicki
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (B.B.); (M.L.-N.); (K.P.); (P.T.); (A.D.-Ś.)
| | - Marcin Renke
- Department of Occupational, Metabolic and Internal Diseases, Medical University of Gdańsk, 81-519 Gdynia, Poland; (A.K.); (M.R.)
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (B.B.); (M.L.-N.); (K.P.); (P.T.); (A.D.-Ś.)
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Benning L, Klein K, Morath C, Bartenschlager M, Kim H, Buylaert M, Reineke M, Töllner M, Nusshag C, Kälble F, Reichel P, Schnitzler P, Zeier M, Süsal C, Bartenschlager R, Schaier M, Speer C. Neutralizing Antibody Activity Against the B.1.617.2 (delta) Variant Before and After a Third BNT162b2 Vaccine Dose in Hemodialysis Patients. Front Immunol 2022; 13:840136. [PMID: 35309320 PMCID: PMC8931261 DOI: 10.3389/fimmu.2022.840136] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/11/2022] [Indexed: 12/20/2022] Open
Abstract
Hemodialysis patients are at high risk for severe COVID-19, and impaired seroconversion rates have been demonstrated after COVID-19 vaccination. Humoral immunity wanes over time and variants of concern with immune escape are posing an increasing threat. Little is known about protection against the B.1.617.2 (delta) variant of concern in hemodialysis patients before and after third vaccination. We determined anti-S1 IgG, surrogate neutralizing, and IgG antibodies against different SARS-CoV-2 epitopes in 84 hemodialysis patients directly before and three weeks after a third vaccine dose with BNT162b2. Third vaccination was performed after a median (IQR) of 119 (109–165) days after second vaccination. In addition, neutralizing activity against the B.1.617.2 (delta) variant was assessed in 31 seroconverted hemodialysis patients before and after third vaccination. Triple seropositivity for anti-S1 IgG, surrogate neutralizing, and anti-RBD antibodies increased from 31/84 (37%) dialysis patients after second to 80/84 (95%) after third vaccination. Neutralizing activity against the B.1.617.2 (delta) variant was significantly higher after third vaccination with a median (IQR) ID50 of 1:320 (1:160–1:1280) compared with 1:20 (0–1:40) before a third vaccine dose (P<0.001). The anti-S1 IgG index showed the strongest correlation with the ID50 against the B.1.617.2 (delta) variant determined by live virus neutralization (r=0.91). We demonstrate low neutralizing activity against the B.1.617.2 (delta) variant in dialysis patients four months after standard two-dose vaccination but a substantial increase after a third vaccine dose. Booster vaccination(s) should be considered earlier than 6 months after the second vaccine dose in immunocompromised individuals.
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Affiliation(s)
- Louise Benning
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
- *Correspondence: Louise Benning,
| | - Katrin Klein
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Christian Morath
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Marie Bartenschlager
- Department of Infectious Diseases, Molecular Virology, University of Heidelberg, Heidelberg, Germany
| | - Heeyoung Kim
- Department of Infectious Diseases, Molecular Virology, University of Heidelberg, Heidelberg, Germany
| | - Mirabel Buylaert
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Marvin Reineke
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | | | - Christian Nusshag
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Florian Kälble
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Paula Reichel
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Paul Schnitzler
- Department of Virology, University of Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Caner Süsal
- Institute of Immunology, University of Heidelberg, Heidelberg, Germany
- Transplant Immunology Research Center of Excellence, Koç University Hospital, Istanbul, Turkey
| | - Ralf Bartenschlager
- Department of Infectious Diseases, Molecular Virology, University of Heidelberg, Heidelberg, Germany
- German Center for Infection Research, Partner Site Heidelberg, Heidelberg, Germany
- Division Virus-Associated Carcinogenesis, German Cancer Research Center, Heidelberg, Germany
| | - Matthias Schaier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Claudius Speer
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
- Department of Molecular Medicine Partnership Unit Heidelberg, European Molecular Biology Laboratory, Heidelberg, Germany
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Housset P, Kubab S, Pardon A, Vittoz N, Bozman DF, Hanafi L, Caudwell V, Faucon AL. Waning but persistent humoral response 6 months after the third dose of the mRNA BNT162b2 vaccine in hemodialysis and peritoneal dialysis patients. J Nephrol 2022; 35:783-785. [PMID: 35192157 PMCID: PMC8861617 DOI: 10.1007/s40620-022-01276-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/06/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Pierre Housset
- Department of Nephrology, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France.
| | - Sabah Kubab
- Department of Microbiology, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Agathe Pardon
- Department of Nephrology, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Nathalie Vittoz
- Department of Nephrology, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Dogan-Firat Bozman
- Department of Nephrology, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Latifa Hanafi
- Department of Nephrology, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Valérie Caudwell
- Department of Nephrology, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Anne-Laure Faucon
- Department of Nephrology, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France. .,INSERM UMRS 1018, Clinical Epidemiology Unit, Centre for Research in Epidemiology and Population Health, Paris-Saclay University, Villejuif, France.
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Jahn M, Korth J, Dorsch O, Anastasiou OE, Krawczyk A, Brochhagen L, van de Sand L, Sorge-Hädicke B, Tyczynski B, Witzke O, Dittmer U, Dolff S, Wilde B, Kribben A. Decline of Humoral Responses 6 Months after Vaccination with BNT162b2 (Pfizer–BioNTech) in Patients on Hemodialysis. Vaccines (Basel) 2022; 10:vaccines10020327. [PMID: 35214785 PMCID: PMC8878048 DOI: 10.3390/vaccines10020327] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/04/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023] Open
Abstract
This study analyzed binding and neutralizing antibody titers up to 6 months after standard vaccination with BNT162b2 (two doses of 30 µg each) in SARS-CoV-2 naïve patients (n = 59) on hemodialysis. Humoral vaccine responses were measured before and 6, 12, and 24 weeks after the first vaccination. A chemiluminescent immunoassay (CLIA) was used to quantify SARS-CoV-2 IgG against the spike glycoprotein. SARS-CoV-2 neutralizing activity was tested against the wild-type virus. A multivariable binary regression model was used to identify risk factors for the absence of humoral immune responses at 6 months. At week 6, vaccine-specific seroconversion was detected in 96.6% of all patients with median anti-SARS-CoV-2 IgGs of 918 BAU/mL. At weeks 12 and 24, seroconversion rates decreased to 91.5% and 79.7%, and corresponding median binding antibody titers declined to 298 BAU/mL and 89 BAU/mL, respectively. Neutralizing antibodies showed a decay from 79.6% at week 6 to 32.8% at week 24. The risk factor with the strongest association for vanishing immune responses was low serum albumin (p = 0.018). Regarding vaccine-specific humoral responses 6 months after the standard BNT162b2 vaccination schedule, SARS-CoV-2 naïve patients receiving hemodialysis must be considered at risk of becoming infected with SARS-CoV-2 and being infectious.
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Affiliation(s)
- Michael Jahn
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
- Correspondence:
| | - Johannes Korth
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
| | - Oliver Dorsch
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, Friesener Straße 37a, 96317 Kronach, Germany;
| | - Olympia Evdoxia Anastasiou
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (O.E.A.); (U.D.)
| | - Adalbert Krawczyk
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Leonie Brochhagen
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Lukas van de Sand
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Burkhard Sorge-Hädicke
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, Alfried-Krupp-Str. 43, 45131 Essen, Germany;
| | - Bartosz Tyczynski
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Ulf Dittmer
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (O.E.A.); (U.D.)
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
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Milia VL, Tonolo S, Luzzaro F, Bonato C, Limardo M, Longhi S, Ravasi C, Viganò S, Cavalli A. Sustained humoral response six months after the anti-SARS-CoV-2 mRNA-BNT162b2 vaccine in hemodialysis patients: should booster vaccine doses be given in all patients at the same time? Clin Kidney J 2022; 15:1012-1014. [PMID: 35498885 PMCID: PMC9050530 DOI: 10.1093/ckj/sfac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Silvia Tonolo
- Microbiology Unit, A. Manzoni Hospital, Lecco, Italy
| | | | - Claudio Bonato
- Department of Clinical Services, A. Manzoni Hospital, Lecco, Italy
| | - Monica Limardo
- Nephrology and Dialysis Unit, A. Manzoni Hospital, Lecco, Italy
| | - Selena Longhi
- Nephrology and Dialysis Unit, A. Manzoni Hospital, Lecco, Italy
| | - Chiara Ravasi
- Nephrology and Dialysis Unit, A. Manzoni Hospital, Lecco, Italy
| | - Sara Viganò
- Nephrology and Dialysis Unit, A. Manzoni Hospital, Lecco, Italy
| | - Andrea Cavalli
- Nephrology and Dialysis Unit, A. Manzoni Hospital, Lecco, Italy
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Immunogenicity and reactogenicity of homologous mRNA-based and vector-based SARS-CoV-2 vaccine regimens in patients receiving maintenance dialysis. Clin Immunol 2022; 236:108961. [PMID: 35227871 PMCID: PMC8875769 DOI: 10.1016/j.clim.2022.108961] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/27/2022]
Abstract
Patients receiving maintenance dialysis (MD) are vulnerable to COVID-19-related morbidity and mortality. Currently, data on SARS-CoV-2-specific cellular and humoral immunity post-vaccination in this population are scarce. We conducted a prospective single-center study exploring the specific cellular (interferon-γ and interleukin-2 ELISpot assays) and humoral immune responses (dot plot array and chemiluminescent microparticle immunoassay [CMIA]) at 4 weeks and 6 weeks following a single dose or a complete homologous dual dose SARS-CoV-2 vaccine regimen in 60 MD patients (six with a history of COVID-19). Our results show that MD patients exhibit a high seroconversion rate (91.7%) but the anti-spike IgG antibodies (CMIA) tend to wane rapidly after full immunization. Only 51.7% of the patients developed T cell immune response. High anti-spike IgG antibodies may predict a better cellular immunity. While patients with prior COVID-19 showed the best response after one, SARS-CoV-2-naïve patients may benefit from a third vaccine injection.
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De Vriese AS, Van Praet J, Reynders M, Heylen L, Viaene L, Caluwé R, Schoutteten M, De Bacquer D. Longevity and clinical effectiveness of the humoral and cellular response to SARS-CoV-2 vaccination in hemodialysis patients. Kidney Int Rep 2022; 7:1103-1107. [PMID: 35224315 PMCID: PMC8861256 DOI: 10.1016/j.ekir.2022.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/10/2022] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- An S. De Vriese
- Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
- Department of Internal Medicine, Ghent University, Ghent, Belgium
- Correspondence: An S. De Vriese, Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000 Brugge, Belgium.
| | - Jens Van Praet
- Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
- Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Marijke Reynders
- Division of Medical Microbiology, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | - Line Heylen
- Division of Nephrology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | | | - Rogier Caluwé
- Division of Nephrology, OLV Hospital, Aalst, Belgium
| | - Melanie Schoutteten
- Division of Nephrology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Quiroga B, Soler MJ, Ortiz A, Bernat A, Díaz ABM, Mantecón CJJ, Pérez VOG, González CC, Cervienka M, Mazuecos A, Cazorla JM, Riso MCD, Martínez S, Diaz MO, Valverde RL, Márquez MGS, Novillo CL, Parra EG, Gracia-Iguacel C, De Tomas MTR, Cervera MCA, Giorgi M, Ramos PM, Carmona NM, Toapanta N, Guldris SC, Millán JCRS, Estupiñán RS, Crespo M, Linaza BV, Martín MIJ, Jiménez LRO, Soriano S, Ferri DG, Sánchez MSP, Yugueros A, Leyva A, Rojas J, Gansevoort RT, de Sequera P, Carretero MP, Tocora DG, Rodríguez MJ, Zanón TT, Suárez ER, Santolaya AJS, Calero RC, Cobo PA, Martin-Cleary C, Sánchez-Rodríguez J, Pereira M, Ramos-Verde A, Sánchez C, Giraldo YG, Horrillo AS, Suárez PR, Perpén AF, Ramos AF, Villanueva LS, Cortiñas A, Arias PAD, Cárdenas AC, de Santos A, Núñez A, Cuadrado GB, Repollet R, Moreso F, Azancot MA, Ramos N, Bestard O, Cidraque I, Bermejo S, Agraz I, Prat O, Medina C, Pardo E, Saiz A, Vila MAM, Granados NM, Cabo MJC, Alarcón WL, Alexandru S, Suarez LGP, Saico SP, Tapia MP, Hernández RS, García-Fernández N, Moreno PLM, González NA, Ortiz AS, Iñarrea MNB, López RO, Peregrí CM, Morales MLA, Cabello MDN, Ribera AMT, Valcarce EG, Vergara EG, García T, Narváez C, Orellana C, Ganga PLQ, Carrión FV, Herrera ALG, Chamoun B, Barbosa F, Faura A, Pachón DR, Castro NB, Cendrero RMRC, Hidalgo-Barquero MVM, Gallego RH, Alvarez Á, Leo EV, León JLP, García MAM, Jiménez BG, Moya JDDR, Espinosa DL, Herrador AJ, Zurita MN, Álvarez LD, Martínez ÁG, Arroyo SB, Fernández RR, Vargas MJS, Casero RC, Useche G, de Miguel CS, Palacios Á, Henningsmeyer B, Calve EO, Moya JL, Sato Y, Marín MS, Torres I, Conde PD, Alfaro G, Halauko O, Rifai FEL, Martínez AD, Ávila PJ, Franco AM, Sainz MS, Martín JMB, García LDR, Canga JLP, Ochoa PMV, Pacios LM, Machado LL, Morales AQ, Cavalotti IM, Zorita IN, López SO, González SO, Montañez CS, Rubio AB, Gilsanz GDP, Gonzalez MO, Villanueva RS, Oliva MOL, Varela JC, Enríquez AG, Casas CC, Alonso PO, Tabares LG, Barreiro JML, Solla LP, Gándara A, de la Garza WN, Fleming FF, Goyanes MGR, Feijoo CC, Plaza MMM, Juan CB, Cecilio RVS, Haces CP, Kislikova M, Rodrigo E, Contreras FJP, Lara NB, Llorente EMDB, Díaz LS, Bustamante AMC, Ruiz JM, Rodríguez EG, Perez VLDLM, Arevalo MC, Calvo JAH, Carratalá MRL, Rodríguez LMM, Salazar MS, Prieto BB, Pérez JMP, Rueda DA, Ferrero MLR, Martínez AV, Estébanez SA, Paraíso AG, Huarte E, Lanau M, Campos RA, Ubé JM, Pérez PS, Godoy IB, Aguilera ET, Alea RT, Saldaña MSDR, Salvetti ML, Valmajor MC, Sánchez MP, Barragán ML, Aunatell LR, Salgueira M, Aresté N, de Los Ángeles Rodríguez M, Collantes R, Martínez AI, Moyano MJ, Víbora EJ, Gash SC, Martínez LR, Prieto BA, Toyos C, Rio JM, Acosta AR, Zamacona AC, Ortega SB, Ruiz MIG, Rubio AH, Ledesma PG, Alvarez AG, de Briñas EPL, Cucchiari D, Monzo JB, Cabrera BE, Hernández APR, Rebollo MSG, Hernández JMR, Alonso JC, Más AM, Calvé M, Cardona MG, Balaguer VC, Pesquera JIM, Serrano AG, Simó PT, Mancilla HDR, Gómez MP, Gumpert JV, de la Fuente GDA, Del Valle KP, de la Rosa EC, Santarelli DR, Garcia AS, Martin-Caro AC, Santamaria IM, Umpierrez AM, Ruiz EH, Corbella AM, Perdomo KT, Martín YM, de la Pisa AMU, Monzon LS, Anachuri KA, Garcia EH, Gomez VO, Amado FV, Borges PP, Vázquez RM, Beloso MD, Alonso FA, Felpete NP, Ameneiro AM, Mera MC, Casares BG, Larrondo SZ, Kareaga NM, Del Valle AISS, García ARM, Del Toro Espinosa N, Perico PE, Oliva JMS, Manrique J, Castaño I, Purroi C, Gómez N, Mansilla C, Utzurrum A. Loss of humoral response 3 months after SARS-CoV-2 vaccination in the CKD spectrum: the multicentric SENCOVAC study. Nephrol Dial Transplant 2022; 37:994-999. [PMID: 35022757 PMCID: PMC9383183 DOI: 10.1093/ndt/gfac007] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Borja Quiroga
- Nephrology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - María José Soler
- Nephrology Department, Vall d'Hebrón University Hospital, Barcelona, Spain.,RICORS2040 (Kidney Disease)
| | - Alberto Ortiz
- RICORS2040 (Kidney Disease).,IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | - Mayra Ortega Diaz
- Nephrology Department, Hospital Universitario Infanta Leonor - Universidad Complutense de Madrid, Spain
| | - Rafael Lucena Valverde
- Nephrology Department, Hospital Universitario Infanta Leonor - Universidad Complutense de Madrid, Spain
| | | | | | - Emilio González Parra
- IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Carolina Gracia-Iguacel
- IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | | | | | - Martín Giorgi
- Nephrology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | - Néstor Toapanta
- Nephrology Department, Vall d'Hebrón University Hospital, Barcelona, Spain
| | | | | | - Raquel Santana Estupiñán
- Nephrology Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Marta Crespo
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | | | | | | | | | | | | | - Alejandra Yugueros
- Nephrology Department, Hospital Lluis Alcanyis De Xátiva, Valencia, Spain
| | - Alba Leyva
- R&D Department, VIRCELL SL, Granada, Spain
| | - José Rojas
- R&D Department, VIRCELL SL, Granada, Spain
| | - Ron T Gansevoort
- Dept. Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Patricia de Sequera
- RICORS2040 (Kidney Disease).,Nephrology Department, Hospital Universitario Infanta Leonor - Universidad Complutense de Madrid, Spain
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Boedecker-Lips SC, Lautem A, Runkel S, Klimpke P, Kraus D, Keil P, Holtz S, Tomalla V, Marczynski P, Boedecker CB, Galle PR, Koch M, Weinmann-Menke J. Six-Month Follow-Up after Vaccination with BNT162b2: SARS-CoV-2 Antigen-Specific Cellular and Humoral Immune Responses in Hemodialysis Patients and Kidney Transplant Recipients. Pathogens 2022; 11:67. [PMID: 35056015 PMCID: PMC8780885 DOI: 10.3390/pathogens11010067] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/30/2021] [Accepted: 01/02/2022] [Indexed: 02/01/2023] Open
Abstract
Hemodialysis patients (HDP) and kidney transplant recipients (KTR) have a high risk of infection with SARS-CoV-2 with poor clinical outcomes. Because of this, vaccination of these groups of patients against SARS-CoV-2 is particularly important. However, immune responses may be impaired in immunosuppressed and chronically ill patients. Here, our aim was to compare the efficacy of an mRNA-based vaccine in HDP, KTR, and healthy subjects. DESIGN In this prospective observational cohort study, the humoral and cellular response of prevalent 192 HDP, 50 KTR, and 28 healthy controls (HC) was assessed 1, 2, and 6 months after the first immunization with the BNT162b2 mRNA vaccine. RESULTS After 6 months, 97.5% of HDP, 37.9% of KTR, and 100% of HC had an antibody response. Median antibody levels were 1539.7 (±3355.8), 178.5 (±369.5), and 2657.8 (±2965.8) AU/mL in HDP, KTR, and HC, respectively (p ≤ 0.05). A SARS-CoV-2 antigen-specific cell response to vaccination was found in 68.8% of HDP, 64.5% of KTR, and 90% of HC. CONCLUSION The humoral response rates to mRNA-based vaccination of HDPs are comparable to HCs, but antibody titers are lower. Furthermore, HDPs have weaker T-cell response to vaccination than HCs. KTRs have very low humoral and antigen-specific cellular response rates and antibody titers, which requires other vaccination strategies in addition to booster vaccination.
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Affiliation(s)
- Simone Cosima Boedecker-Lips
- Department of Nephrology, I. Department of Medicine, University Medical Center Mainz, Johannes Gutenberg University, D 55131 Mainz, Germany; (S.C.B.-L.); (P.K.); (D.K.); (P.K.); (S.H.); (V.T.); (P.M.)
| | - Anja Lautem
- Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Johannes Gutenberg University, D 55131 Mainz, Germany; (A.L.); (C.B.B.); (M.K.)
| | - Stefan Runkel
- Blood Transfusion Center, University Medical Center Mainz, Johannes-Gutenberg University, D 55131 Mainz, Germany;
| | - Pascal Klimpke
- Department of Nephrology, I. Department of Medicine, University Medical Center Mainz, Johannes Gutenberg University, D 55131 Mainz, Germany; (S.C.B.-L.); (P.K.); (D.K.); (P.K.); (S.H.); (V.T.); (P.M.)
| | - Daniel Kraus
- Department of Nephrology, I. Department of Medicine, University Medical Center Mainz, Johannes Gutenberg University, D 55131 Mainz, Germany; (S.C.B.-L.); (P.K.); (D.K.); (P.K.); (S.H.); (V.T.); (P.M.)
| | - Philipp Keil
- Department of Nephrology, I. Department of Medicine, University Medical Center Mainz, Johannes Gutenberg University, D 55131 Mainz, Germany; (S.C.B.-L.); (P.K.); (D.K.); (P.K.); (S.H.); (V.T.); (P.M.)
| | - Stefan Holtz
- Department of Nephrology, I. Department of Medicine, University Medical Center Mainz, Johannes Gutenberg University, D 55131 Mainz, Germany; (S.C.B.-L.); (P.K.); (D.K.); (P.K.); (S.H.); (V.T.); (P.M.)
| | - Vanessa Tomalla
- Department of Nephrology, I. Department of Medicine, University Medical Center Mainz, Johannes Gutenberg University, D 55131 Mainz, Germany; (S.C.B.-L.); (P.K.); (D.K.); (P.K.); (S.H.); (V.T.); (P.M.)
| | - Paul Marczynski
- Department of Nephrology, I. Department of Medicine, University Medical Center Mainz, Johannes Gutenberg University, D 55131 Mainz, Germany; (S.C.B.-L.); (P.K.); (D.K.); (P.K.); (S.H.); (V.T.); (P.M.)
| | - Christian Benedikt Boedecker
- Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Johannes Gutenberg University, D 55131 Mainz, Germany; (A.L.); (C.B.B.); (M.K.)
| | - Peter Robert Galle
- Department of Internal Medicine, University Medical Center Mainz, Johannes Gutenberg University, D 55131 Mainz, Germany;
| | - Martina Koch
- Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Johannes Gutenberg University, D 55131 Mainz, Germany; (A.L.); (C.B.B.); (M.K.)
| | - Julia Weinmann-Menke
- Department of Nephrology, I. Department of Medicine, University Medical Center Mainz, Johannes Gutenberg University, D 55131 Mainz, Germany; (S.C.B.-L.); (P.K.); (D.K.); (P.K.); (S.H.); (V.T.); (P.M.)
- Research Center of Immunotherapy (FZI), University Medical Center Mainz, Johannes Gutenberg University, D 55131 Mainz, Germany
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Weigert A, Bergman ML, Gonçalves LA, Godinho I, Duarte N, Abrantes R, Borges P, Brennand A, Malheiro V, Matoso P, Akpogheneta O, Kosack L, Cruz P, Nogueira E, Pereira M, Ferreira A, Marques M, Nunes T, Faro-Viana J, Demengeot J, Penha-Gonçalves C. Longitudinal Analysis of Antibody Responses to the mRNA BNT162b2 Vaccine in Patients Undergoing Maintenance Hemodialysis: A 6-Month Follow-Up. Front Med (Lausanne) 2021; 8:796676. [PMID: 35004771 PMCID: PMC8740691 DOI: 10.3389/fmed.2021.796676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 11/24/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Patients on hemodialysis (HD) are at higher risk for COVID-19, overall are poor responders to vaccines, and were prioritized in the Portuguese vaccination campaign. Objective: This work aimed at evaluating in HD patients the immunogenicity of BTN162b2 after the two doses induction phase, the persistence of specific antibodies along time, and factors predicting these outcomes. Methods: We performed a prospective, 6-month long longitudinal cohort analysis of 156 HD patients scheduled to receive BTN162b2. ELISA quantified anti-spike IgG, IgM, and IgA levels in sera were collected every 3 weeks during the induction phase (t0 before vaccine; t1, d21 post first dose; and t2 d21 post second dose), and every 3-4 months during the waning phase (t3, d140, and t4, d180 post first dose). The age-matched control cohort was similarly analyzed from t0 to t2. Results: Upon exclusion of participants identified as previously exposed to SARS-CoV-2, seroconversion at t1 was lower in patients than controls (29 and 50%, respectively, p = 0.0014), while the second vaccine dose served as a boost in both cohorts (91 and 95% positivity, respectively, at t2, p = 0.2463). Lower response in patients than controls at t1 was a singularity of the participants ≤ 70 years (p = 2.01 × 10-05), associated with immunosuppressive therapies (p = 0.013), but not with lack of responsiveness to hepatitis B. Anti-spike IgG, IgM, and IgA levels decreased at t3, with IgG levels further waning at t4 and resulting in >30% seronegativity. Anti-spike IgG levels at t1 and t4 were correlated (ρ = 0.65, p < 2.2 × 10-16). Conclusions: While most HD patients seroconvert upon 2 doses of BNT162b2 vaccination, anti-spike antibodies levels wane over the following 4 months, leading to early seroreversion in a sizeable fraction of the patients. These findings warrant close monitoring of COVID-19 infection in vaccinated HD patients, and advocate for further studies following reinforced vaccination schedules.
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Affiliation(s)
- André Weigert
- DaVita Óbidos, Óbidos, Portugal
- Serviço de Nefrologia, Centro Hospitalar de Lisboa Ocidental, Hospital Santa Cruz, Carnaxide, Portugal
- Faculdade de Medicina, Instituto de Farmacologia e Neurociências, Universidade de Lisboa, Lisboa, Portugal
| | | | | | - Iolanda Godinho
- DaVita Óbidos, Óbidos, Portugal
- Serviço de Nefrologia e Transplantação Renal, Centro Hospitalar de Lisboa Norte EPE, Lisboa, Portugal
| | - Nádia Duarte
- IGC, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Rita Abrantes
- DaVita Óbidos, Óbidos, Portugal
- Serviço de Nefrologia, Centro Hospitalar do Médio Tejo, Torres Novas, Portugal
| | | | - Ana Brennand
- IGC, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | | | - Paula Matoso
- IGC, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | | | | | - Pedro Cruz
- DaVita Óbidos, Óbidos, Portugal
- Serviço de Nefrologia, Hospital Das Forças Armadas, Lisboa, Portugal
| | - Estela Nogueira
- DaVita Óbidos, Óbidos, Portugal
- Serviço de Nefrologia e Transplantação Renal, Centro Hospitalar de Lisboa Norte EPE, Lisboa, Portugal
| | | | | | | | - Telmo Nunes
- CIISA, Centro de Investigação Interdisciplinar em Sanidade Animal, Faculdade de Medicina Veterinária, Universidade de Lisboa, Lisboa, Portugal
| | - João Faro-Viana
- Serviço de Patologia Clínica, Centro Hospitalar de Lisboa Ocidental EPE, Carnaxide, Portugal
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Berar-Yanay N, Freiman S, Shapira M, Saffoury A, Elemy A, Hamze M, Elhaj M, Zaher M, Matanis L, Armaly ZA. Waning Humoral Response 3 to 6 Months after Vaccination with the SARS-COV-2 BNT162b2 mRNA Vaccine in Dialysis Patients. J Clin Med 2021; 11:jcm11010064. [PMID: 35011801 PMCID: PMC8745040 DOI: 10.3390/jcm11010064] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 12/12/2022] Open
Abstract
Background and objectives: The short-term reported antibody response to SARS-COV-2 vaccination in dialysis patients is high, with a seroconversion response rate up to 97%. Data on the long-term durability of this response are scarce. Our objective was to characterize the long-term anti-spike antibody level in dialysis patients. Design, setting, participants, and measurements: In an observational study, we measured SARS-COV-2 anti-spike antibody levels in dialysis patients who completed 2 doses of the BNT162b2 mRNA SAR S-COV-2 vaccine at 1, 3 and 6 months after the second vaccine dose. We compared the response to dialysis patients who were infected with COVD-19 and to a control group of healthcare-employees. Results: One hundred and forty-two dialysis patients who had been vaccinated (ages 64 ± 11.9 years, 61% male), 33 dialysis patients who had COVID-19 infection (ages 54 ± 14.3 years, 55% male) and 104 individuals in the control group (ages 50 ± 12.2 years, 44% male) were included. The response rate in the vaccinated dialysis patients was 94%, 78% and 73% at 1, 3 and 6 months after the second vaccine dose. In the COVID-19 infected dialysis group and in the control group, the response rate remained at 100% over 6 months. The percentage of change in antibody levels between one and 6 months was −66% in the vaccinated dialysis group, −28% in the control group (p < 0.001) and +48% in dialysis patients who had been infected with COVID-19 (p < 0.001). A non-responder status at 6 months was associated with a lower albumin level. No serious adverse events following vaccination were reported. In conclusion: the initially high response rate to the BNT162b2 vaccine in dialysis patients decreases rapidly. Our results indicate that an early booster (3rd) dose, at three months after the second dose, may be advised for this population to preserve the humoral immunity.
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Affiliation(s)
- Noa Berar-Yanay
- Department of Nephrology, Hillel Yaffe Medical Center, Hadera 38100, Israel
- Correspondence: (N.B.-Y.); (Z.A.A.); Fax: +972-74-755-9067 (Z.A.A.)
| | - Sarit Freiman
- Laboratory Division Hillel Yaffe Medical Center, Hadera 38100, Israel; (S.F.); (M.S.)
| | - Maʹanit Shapira
- Laboratory Division Hillel Yaffe Medical Center, Hadera 38100, Israel; (S.F.); (M.S.)
- Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa 31096, Israel
| | - Amer Saffoury
- Department of Victory-COVID-19, Nazareth Hospital, EMMS, Nazareth 19152, Israel; (A.S.); (A.E.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 52100, Israel
| | - Ameer Elemy
- Department of Victory-COVID-19, Nazareth Hospital, EMMS, Nazareth 19152, Israel; (A.S.); (A.E.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 52100, Israel
| | - Munir Hamze
- Department of Nephrology and hypertension, Nazareth Hospital, EMMS, Nazareth 19152, Israel; (M.H.); (M.E.); (M.Z.); (L.M.)
| | - Mohamad Elhaj
- Department of Nephrology and hypertension, Nazareth Hospital, EMMS, Nazareth 19152, Israel; (M.H.); (M.E.); (M.Z.); (L.M.)
| | - Maha Zaher
- Department of Nephrology and hypertension, Nazareth Hospital, EMMS, Nazareth 19152, Israel; (M.H.); (M.E.); (M.Z.); (L.M.)
| | - Loai Matanis
- Department of Nephrology and hypertension, Nazareth Hospital, EMMS, Nazareth 19152, Israel; (M.H.); (M.E.); (M.Z.); (L.M.)
| | - Zaher Anis Armaly
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 52100, Israel
- Department of Nephrology and hypertension, Nazareth Hospital, EMMS, Nazareth 19152, Israel; (M.H.); (M.E.); (M.Z.); (L.M.)
- Correspondence: (N.B.-Y.); (Z.A.A.); Fax: +972-74-755-9067 (Z.A.A.)
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38
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Rodríguez-Espinosa D, Broseta JJ, Bedini JL, Rodríguez N, Maduell F. Antibody maintenance and breakthrough infections 6 months after complete COVID-19 vaccination with the mRNA-1273 and BNT162b2 vaccines in hemodialysis patients. Clin Kidney J 2021; 15:818-819. [PMID: 35371449 PMCID: PMC8967668 DOI: 10.1093/ckj/sfab282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Diana Rodríguez-Espinosa
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | - José Jesús Broseta
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | - José Luis Bedini
- Department of Biochemistry and Molecular Genetics, Hospital Clínic of Barcelona, Barcelona, Spain
| | | | - Francisco Maduell
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
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Drożdżal S, Rosik J, Lechowicz K, Machaj F, Szostak B, Przybyciński J, Lorzadeh S, Kotfis K, Ghavami S, Łos MJ. An update on drugs with therapeutic potential for SARS-CoV-2 (COVID-19) treatment. Drug Resist Updat 2021; 59:100794. [PMID: 34991982 PMCID: PMC8654464 DOI: 10.1016/j.drup.2021.100794] [Citation(s) in RCA: 158] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic is one of the greatest threats to human health in the 21st century with more than 257 million cases and over 5.17 million deaths reported worldwide (as of November 23, 2021. Various agents were initially proclaimed to be effective against SARS-CoV-2, the etiological agent of COVID-19. Hydroxychloroquine, lopinavir/ritonavir, and ribavirin are all examples of therapeutic agents, whose efficacy against COVID-19 was later disproved. Meanwhile, concentrated efforts of researchers and clinicians worldwide have led to the identification of novel therapeutic options to control the disease including PAXLOVID™ (PF-07321332). Although COVID-19 cases are currently treated using a comprehensive approach of anticoagulants, oxygen, and antibiotics, the novel Pfizer agent PAXLOVID™ (PF-07321332), an investigational COVID-19 oral antiviral candidate, significantly reduced hospitalization time and death rates, based on an interim analysis of the phase 2/3 EPIC-HR (Evaluation of Protease Inhibition for COVID-19 in High-Risk Patients) randomized, double-blind study of non-hospitalized adult patients with COVID-19, who are at high risk of progressing to severe illness. The scheduled interim analysis demonstrated an 89 % reduction in risk of COVID-19-related hospitalization or death from any cause compared to placebo in patients treated within three days of symptom onset (primary endpoint). However, there still exists a great need for the development of additional treatments, as the recommended therapeutic options are insufficient in many cases. Thus far, mRNA and vector vaccines appear to be the most effective modalities to control the pandemic. In the current review, we provide an update on the progress that has been made since April 2020 in clinical trials concerning the effectiveness of therapies available to combat COVID-19. We focus on currently recommended therapeutic agents, including steroids, various monoclonal antibodies, remdesivir, baricitinib, anticoagulants and PAXLOVID™ summarizing the latest original studies and meta-analyses. Moreover, we aim to discuss other currently and previously studied agents targeting COVID-19 that either show no or only limited therapeutic activity. The results of recent studies report that hydroxychloroquine and convalescent plasma demonstrate no efficacy against SARS-CoV-2 infection. Lastly, we summarize the studies on various drugs with incoherent or insufficient data concerning their effectiveness, such as amantadine, ivermectin, or niclosamide.
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Affiliation(s)
- Sylwester Drożdżal
- Department of Nephrology, Transplantation and Internal Medicine, Pomeranian Medical University in Szczecin, Poland
| | - Jakub Rosik
- Department of Physiology, Pomeranian Medical University in Szczecin, Poland
| | - Kacper Lechowicz
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Filip Machaj
- Department of Physiology, Pomeranian Medical University in Szczecin, Poland
| | - Bartosz Szostak
- Department of Physiology, Pomeranian Medical University in Szczecin, Poland
| | - Jarosław Przybyciński
- Department of Nephrology, Transplantation and Internal Medicine, Pomeranian Medical University in Szczecin, Poland
| | - Shahrokh Lorzadeh
- Department of Molecular Genetics, Science and Research Branch, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Saeid Ghavami
- Department of Human Anatomy and Cell Science, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Research Institutes of Oncology and Hematology, Cancer Care Manitoba-University of Manitoba, Winnipeg, MB R3E 0V9, Canada; Biology of Breathing Theme, Children Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB R3E 0V9, Canada; Autophagy Research Center, Shiraz University of Medical Sciences, Shiraz 7134845794, Iran; Faculty of Medicine, Katowice School of Technology, 40-555 Katowice, Poland
| | - Marek J Łos
- Biotechnology Centre, Silesian University of Technology, 44-100 Gliwice, Poland.
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