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Goggins E, Sharma B, Ma JZ, Gautam J, Bowman B. Humoral immunity trends in a hemodialysis cohort following SARS-CoV-2 mRNA booster: A cohort study. Health Sci Rep 2024; 7:e1858. [PMID: 38357484 PMCID: PMC10864730 DOI: 10.1002/hsr2.1858] [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: 07/22/2023] [Revised: 10/24/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
Background and Aims Patients with end stage kidney disease on hemodialysis are vulnerable to SARS-CoV-2 infection. Current guidelines recommend boosters of SARS-CoV-2 mRNA-based vaccines. The long-term humoral response of hemodialysis patients infected with SARS-CoV-2 after receiving a booster of SARS-CoV-2 mRNA-based vaccines has been incompletely characterized. Here, we determined the long-term humoral response of hemodialysis patients to two and three doses of the Pfizer BioNTech (BNT162b2) mRNA SARS-CoV-2 vaccine and investigated the effect of postbooster SARS-CoV-2 infection on antibody levels over time. Methods Samples were collected on a monthly basis and tested for anti-SARS-CoV-2 antibodies against anti-spike S1 domain. Thirty-five hemodialysis patients were enrolled in the original study and 27 of these received a booster. Patients were followed up to 6 months after the first two doses and an additional 7 months after the third BNT162b2 dose. Results are presented as the internationally harmonized binding antibody units (BAU/mL). Results Antibody level significantly increased from prebooster to 2 weeks postbooster, with a median [25th, 75th percentile] rise from 52.72 [28.55, 184.7] to 6216 [3806, 11,730] BAU/mL in the total population. Of patients with a negative or borderline detectable antibody level 6 months after vaccination who received a third dose, 89% developed positive antibody levels 2 weeks postbooster. Postbooster antibody levels declined an average rate of 29% per month in infection-naïve patients. Antibody levels spiked in patients infected with SARS-CoV-2 after receiving a booster but declined rapidly. No patients infected postbooster required hospitalization. Conclusions A third dose of BNT162b2 restores antibody levels to high levels in dialysis patients but levels decline over time. A third dose did not necessarily prevent infection, but no patients suffered severe infection or required hospitalization. SARS-CoV-2 recovered patients appear to have a blunted rise in antibody levels after a third dose. Although patients infected with SARS-CoV-2 postbooster had an immediate spike in antibody levels, these declined over time.
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Affiliation(s)
- Eibhlin Goggins
- Division of NephrologyUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Binu Sharma
- Division of NephrologyUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Jennie Z. Ma
- Division of NephrologyUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
- Public Health SciencesUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Jitendra Gautam
- Division of NephrologyUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Brendan Bowman
- Division of NephrologyUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
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Yamaguchi K, Kitamura M, Takazono T, Hashiguchi J, Funakoshi S, Mukae H, Nishino T. Prognoses of patients undergoing hemodialysis administered 23-valent pneumococcal polysaccharide versus 13-valent pneumococcal protein conjugate vaccines. J Infect Chemother 2023; 29:1126-1131. [PMID: 37604429 DOI: 10.1016/j.jiac.2023.08.010] [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: 03/18/2023] [Revised: 07/22/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Sequential vaccination with the 13-valent pneumococcal protein conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for patients undergoing hemodialysis; however, evidence for the efficacy of these pneumococcal vaccines for patients undergoing hemodialysis is limited to a single dose. We aimed to evaluate the prognosis of patients undergoing hemodialysis who received vaccination with PPSV23 alone versus sequential vaccination with PCV13 and PPSV23. METHODS Patients undergoing hemodialysis who were vaccinated with PPSV23 alone (PPSV23 group) or PCV13 followed by PPSV23 (PCV13+PPSV23 group) between 2014 and 2016 were included; the observation period was three years from the first injection. Patients who underwent hemodialysis between 2011 and 2012 were included as controls. After propensity score matching using age, sex, dialysis vintage, diabetes history, pneumonia history, and serum albumin and creatinine levels, survival analysis was performed. RESULTS The study included 89, 71, and 319 patients in the PPSV23, PCV13+PPSV23, and control groups, respectively. After propensity score matching, the PPSV23 and control group 1 (79 patients each) and the PCV13+PPSV23 and control group 2 (61 patients each) were compared. Significant differences were observed in the survival rate between the PPSV23 group and control group 1 (p = 0.005) but not between the PCV13+PPSV23 group and control group 2. Pneumonia-related mortality in the two vaccinated groups did not differ significantly during the observation period. CONCLUSIONS Patients who received PPSV23 had a favorable prognosis; however, no positive effect was demonstrated in the PCV13+PPSV23 group.
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Affiliation(s)
- Kosei Yamaguchi
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Nagasaki Renal Center, Nagasaki, Japan
| | - Mineaki Kitamura
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Nagasaki Renal Center, Nagasaki, Japan.
| | - Takahiro Takazono
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | | | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Lee CC, Hsu CC, Lin MH, Chen KH, Wu IW. Hospitalization in patients with dialysis in Taiwan: A nationwide population-based observational study. J Formos Med Assoc 2022; 121 Suppl 1:S39-S46. [PMID: 34998659 DOI: 10.1016/j.jfma.2021.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The hospitalization rate is higher in patients with end-stage kidney disease (ESKD) than in the general population. However, the national estimates in Taiwan remain unclear. Therefore, we investigated the hospitalization rates of ESKD patients in a disease-specific manner from 2010 to 2018 in Taiwan. METHODS This population-based study was conducted using data from the National Health Insurance Research Database. We analyzed the hospitalization rates of patients with ESKD, defined as continuous dialysis for at least three successive months. The first diagnosis at discharge for each hospitalization was defined as the main diagnosis of hospitalization. The hospitalization rate in a certain year was calculated as the number of hospitalizations divided by the number of patients undergoing chronic dialysis in the respective year. RESULTS Hospitalization occurred in half of all prevalent ESKD patients, with an increasing trend over time. The hospitalization rate increased from 964.1 per 1000 person-years in 2010 to 1037.9 per 1000 person-years in 2018. ESKD patients who were male, aged over 75 years, and receiving hemodialysis had higher hospitalization rates. Infection-related hospitalization was the main cause of hospitalization, followed by cardiovascular disease. The 30-day re-admission rate was 19%, and the in-hospital mortality rate was 9%. CONCLUSION Hospitalization rates continued to increase from 2010 to 2018. The high hospitalization rates for infection-related diseases and hemodialysis patients call for further strategies to be developed that reduce the hospitalization burden.
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Affiliation(s)
- Chin-Chan Lee
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Ming-Huang Lin
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Kuan-Hsing Chen
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - I-Wen Wu
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Wang Y, Zhang Y, Wu H, Huang L, Yu H, Xie Z, Zhang H, Zhang W, Chen X, Zhang H, Zhang H, Jia C, Xia S, Wang S. Safety and immunogenicity of a quadrivalent inactivated subunit non-adjuvanted influenza vaccine: A randomized, double-blind, active-controlled phase 1 clinical trial. Vaccine 2021; 39:3871-3878. [PMID: 34088505 DOI: 10.1016/j.vaccine.2021.05.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/24/2021] [Accepted: 05/23/2021] [Indexed: 12/25/2022]
Abstract
Quadrivalent influenza inactivated vaccine (IIV4) is more likely to provide wider protection against yearly circulating influenza viruses than trivalent inactivated influenza vaccine (IIV3). In this study, a total of 320 participants were allocated to four age cohorts (6-35 months, 3-8 years, 9-17 years, and ≥ 18 years; 80 participants/cohort) according to their actual date of birth. Participants in each cohort were randomly assigned to two groups to receive intramuscular injection of the trial vaccine or the comparative vaccine in a one-dose (3-8 years, 9-17 years,and ≥ 18 years) schedule on day 0 or two-dose (6-35 months cohort) schedule on day 0 and 28. The first objective is to evaluate the safety and immunogenicity of the full-dose subunit non-adjuvanted IIV4 (FD-subunit NAIIV4) we developed versus an active-control, China-licensed split-virion NAIIV4, in people ≥ 3 years. The second objective is to evaluate the safety and immunogenicity of FD-subunit NAIIV4 versus the half-dose (HD-subunit NAIIV4) in toddlers aged 6-35 months. Results showed that all adverse reactions noted were rare, mild, and self-limited. In ≥ 3 years cohorts, systemic adverse reactions in FD-subunit NAIIV4 groups were less than the active control split-virion NAIIV4 groups ([Systemic adverse reaction rates (95%CI)], 15.0 (8.6-21.4) versus 19.2(12.1-26.2), p = 0.391). The overall seroprotection efficacy after vaccination were comparable between FD-subunit NAIIV4 and the active control split-virion NAIIV4([Seroprotection rates (95%CI)], H1N1, 99.2(81.3-100.0) versus 94.9(90.9-98.9), p = 0.117; H3N2, 81.7(74.7-88.6) versus 82.1(75.1-89.0), p = 0.939; BV, 75.8(68.2-83.5) versus 74.4(66.4-82.3), p = 0.793; BY, 94.2(90.0-98.4) versus 92.3(87.5-97.1), p = 0.568). Additionally, FD-subunit NAIIV4 has comparable safety and better seroprotection versus that of the half-dose in 6-35 months toddlers groups ([Total adverse reaction rates (95%CI)], 37.5(18.5-56.5) versus 47.5(26.1-68.9), p = 0.366) ([Seroprotection rates (95%CI)], H1N1, 85(56.4-100.0) versus 75.7(47.6-100.0), p = 0.117; H3N2, 50(28.1-71.9) versus 29.7(12.2-47.3), p = 0.070; BV, 75(48.2-100.0) versus 29.7(12.2-47.3), p < 0.001; BY, 75(48.2-100.0) versus 56.8(32.5-81.0), p = 0.091). As a result, the FD-subunit NAIIV4 we developed is safe and effective to provide broader and adequate protection against the circulating influenza viruses during 2018-2019, which could be an essential component of the global preventive strategy for influenza pandemic.
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Affiliation(s)
- Yanxia Wang
- Henan Provincial Centre for Disease Control and Prevention, Zhenzhou, Henan, China
| | - Yuhui Zhang
- Department of Quality Control, Ab&B Biotech Co., Ltd, Taizhou, Jiangsu, China
| | - Haofei Wu
- Department of Research and Development, Ab&B Biotech Co., Ltd, Taizhou, Jiangsu, China
| | - Lili Huang
- Henan Provincial Centre for Disease Control and Prevention, Zhenzhou, Henan, China
| | - Hailong Yu
- Department of Quality Control, Ab&B Biotech Co., Ltd, Taizhou, Jiangsu, China
| | - Zhiqiang Xie
- Henan Provincial Centre for Disease Control and Prevention, Zhenzhou, Henan, China
| | - Huiping Zhang
- Department of Quality Control, Ab&B Biotech Co., Ltd, Taizhou, Jiangsu, China
| | - Wei Zhang
- Henan Provincial Centre for Disease Control and Prevention, Zhenzhou, Henan, China
| | - Xiaofen Chen
- Department of Quality Control, Ab&B Biotech Co., Ltd, Taizhou, Jiangsu, China
| | - Huan Zhang
- Department of Research and Development, Ab&B Biotech Co., Ltd, Taizhou, Jiangsu, China
| | - Hongdong Zhang
- Department of Research and Development, Ab&B Biotech Co., Ltd, Taizhou, Jiangsu, China
| | - Chunyu Jia
- Department of Research and Development, Ab&B Biotech Co., Ltd, Taizhou, Jiangsu, China
| | - Shengli Xia
- Henan Provincial Centre for Disease Control and Prevention, Zhenzhou, Henan, China.
| | - Shuai Wang
- Department of Research and Development, Ab&B Biotech Co., Ltd, Taizhou, Jiangsu, China; Department of Research and Development, Yither Biotech Co., Ltd, Shanghai, China.
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