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Rodriguez Velásquez S, Biru LE, Hakiza SM, Al-Gobari M, Triulzi I, Dalal J, Varela CBG, Botero Mesa S, Keiser O. Long-term levels of protection of different types of immunity against the Omicron variant: a rapid literature review. Swiss Med Wkly 2024; 154:3732. [PMID: 38749028 DOI: 10.57187/s.3732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION With the emergence of newer SARS-CoV-2 variants and their substantial effects on the levels and duration of protection against infection, an understanding of these characteristics of the protection conferred by humoral and cellular immunity can aid in the proper development and implementation of vaccine and safety guidelines. METHODS We conducted a rapid literature review and searched five electronic databases weekly from 1 November 2021 to 30 September 2022. Studies that assessed the humoral or cellular immunity conferred by infection, vaccination or a hybrid (combination of both) in adults and risk groups (immunocompromised and older populations) were identified. Studies were eligible when they reported data on immunological assays of COVID-19 (related to vaccination and/or infection) or the effectiveness of protection (related to the effectiveness of vaccination and/or infection). RESULTS We screened 5103 studies and included 205 studies, of which 70 provided data on the duration of protection against SARS-CoV-2 infection. The duration of protection of adaptive immunity was greatly impacted by Omicron and its subvariants: levels of protection were low by 3-6 months from exposure to infection/vaccination. Although more durable, cellular immunity also showed signs of waning by 6 months. First and second mRNA vaccine booster doses increased the levels of protection against infection and severe disease from Omicron and its subvariants but continued to demonstrate a high degree of waning over time. CONCLUSION All humoral immunities (infection-acquired, vaccine-acquired and hybrid) waned by 3-6 months. Cellular immunity was more durable but showed signs of waning by 6 months. Hybrid immunity had the highest magnitude of protection against SARS-CoV-2 infection. Boosting may be recommended as early as 3-4 months after the last dose, especially in risk groups.
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Affiliation(s)
- Sabina Rodriguez Velásquez
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- The GRAPH Network, Geneva, Switzerland
| | - Loza Estifanos Biru
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- The GRAPH Network, Geneva, Switzerland
| | - Sandrine Marie Hakiza
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- The GRAPH Network, Geneva, Switzerland
| | - Muaamar Al-Gobari
- The GRAPH Network, Geneva, Switzerland
- HIV/AIDS Unit Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Isotta Triulzi
- The GRAPH Network, Geneva, Switzerland
- Scuola Superiore Sant'Anna, Pisa, Italy
| | | | | | - Sara Botero Mesa
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- The GRAPH Network, Geneva, Switzerland
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- The GRAPH Network, Geneva, Switzerland
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Zheng B, Campbell J, Carr EJ, Tazare J, Nab L, Mahalingasivam V, Mehrkar A, Santhakumaran S, Steenkamp R, Loud F, Lyon S, Scanlon M, Hulme WJ, Green ACA, Curtis HJ, Fisher L, Parker E, Goldacre B, Douglas I, Evans S, MacKenna B, Bell S, Tomlinson LA, Nitsch D. Comparative effectiveness of sotrovimab and molnupiravir for preventing severe COVID-19 outcomes in patients on kidney replacement therapy: observational study using the OpenSAFELY-UKRR and SRR databases. Clin Kidney J 2023; 16:2048-2058. [PMID: 37915915 PMCID: PMC10616487 DOI: 10.1093/ckj/sfad184] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Indexed: 11/03/2023] Open
Abstract
Background Due to limited inclusion of patients on kidney replacement therapy (KRT) in clinical trials, the effectiveness of coronavirus disease 2019 (COVID-19) therapies in this population remains unclear. We sought to address this by comparing the effectiveness of sotrovimab against molnupiravir, two commonly used treatments for non-hospitalised KRT patients with COVID-19 in the UK. Methods With the approval of National Health Service England, we used routine clinical data from 24 million patients in England within the OpenSAFELY-TPP platform linked to the UK Renal Registry (UKRR) to identify patients on KRT. A Cox proportional hazards model was used to estimate hazard ratios (HRs) of sotrovimab versus molnupiravir with regards to COVID-19-related hospitalisations or deaths in the subsequent 28 days. We also conducted a complementary analysis using data from the Scottish Renal Registry (SRR). Results Among the 2367 kidney patients treated with sotrovimab (n = 1852) or molnupiravir (n = 515) between 16 December 2021 and 1 August 2022 in England, 38 cases (1.6%) of COVID-19-related hospitalisations/deaths were observed. Sotrovimab was associated with substantially lower outcome risk than molnupiravir {adjusted HR 0.35 [95% confidence interval (CI) 0.17-0.71]; P = .004}, with results remaining robust in multiple sensitivity analyses. In the SRR cohort, sotrovimab showed a trend toward lower outcome risk than molnupiravir [HR 0.39 (95% CI 0.13-1.21); P = .106]. In both datasets, sotrovimab had no evidence of an association with other hospitalisation/death compared with molnupiravir (HRs ranged from 0.73 to 1.29; P > .05). Conclusions In routine care of non-hospitalised patients with COVID-19 on KRT, sotrovimab was associated with a lower risk of severe COVID-19 outcomes compared with molnupiravir during Omicron waves.
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Affiliation(s)
- Bang Zheng
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Jacqueline Campbell
- Scottish Renal Registry, Scottish Health Audits, Public Health Scotland, Glasgow, UK
| | | | - John Tazare
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Linda Nab
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | | | - Susan Lyon
- Patient Council, UK Kidney Association, Bristol, UK
| | | | - William J Hulme
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amelia C A Green
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Helen J Curtis
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louis Fisher
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Edward Parker
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ian Douglas
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Stephen Evans
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Samira Bell
- Scottish Renal Registry, Scottish Health Audits, Public Health Scotland, Glasgow, UK
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Laurie A Tomlinson
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Dorothea Nitsch
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- UK Renal Registry, Bristol, UK
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3
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Barnes E, Goodyear CS, Willicombe M, Gaskell C, Siebert S, I de Silva T, Murray SM, Rea D, Snowden JA, Carroll M, Pirrie S, Bowden SJ, Dunachie SJ, Richter A, Lim Z, Satsangi J, Cook G, Pope A, Hughes A, Harrison M, Lim SH, Miller P, Klenerman P, Basu N, Gilmour A, Irwin S, Meacham G, Marjot T, Dimitriadis S, Kelleher P, Prendecki M, Clarke C, Mortimer P, McIntyre S, Selby R, Meardon N, Nguyen D, Tipton T, Longet S, Laidlaw S, Orchard K, Ireland G, Thomas D, Kearns P, Kirkham A, McInnes IB. SARS-CoV-2-specific immune responses and clinical outcomes after COVID-19 vaccination in patients with immune-suppressive disease. Nat Med 2023; 29:1760-1774. [PMID: 37414897 PMCID: PMC10353927 DOI: 10.1038/s41591-023-02414-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 05/23/2023] [Indexed: 07/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immune responses and infection outcomes were evaluated in 2,686 patients with varying immune-suppressive disease states after administration of two Coronavirus Disease 2019 (COVID-19) vaccines. Overall, 255 of 2,204 (12%) patients failed to develop anti-spike antibodies, with an additional 600 of 2,204 (27%) patients generating low levels (<380 AU ml-1). Vaccine failure rates were highest in ANCA-associated vasculitis on rituximab (21/29, 72%), hemodialysis on immunosuppressive therapy (6/30, 20%) and solid organ transplant recipients (20/81, 25% and 141/458, 31%). SARS-CoV-2-specific T cell responses were detected in 513 of 580 (88%) patients, with lower T cell magnitude or proportion in hemodialysis, allogeneic hematopoietic stem cell transplantation and liver transplant recipients (versus healthy controls). Humoral responses against Omicron (BA.1) were reduced, although cross-reactive T cell responses were sustained in all participants for whom these data were available. BNT162b2 was associated with higher antibody but lower cellular responses compared to ChAdOx1 nCoV-19 vaccination. We report 474 SARS-CoV-2 infection episodes, including 48 individuals with hospitalization or death from COVID-19. Decreased magnitude of both the serological and the T cell response was associated with severe COVID-19. Overall, we identified clinical phenotypes that may benefit from targeted COVID-19 therapeutic strategies.
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Affiliation(s)
- Eleanor Barnes
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl S Goodyear
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Michelle Willicombe
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Charlotte Gaskell
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Stefan Siebert
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Thushan I de Silva
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School, The University of Sheffield, Sheffield, UK
| | - Sam M Murray
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Daniel Rea
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Miles Carroll
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Sarah Pirrie
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Sarah J Bowden
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Susanna J Dunachie
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alex Richter
- Clinical Immunology Service, University of Birmingham, Edgbaston, Birmingham, UK
| | - Zixiang Lim
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jack Satsangi
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Gordon Cook
- National Institute for Health Research, Leeds MIC, University of Leeds, Leeds, UK
| | - Ann Pope
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Ana Hughes
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Molly Harrison
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Sean H Lim
- Centre for Cancer Immunology, University of Southampton, Southampton, UK
| | - Paul Miller
- British Society of Blood and Marrow Transplantation and Cellular Therapy, Guy's Hospital, London, UK
| | - Paul Klenerman
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Neil Basu
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Ashley Gilmour
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Sophie Irwin
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Georgina Meacham
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Thomas Marjot
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Peter Kelleher
- Department of Infectious Diseases, Imperial College London, School of Medicine Chelsea and Westminster Hospital, London, UK
| | - Maria Prendecki
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Candice Clarke
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Paige Mortimer
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Stacey McIntyre
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Rachael Selby
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Naomi Meardon
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School, The University of Sheffield, Sheffield, UK
| | - Dung Nguyen
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Tom Tipton
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Stephanie Longet
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Stephen Laidlaw
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Kim Orchard
- Department of Haematology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Georgina Ireland
- UK Health Security Agency (UKHSA), Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - David Thomas
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
- National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Amanda Kirkham
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Iain B McInnes
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.
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Parker EP, Horne EM, Hulme WJ, Tazare J, Zheng B, Carr EJ, Loud F, Lyon S, Mahalingasivam V, MacKenna B, Mehrkar A, Scanlon M, Santhakumaran S, Steenkamp R, Goldacre B, Sterne JA, Nitsch D, Tomlinson LA. Comparative effectiveness of two- and three-dose COVID-19 vaccination schedules involving AZD1222 and BNT162b2 in people with kidney disease: a linked OpenSAFELY and UK Renal Registry cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 30:100636. [PMID: 37363796 PMCID: PMC10155829 DOI: 10.1016/j.lanepe.2023.100636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 06/28/2023]
Abstract
Background Kidney disease is a key risk factor for COVID-19-related mortality and suboptimal vaccine response. Optimising vaccination strategies is essential to reduce the disease burden in this vulnerable population. We therefore compared the effectiveness of two- and three-dose schedules involving AZD1222 (AZ; ChAdOx1-S) and BNT162b2 (BNT) among people with kidney disease in England. Methods With the approval of NHS England, we performed a retrospective cohort study among people with moderate-to-severe kidney disease. Using linked primary care and UK Renal Registry records in the OpenSAFELY-TPP platform, we identified adults with stage 3-5 chronic kidney disease, dialysis recipients, and kidney transplant recipients. We used Cox proportional hazards models to compare COVID-19-related outcomes and non-COVID-19 death after two-dose (AZ-AZ vs BNT-BNT) and three-dose (AZ-AZ-BNT vs BNT-BNT-BNT) schedules. Findings After two doses, incidence during the Delta wave was higher in AZ-AZ (n = 257,580) than BNT-BNT recipients (n = 169,205; adjusted hazard ratios [95% CIs] 1.43 [1.37-1.50], 1.59 [1.43-1.77], 1.44 [1.12-1.85], and 1.09 [1.02-1.17] for SARS-CoV-2 infection, COVID-19-related hospitalisation, COVID-19-related death, and non-COVID-19 death, respectively). Findings were consistent across disease subgroups, including dialysis and transplant recipients. After three doses, there was little evidence of differences between AZ-AZ-BNT (n = 220,330) and BNT-BNT-BNT recipients (n = 157,065) for any outcome during a period of Omicron dominance. Interpretation Among individuals with moderate-to-severe kidney disease, two doses of BNT conferred stronger protection than AZ against SARS-CoV-2 infection and severe disease. A subsequent BNT dose levelled the playing field, emphasising the value of heterologous RNA doses in vulnerable populations. Funding National Core Studies, Wellcome Trust, MRC, and Health Data Research UK.
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Affiliation(s)
- The OpenSAFELY Collaborative
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
- The Francis Crick Institute, London, NW1 1AT, UK
- Kidney Care UK, Alton, UK
- Patient Council, UK Kidney Association, Bristol, UK
- Kidney Research UK, Peterborough, UK
- UK Renal Registry, Bristol, UK
- Health Data Research UK South-West, Bristol, UK
| | - Edward P.K. Parker
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Elsie M.F. Horne
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - William J. Hulme
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - John Tazare
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Bang Zheng
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | | | - Susan Lyon
- Patient Council, UK Kidney Association, Bristol, UK
| | | | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | | | | | | | - Ben Goldacre
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Jonathan A.C. Sterne
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- Health Data Research UK South-West, Bristol, UK
| | - Dorothea Nitsch
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- UK Renal Registry, Bristol, UK
| | - Laurie A. Tomlinson
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - The LH&W NCS (or CONVALESCENCE) Collaborative
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
- The Francis Crick Institute, London, NW1 1AT, UK
- Kidney Care UK, Alton, UK
- Patient Council, UK Kidney Association, Bristol, UK
- Kidney Research UK, Peterborough, UK
- UK Renal Registry, Bristol, UK
- Health Data Research UK South-West, Bristol, UK
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Soeiro EMD, Penido MGMG, Palma LMP, Bresolin NL, Lima EJDF, Koch VHK, Tavares MDS, Sylvestre L, Bernardes RDP, Garcia CD, de Andrade MC, Kaufman A, Chow CYZ, Martins SBS, Camargo SFDN. The challenges of the pandemic and the vaccination against covid-19 in pediatric patients with kidney disease. J Bras Nefrol 2023; 45:244-251. [PMID: 36282106 PMCID: PMC10627141 DOI: 10.1590/2175-8239-jbn-2022-0081en] [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: 05/07/2022] [Accepted: 09/11/2022] [Indexed: 11/21/2022] Open
Abstract
The covid-19 vaccine confers direct protection and reduces transmission rates of the virus and new variants. Vaccines from Pfizer/BioNTech and CoronaVac have been cleared for children in Brazil. They are safe, effective, and immunogenic. There are no known complications associated with the use of steroids or vaccines in pediatric patients with covid-19 and nephrotic syndrome. With or without immunosuppression, these patients are not at increased risk of severe covid-19, and steroids are safe for them. A milder form of covid-19 occurs in patients with chronic kidney disease without the need for hospitalization. The vaccine response may be reduced and/or the duration of antibodies after vaccination may be shorter than in the general population. However, considering risk of exposure, vaccination against covid-19 is recommended. It is believed that patients with hemolytic-uremic syndrome are at higher risk of severe covid-19. Vaccination is recommended, although specific data on the safety and efficacy of the covid-19 vaccine are limited. There is agreement that the benefits of induced immunity outweigh the risks of immunization. Vaccination against covid-19 is recommended for children and adolescents needing kidney transplantation or who have undergone transplantation. These patients present decreased immune response after vaccination, but immunization is recommended because the benefits outweigh the risks of vaccination. Current recommendations in Brazil stipulate the use of the messenger RNA vaccine. This paper aims to provide pediatric nephrologists with the latest knowledge about vaccination against covid-19 for children with kidney disease.
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Affiliation(s)
| | | | | | | | | | - Vera Hermina Kalika Koch
- Hospital das Clínicas da Faculdade de Medicina da USP, Instituto da
Criança e do Adolescente, São Paulo, SP, Brazil
| | - Marcelo de Sousa Tavares
- Santa Casa de Belo Horizonte, Centro de Nefrologia, Unidade de
Nefrologia Pediátrica, Belo Horizonte, MG, Brazil
| | | | | | - Clotilde Druck Garcia
- Universidade Federal de Ciências da Saúde de Porto Alegre, Santa
Casa de Porto Alegre, Serviço de Pediátrica, Porto Alegre, RS, Brazil
| | | | - Arnauld Kaufman
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de
Janeiro, RJ, Brazil
- Universidade Federal do Rio de Janeiro, RJ, Brazil
- Hospital Federal dos Servidores do Estado do Rio de Janeiro, RJ,
Brazil
- Grupo Assistência Médica Nefrológica, Rio de Janeiro, RJ,
Brazil
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6
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McDonnell T, Wu HHL, Kalra PA, Chinnadurai R. COVID-19 in Elderly Patients Receiving Haemodialysis: A Current Review. Biomedicines 2023; 11:biomedicines11030926. [PMID: 36979905 PMCID: PMC10046485 DOI: 10.3390/biomedicines11030926] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
There is an increased incidence of elderly adults diagnosed with kidney failure as our global aging population continues to expand. Hence, the number of elderly adults indicated for kidney replacement therapy is also increasing simultaneously. Haemodialysis initiation is more commonly observed in comparison to kidney transplantation and peritoneal dialysis for the elderly. The onset of the coronavirus 2019 (COVID-19) pandemic brought new paradigms and insights for the care of this patient population. Elderly patients receiving haemodialysis have been identified as high-risk groups for poor COVID-19 outcomes. Age, immunosenescence, impaired response to COVID-19 vaccination, increased exposure to sources of COVID-19 infection and thrombotic risks during dialysis are key factors which demonstrated significant associations with COVID-19 incidence, severity and mortality for this patient group. Recent findings suggest that preventative measures such as regular screening and, if needed, isolation in COVID-19-positive cases, alongside the fulfillment of COVID-19 vaccination programs is an integral strategy to reduce the number of COVID-19 cases and consequential complications from COVID-19, particularly for high-risk groups such as elderly haemodialysis patients. The COVID-19 pandemic brought about the rapid development and repurposing of a number of medications to treat patients in the viral and inflammatory stages of their disease. However, elderly haemodialysis patients were grossly unrepresented in many of these trials. We review the evidence for contemporary treatments for COVID-19 in this population to provide clinicians with an up-to-date guide. We hope our article increases awareness on the associations and impact of COVID-19 for the elderly haemodialysis population, and encourage research efforts to address knowledge gaps in this topical area.
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Affiliation(s)
- Thomas McDonnell
- Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK
| | - Henry H. L. Wu
- Renal Research Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, The University of Sydney, Sydney, NSW 2065, Australia
- Correspondence: ; Tel.: +61-9926-4751
| | - Philip A. Kalra
- Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M1 7HR, UK
| | - Rajkumar Chinnadurai
- Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M1 7HR, UK
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7
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Huth L, Schäfer L, Almanzar G, Lupoli G, Bischof M, Wratil PR, Stövesand T, Drechsler C, Keppler OT, Prelog M. Immunologic Effect of Bivalent mRNA Booster in Patients Undergoing Hemodialysis. N Engl J Med 2023; 388:950-952. [PMID: 36791308 PMCID: PMC9944762 DOI: 10.1056/nejmc2216309] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Luca Huth
- University Hospital Würzburg, Würzburg, Germany
| | | | | | - Gaia Lupoli
- Ludwig Maximilian University, Munich, Germany
| | | | | | - Torsten Stövesand
- Kuratorium für Dialyse und Nierentransplantation, Neu-Isenburg, Germany
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8
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Ling TC, Chen PL, Li NY, Ko WC, Sun CY, Chao JY, Shieh CC, Shen CF, Wu JL, Huang TC, Chao CH, Wang JR, Chang YT. Trajectory of Humoral Responses to Two Doses of ChAdOx1 nCoV-19 Vaccination in Patients Receiving Maintenance Hemodialysis. Microbiol Spectr 2023; 11:e0344522. [PMID: 36809164 PMCID: PMC10100369 DOI: 10.1128/spectrum.03445-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/27/2023] [Indexed: 02/23/2023] Open
Abstract
The ChAdOx1 nCoV-19 (AZD1222) vaccine is one of the most commonly delivered SARS-CoV-2 vaccines worldwide; however, few clinical studies have investigated its immunogenicity in dialysis patients. We prospectively enrolled 123 patients on maintenance hemodialysis at a medical center in Taiwan. All patients were infection-naive, had received two doses of the AZD1222 vaccine, and were monitored for 7 months. The primary outcomes were anti-SARS-CoV-2 receptor-binding domain (RBD) antibody concentrations before and after each dose and 5 months after the second dose and neutralization capacity against ancestral SARS-CoV-2, delta, and omicron variants. The anti-SARS-CoV-2 RBD antibody titers significantly increased with time following vaccination, with a peak at 1 month after the second dose (median titer, 498.8 U/mL; interquartile range, 162.5 to 1,050 U/mL), and a 4.7-fold decrease at 5 months. At 1 month after the second dose, 84.6, 83.7, and 1.6% of the participants had neutralizing antibodies against the ancestral virus, delta variant, and omicron variant, respectively, measured by a commercial surrogate neutralization assay. The geometric mean 50% pseudovirus neutralization titers for the ancestral virus, delta variant, and omicron variant were 639.1, 264.2, and 24.7, respectively. The anti-RBD antibody titers correlated well with neutralization capacity against the ancestral virus and delta variant. Transferrin saturation and C-reactive protein were associated with neutralization against the ancestral virus and delta variant. Although two doses of the AZD1222 vaccine initially elicited high anti-RBD antibody titers and neutralization against the ancestral virus and delta variant in hemodialysis patients, neutralizing antibodies against omicron variant were rarely detected, and the anti-RBD and neutralization antibodies waned over time. Additional/booster vaccinations are warranted in this population. IMPORTANCE Patients with kidney failure have worse immune response following vaccination compared to general population, but few clinical studies have investigated immunogenicity of ChAdOx1 nCoV-19 (AZD1222) vaccination in hemodialysis patients. Here, we showed two doses of AZD1222 vaccines lead to high seroconversion rate of anti-SARS-CoV-2 receptor-binding domain (RBD) antibodies, and more than 80% patients acquired neutralizing antibodies against ancestral virus and delta variant. However, seldom did they obtain neutralizing antibodies against the omicron variant. The geometric mean 50% pseudovirus neutralization titer against the ancestral virus was 25.9-fold higher than that against the omicron variant. Also, there was a substantial decay in anti-RBD titers with time. Our findings provided evidence supporting that more protective measures, including additional/booster vaccinations, is warranted in these patients during the current COVID-19 pandemic.
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Affiliation(s)
- Tsai-Chieh Ling
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Lin Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Infection Control Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nan-Yao Li
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Yao Sun
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jo-Yen Chao
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Chang Shieh
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jia-Ling Wu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Teng-Ching Huang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chiao-Hsuan Chao
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jen-Ren Wang
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Tainan, Taiwan
| | - Yu-Tzu Chang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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9
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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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10
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Banshodani M, Kawanishi H, Hirai T, Kawai Y, Hashimoto S, Shintaku S, Moriishi M, Marubayashi S, Tsuchiya S. The predictive markers of severity and mortality in hospitalized hemodialysis patients with COVID-19 during Omicron epidemic. Ther Apher Dial 2023. [PMID: 36691364 DOI: 10.1111/1744-9987.13970] [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: 08/29/2022] [Revised: 12/05/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Predictive markers and prognosis remain unclear in hospitalized hemodialysis (HD) patients with coronavirus disease 2019 (COVID-19) during the Omicron epidemic. METHODS We evaluated characteristics, laboratory parameters, and outcomes in hospitalized HD patients with COVID-19 (n = 102) at two centers between January and April 2022. RESULTS The 30-day mortality rate was higher in moderate-critical group (n = 43) than mild group (n = 59) (16.3% vs. 1.7%; p = 0.007), and higher in patients with lower CC chemokine ligand 17 (CCL17) levels (<95.0 pg/mL) compared with normal CCL17 levels (19.0% versus 4.9%; p = 0.03). In multivariate analyses, a low CCL17 level (p = 0.003) was associated with moderate-critical conditions, and moderate-critical conditions (p = 0.04) were associated with 30-day mortality, whereas CCL17 was not associated with 30-day mortality. CONCLUSIONS COVID-19 remains a fatal complication, and CCL17 was a predictive marker of severity in hospitalized HD patients during the Omicron epidemic.
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Affiliation(s)
- Masataka Banshodani
- Kidney Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Hideki Kawanishi
- Kidney Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Takayuki Hirai
- Kidney Disease and Dialysis, Akane-Foundation, Ajina Tsuchiya Hospital, Hatsukaichi, Japan
| | - Yusuke Kawai
- Kidney Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Shinji Hashimoto
- Kidney Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Sadanori Shintaku
- Kidney Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Misaki Moriishi
- Kidney Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Seiji Marubayashi
- Kidney Disease and Dialysis, Akane-Foundation, Ajina Tsuchiya Hospital, Hatsukaichi, Japan
| | - Shinichiro Tsuchiya
- Kidney Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
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11
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Soeiro EMD, Penido MGMG, Palma LMP, Bresolin NL, Lima EJDF, Koch VHK, Tavares MDS, Sylvestre L, Bernardes RDP, Garcia CD, Andrade MCD, Kaufman A, Chow CYZ, Martins SBS, Camargo SFDN. Os desafios da pandemia e a vacinação covid-19 na população pediátrica com doenças renais. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2022-0081pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo A vacina covid-19 confere proteção direta, reduz as taxas de transmissão do vírus e de novas variantes. No Brasil, estão liberadas para a população pediátrica as vacinas Pfizer/BioNTech e a CoronaVac, ambas seguras, eficazes e imunogênicas. Pacientes pediátricos com síndrome nefrótica e covid-19 têm curso clínico regular sem complicações relacionadas ao uso de esteroides ou vacinas. Esses pacientes, com ou sem imunossupressão, não apresentam maior risco de covid-19 grave e o tratamento com esteroides é seguro. Os pacientes com doença renal crônica têm covid-19 mais leve, sem necessidade de hospitalização. A resposta vacinal pode ser reduzida e/ou a duração dos anticorpos pós-vacinação pode ser menor do que na população geral. Entretanto, a vacina covid-19 está recomendada, considerando o risco de exposição. Acredita-se que pacientes com síndrome hemolítico-urêmica teriam maior risco de covid-19 grave. A vacina é recomendada, embora dados específicos sobre segurança e eficácia da vacina covid-19 sejam limitados. Há concordância que os benefícios da imunidade induzida superam quaisquer riscos da imunização. A vacina covid-19 é recomendada para crianças e adolescentes candidatos ao transplante renal ou já transplantados. Esses pacientes têm resposta imunológica reduzida após a vacina, entretanto ela é recomendada porque os benefícios superam qualquer risco dessa vacinação. A recomendação atual no Brasil é a vacina de tecnologia RNA mensageiro. O objetivo deste documento é levar aos nefrologistas pediátricos os conhecimentos mais recentes sobre a vacinação contra contra-19 em crianças com doenças renais.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Arnauld Kaufman
- Instituto de Puericultura e Pediatria Martagão Gesteira, Brazil; Universidade Federal do Rio de Janeiro, Brazil; Hospital Federal dos Servidores do Estado do Rio de Janeiro, Brazil; Grupo Assistência Médica Nefrológica, Brazil
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12
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Brown M, Saund J, Qureshi A, Plowright M, Drury K, Gahir J, Simpson T, Newman T, Adams K, Galloway J, Durairaj K, Elgizouli K, Rampling T, Cole J, Easom N, Goodman AL, Marks M. Demographics and Outcomes of Initial Phase of COVID-19 Medicines Delivery Units Across 4 UK Centers During Peak B1.1.529 Omicron Epidemic: A Service Evaluation. Open Forum Infect Dis 2022; 9:ofac527. [PMID: 36320201 PMCID: PMC9605703 DOI: 10.1093/ofid/ofac527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/04/2022] [Indexed: 12/04/2022] Open
Abstract
Background COVID-19 medicines delivery units (CMDU) were established in late December 2021 to deliver early antiviral therapy to patients classified as at risk with the aim of preventing hospitalization. Methods We performed a service evaluation at 4 CMDUs in England. We assessed demographics and triage outcomes of CMDU referral, uptake of antiviral therapy, and the rate of subsequent hospitalizations within 2 weeks of CMDU referral. Results Over a 3-week period, 4788 patients were referred and 3989 were ultimately assessed by a CMDU. Overall, 832 of the patients referred (17%) were judged eligible for treatment and 628 (13%) were ultimately prescribed an antiviral agent. The overall rate of admission within 14 days was 1%. Patients who were admitted were significantly older than those who did not require hospitalization. Of patients prescribed molnupiravir and sotrovimab, 1.8% and 3.2%, respectively, were admitted. Conclusions There was a high volume of referrals to CMDU service during the initial surge of the Omicron wave in the United Kingdom. A minority of patients were judged to be eligible for therapy. In a highly vaccinated population, the overall hospitalization rate was low.
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Affiliation(s)
- Michael Brown
- Division of Infection, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jasjot Saund
- Division of Infection, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Azka Qureshi
- Department of Infection, Guys and St Thomas’s NHS Foundation Trust, London, United Kingdom
- South East London Covid Prevention and Intervention Service, Guys and St Thomas’s NHS Foundation Trust, London, United Kingdom
| | - Megan Plowright
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Katie Drury
- Infection Research Group, Hull University Teaching Hospitals NHS Foundation Trust, Hull, United Kingdom
| | - Joshua Gahir
- Division of Infection, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Tom Simpson
- Department of Respiratory Medicine, Lewisham Hospital, London, United Kingdom
| | - Thomas Newman
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Kate Adams
- Infection Research Group, Hull University Teaching Hospitals NHS Foundation Trust, Hull, United Kingdom
| | - James Galloway
- Centre for Rheumatic Disease, Kings College London, London, United Kingdom
| | - Kezia Durairaj
- Department of Infection, Guys and St Thomas’s NHS Foundation Trust, London, United Kingdom
- South East London Covid Prevention and Intervention Service, Guys and St Thomas’s NHS Foundation Trust, London, United Kingdom
| | - Kamla Elgizouli
- Infection Research Group, Hull University Teaching Hospitals NHS Foundation Trust, Hull, United Kingdom
| | - Tommy Rampling
- Division of Infection, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Joby Cole
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Nicholas Easom
- Infection Research Group, Hull University Teaching Hospitals NHS Foundation Trust, Hull, United Kingdom
| | - Anna L Goodman
- Department of Infection, Guys and St Thomas’s NHS Foundation Trust, London, United Kingdom
- South East London Covid Prevention and Intervention Service, Guys and St Thomas’s NHS Foundation Trust, London, United Kingdom
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom
| | - Michael Marks
- Division of Infection, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Division of Infection and Immunity, University College London, London, United Kingdom
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13
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Montez-Rath ME, Garcia P, Han J, Cadden L, Hunsader P, Morgan C, Kerschmann R, Beyer P, Dittrich M, Block GA, Parsonnet J, Chertow GM, Anand S. SARS-CoV-2 Infection during the Omicron Surge among Patients Receiving Dialysis: The Role of Circulating Receptor-Binding Domain Antibodies and Vaccine Doses. J Am Soc Nephrol 2022; 33:1832-1839. [PMID: 35973733 PMCID: PMC9528334 DOI: 10.1681/asn.2022040504] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/17/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND It is unclear whether circulating antibody levels conferred protection against SARS-CoV-2 infection among patients receiving dialysis during the Omicron-dominant period. METHODS We followed monthly semiquantitative SARS-CoV-2 RBD IgG index values in a randomly selected nationwide cohort of patients receiving dialysis and ascertained SARS-CoV-2 infection during the Omicron-dominant period of December 25, 2021 to January 31, 2022 using electronic health records. We estimated the relative risk for documented SARS-CoV-2 infection by vaccination status and by circulating RBD IgG using a log-binomial model accounting for age, sex, and prior COVID-19. RESULTS Among 3576 patients receiving dialysis, 901 (25%) received a third mRNA vaccine dose as of December 24, 2021. Early antibody responses to third doses were robust (median peak index IgG value at assay limit of 150). During the Omicron-dominant period, SARS-CoV-2 infection was documented in 340 (7%) patients. Risk for infection was higher among patients without vaccination and with one to two doses (RR, 2.1; 95% CI, 1.6 to 2.8, and RR, 1.3; 95% CI, 1.0 to 1.8 versus three doses, respectively). Irrespective of the number of vaccine doses, risk for infection was higher among patients with circulating RBD IgG <23 (506 BAU/ml) (RR range, 2.1 to 3.2, 95% CI, 1.3 to 3.4 and 95% CI, 2.2 to 4.5, respectively) compared with RBD IgG ≥23. CONCLUSIONS Among patients receiving dialysis, a third mRNA vaccine dose enhanced protection against SARS-CoV-2 infection during the Omicron-dominant period, but a low circulating RBD antibody response was associated with risk for infection independent of the number of vaccine doses. Measuring circulating antibody levels in this high-risk group could inform optimal timing of vaccination and other measures to reduce risk of SARS-CoV-2 infection.
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Affiliation(s)
| | - Pablo Garcia
- Department of Medicine (Nephrology), Stanford University, Palo Alto, California
| | - Jialin Han
- Department of Medicine (Nephrology), Stanford University, Palo Alto, California
| | | | | | - Curt Morgan
- Ascend Clinical Laboratory, Redwood City, California
| | | | - Paul Beyer
- Ascend Clinical Laboratory, Redwood City, California
| | | | | | - Julie Parsonnet
- Department of Medicine (Infectious Diseases and Geographic Medicine), Stanford University, Palo Alto, California
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California
| | - Glenn M. Chertow
- Department of Medicine (Nephrology), Stanford University, Palo Alto, California
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California
| | - Shuchi Anand
- Department of Medicine (Nephrology), Stanford University, Palo Alto, California
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14
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Cheng CC, Platen L, Christa C, Tellenbach M, Kappler V, Bester R, Liao BH, Holzmann-Littig C, Werz M, Schönhals E, Platen E, Eggerer P, Tréguer L, Küchle C, Schmaderer C, Heemann U, Renders L, Protzer U, Braunisch MC. Improved SARS-CoV-2 Neutralization of Delta and Omicron BA.1 Variants of Concern after Fourth Vaccination in Hemodialysis Patients. Vaccines (Basel) 2022; 10:vaccines10081328. [PMID: 36016216 PMCID: PMC9415993 DOI: 10.3390/vaccines10081328] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 12/21/2022] Open
Abstract
Hemodialysis patients are exposed to a markedly increased risk when infected with SARS-CoV-2. To date, it is unclear if hemodialysis patients benefit from four vaccinations. A total of 142 hemodialysis patients received four COVID-19 vaccinations until March 2022. RDB binding antibody titers were determined in a competitive surrogate neutralization assay. Vero-E6 cells were infected with SARS-CoV-2 variants of concern (VoC), Delta (B.1.617.2), or Omicron (B.1.1.529, sub-lineage BA.1) to determine serum infection neutralization capacity. Four weeks after the fourth vaccination, serum infection neutralization capacity significantly increased from a 50% inhibitory concentration (IC50, serum dilution factor 1:x) of 247.0 (46.3−1560.8) to 2560.0 (1174.0−2560.0) for the Delta VoC, and from 37.5 (20.0−198.8) to 668.5 (182.2−2560.0) for the Omicron VoC (each p < 0.001) compared to four months after the third vaccination. A significant increase in the neutralization capacity was even observed for patients with high antibody titers after three vaccinations (p < 0.001). Ten patients with SARS-CoV-2 breakthrough infection after the first blood sampling had by trend lower prior neutralization capacity for Omicron (p = 0.051). Our findings suggest that hemodialysis patients benefit from a fourth vaccination in particular in the light of the highly infectious SARS-CoV-2 Omicron-variants. A routinely applied four-time vaccination seems to broaden immunity against variants and would be recommended in hemodialysis patients.
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Affiliation(s)
- Cho-Chin Cheng
- Institute of Virology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Louise Platen
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Catharina Christa
- Institute of Virology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Myriam Tellenbach
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Verena Kappler
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Romina Bester
- Institute of Virology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Bo-Hung Liao
- Institute of Virology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Christopher Holzmann-Littig
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
- TUM Medical Education Center, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Maia Werz
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Emely Schönhals
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Eva Platen
- Kidney Center Eifel Dialyse, 53894 Mechernich, Germany
| | - Peter Eggerer
- KfH Kidney Center Harlaching, Munich-Harlaching, 81545 Munich, Germany
| | | | - Claudius Küchle
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Lutz Renders
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
- German Center for Infection Research (DZIF), Partner Site, 81675 Munich, Germany
| | - Ulrike Protzer
- Institute of Virology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
- German Center for Infection Research (DZIF), Partner Site, 81675 Munich, Germany
- Institute of Virology, Helmholtz Munich, 85764 Munich, Germany
- Correspondence: (U.P.); (M.C.B.); Tel.: +0049-(0)-89-4140-6863 (U.P.); +0049-(0)-89-4140-2231 (M.C.B.); Fax: +0049-(0)-89-4140-6823 (U.P.); +0049-(0)-89-4140-7734 (M.C.B.)
| | - Matthias Christoph Braunisch
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
- Correspondence: (U.P.); (M.C.B.); Tel.: +0049-(0)-89-4140-6863 (U.P.); +0049-(0)-89-4140-2231 (M.C.B.); Fax: +0049-(0)-89-4140-6823 (U.P.); +0049-(0)-89-4140-7734 (M.C.B.)
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15
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Cantarelli C, Angeletti A, Perin L, Russo LS, Sabiu G, Podestà MA, Cravedi P. Immune responses to SARS-CoV-2 in dialysis and kidney transplantation. Clin Kidney J 2022; 15:1816-1828. [PMID: 36147709 PMCID: PMC9384565 DOI: 10.1093/ckj/sfac174] [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: 06/01/2022] [Indexed: 11/15/2022] Open
Abstract
Despite progressive improvements in the management of patients with coronavirus disease 2019 (COVID-19), individuals with end-stage kidney disease (ESKD) are still at high risk of infection-related complications. Although the risk of infection in these patients is comparable to that of the general population, their lower rate of response to vaccination is a matter of concern. When prevention strategies fail, infection is often severe. Comorbidities affecting patients on maintenance dialysis and kidney transplant recipients clearly account for the increased risk of severe COVID-19, while the role of uremia and chronic immunosuppression is less clear. Immune monitoring studies have identified differences in the innate and adaptive immune response against the virus that could contribute to the increased disease severity. In particular, individuals on dialysis show signs of T cell exhaustion that may impair antiviral response. Similar to kidney transplant recipients, antibody production in these patients occurs, but with delayed kinetics compared with the general population, leaving them more exposed to viral expansion during the early phases of infection. Overall, unique features of the immune response during COVID-19 in individuals with ESKD may occur with severe comorbidities affecting these individuals in explaining their poor outcomes.
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Affiliation(s)
- Chiara Cantarelli
- UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma , Parma , Italy
| | - Andrea Angeletti
- Division of Nephrology, Dialysis, Transplantation, IRCCS Istituto Giannina Gaslini
| | - Laura Perin
- GOFARR Laboratory for Organ Regenerative Research and Cell Therapeutics in Urology, Saban Research Institute, Division of Urology, Children's Hospital Los Angeles , Los Angeles, CA , USA ; , Los Angeles, CA
- Department of Urology, Keck School of Medicine, University of Southern California , Los Angeles, CA , USA ; , Los Angeles, CA
| | - Luis Sanchez Russo
- Department of Medicine, Icahn School of Medicine at Mount Sinai , New York, NY
| | - Gianmarco Sabiu
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Università degli Studi di Milano , Italy
| | - Manuel Alfredo Podestà
- Nephrology Unit, Department of Health Sciences, Università degli Studi di Milano , Italy
| | - Paolo Cravedi
- Department of Medicine, Icahn School of Medicine at Mount Sinai , New York, NY
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16
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Quiroga B, Soler MJ, Ortiz A, Mantecón CJJ, Pérez NN, Martín MS, Sato Y, Franco AJM, Zambrano DFP, Valverde RL, Diaz MO, González CC, López JMC, Pereira M, Parra EG, Horrillo AS, González CS, Toapanta N, Guldris SC, Hernández RS, Sánchez SP, Rincón MM, Garcia-Fernandez N, Castro NB, Mateo RC, Morales MAQ, Escamilla-Cabrera B, Godoy IB, Casanova BGC, Leyva A, Rojas J, Gansevoort RT, de Sequera P, Carretero MP, Tocora DG, Rodríguez MTJ, Zanón TT, Suárez ER, Santolaya AJS, Calero RC, Cobo PA, Ramos PM, Gracia-Iguacel C, Martin-Cleary C, Sánchez-Rodríguez J, Ramos-Verde A, Giraldo YG, 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, Granados NM, Cabo MJC, Alarcón WL, Alexandru S, Suarez LGP, Saico SP, Tapia MP, Osorio LR, Zamora R, Moreno PLM, González NA, Ortiz AS, Iñarrea MNB, García T, Narváez C, Orellana C, León JLP, García MAM, Jiménez BG, Moya JDDR, Espinosa DL, Herrador AJ, Zurita MN, Díaz Álvarez L, Martínez ÁG, Arroyo SB, Fernández RR, Vargas MJS, Casero RC, Useche G, de Miguel CS, Palacios Á, Henningsmeyer B, Calve EO, Moya JL, Gash SC, Martínez LR, Perez VLDLM, Arevalo MC, Calvo JAH, Salgueira M, Aresté N, Rodríguez MDLÁ, Collantes R, Martínez AI, Moyano MJ, Víbora EJ, Hernández APR, Rebollo MSG, Hernández JMR, Aguilera ET, Alea RT, Saldaña MSDR, de la Pisa AMU, Monzon LS, Anachuri KA, Garcia EH, Gomez VO, Cavalotti IM, Zorita IN, López SO, González SO, Montañez CS, Serna MRDA, Perich LG, de la Rosa EC. Anti-Spike antibodies three months after SARS-CoV-2 mRNA vaccine booster dose in patients on hemodialysis: the prospective SENCOVAC study. Clin Kidney J 2022; 15:1856-1864. [PMID: 36147708 PMCID: PMC9384616 DOI: 10.1093/ckj/sfac169] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Patients on hemodialysis are at high-risk for complications derived from coronavirus disease-19 (COVID-19). The present analysis evaluated the impact of a booster vaccine dose and breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on humoral immunity three months after the booster dose.
Methods
This is a multicentric and prospective study assessing IgG anti-Spike antibodies 6 and 9 months after initial SARS-CoV-2 vaccination in patients on hemodialysis that had also received a booster dose before the 6-month assessment (early booster) or between the 6- and 9-month assessments (late booster). The impact of breakthrough infections, type of vaccine, time from the booster and clinical variables were assessed.
Results
A total of 711 patients (67% male, 67 [20-89] years) were included. Of which, 545 (77%) received an early booster and the rest a late booster. At 6 months, 64 (9%) patients had negative anti-Spike antibody titers (3% of early booster and 29% of late booster patients, p = 0.001). At 9 months, 91% of patients with 6-month negative response had seroconverted and there were no differences in residual prevalence of negative humoral response between early and late booster patients (0.9% vs 0.6%, p = 0.693). During follow-up, 35 patients (5%) developed breakthrough SARS-CoV-2 infection. Antibody titers at 9 months were independently associated to mRNA-1273 booster (p = 0.001), lower time from booster (p = 0.043) and past breakthrough SARS-CoV-2 infection (p<0.001).
Conclusions
In hemodialysis patients, higher titers of anti-Spike antibodies at 9 months were associated to mRNA-1273 booster, lower time from booster and past breakthrough SARS-CoV-2 infection.
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Affiliation(s)
- Borja Quiroga
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa , Madrid ( Spain )
| | - María José Soler
- Nephrology Department, Vall d'Hebrón University Hospital , 08035 Barcelona ( Spain )
- RICORS2040 (Kidney Disease)
| | - Alberto Ortiz
- RICORS2040 (Kidney Disease)
- IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Álvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III , Madrid ( Spain )
| | | | | | | | | | | | | | - Rafael Lucena Valverde
- Nephrology Department, Hospital Universitario Infanta Leonor – Universidad Complutense de Madrid ( Spain )
| | - Mayra Ortega Diaz
- Nephrology Department, Hospital Universitario Infanta Leonor – Universidad Complutense de Madrid ( Spain )
| | | | | | - Mónica Pereira
- IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Álvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III , Madrid ( Spain )
| | - Emilio González Parra
- IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Álvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III , Madrid ( Spain )
| | - Ana Sánchez Horrillo
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa , Madrid ( Spain )
| | - Carmen Sánchez González
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa , Madrid ( Spain )
| | - Néstor Toapanta
- Nephrology Department, Vall d'Hebrón University Hospital , 08035 Barcelona ( 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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Bell S, Campbell J, Watters C, O'Neil M, Almond A, Buck K, Carr EJ, Cousland Z, Findlay M, Joss N, Metcalfe W, Spalding E, Methven S, Mark PB. The impact of Omicron on outcomes following infection with SARS-CoV-2 in patients with kidney failure in Scotland. Clin Kidney J 2022; 16:197-200. [PMID: 36721388 PMCID: PMC9384465 DOI: 10.1093/ckj/sfac173] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
| | - Jacqueline Campbell
- The Scottish Renal Registry, Scottish Health Audits, Public Health Scotland, Glasgow, UK
| | - Chrissie Watters
- The Scottish Renal Registry, Scottish Health Audits, Public Health Scotland, Glasgow, UK
| | - Martin O'Neil
- The Scottish Renal Registry, Scottish Health Audits, Public Health Scotland, Glasgow, UK
| | | | | | - Edward J Carr
- Cell Biology of Infection Laboratory, Francis Crick Institute, London, UK
| | | | - Mark Findlay
- Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Nicola Joss
- Renal Unit, Raigmore Hospital, Inverness, UK
| | - Wendy Metcalfe
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Shona Methven
- Department of Renal Medicine, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Patrick B Mark
- Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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18
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Ashby DR, Caplin B, Corbett RW, Asgari E, Kumar N, Sarnowski A, Hull R, Makanjuola D, Cole N, Chen J, Nyberg S, Forbes S, McCafferty K, Zaman F, Cairns H, Sharpe C, Bramham K, Motallebzadeh R, Anwari K, Roper T, Salama AD, Banerjee D. Outcome and effect of vaccination in SARS-CoV-2 Omicron infection in hemodialysis patients: a cohort study. Nephrol Dial Transplant 2022; 37:1944-1950. [PMID: 35767848 PMCID: PMC9278226 DOI: 10.1093/ndt/gfac209] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background Hemodialysis patients are at high risk of Covid-19, though vaccination has significant efficacy in preventing and reducing the severity of infection. Little information is available on disease severity and vaccine efficacy since the dissemination of the Omicron variant. Methods In a multi-center study, during a period of the epidemic driven by the Omicron variant, all hemodialysis patients positive for SARS-CoV-2 were identified. Outcomes were analyzed according to predictor variables including vaccination status. Risk of infection was analyzed using a Cox proportional hazards model. Results SARS-CoV-2 infection was identified in 1126 patients including 200 (18%) unvaccinated, 56 (5%) post first dose, 433 (38%) post second dose, and 437 (39%) at least 7 days beyond their third dose. The majority of patients had a mild course but 160 (14%) were hospitalized and 28 (2%) died. In regression models adjusted for age and comorbidity, two-dose vaccination was associated with a 39% (95%CI: 2%–62%) reduction in admissions, but third doses provided additional protection, with a 51% (95%CI: 25%–69%) further reduction in admissions. Among 1265 patients at risk at the start of the observation period, SARS-CoV-2 infection was observed in 211 (17%). Two-dose vaccination was associated with a 41% (95%CI: 3%–64%) reduction in the incidence of infection, with no clear additional effect provided by third doses. Conclusions These data demonstrate lower incidence of SARS-CoV-2 infection after vaccination in dialysis patients during an Omicron dominant period of the epidemic. Among those developing infection, severe illness was less common with prior vaccination, particularly after third vaccine doses.
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Affiliation(s)
- Damien R Ashby
- Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.,Department of Immunology and Inflammation, Imperial College London, UK
| | - Ben Caplin
- Department of Renal Medicine, University College London, UK
| | - Richard W Corbett
- Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Elham Asgari
- Kidney Services, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Nicola Kumar
- Kidney Services, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Alexander Sarnowski
- Renal and Transplantation Unit, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Richard Hull
- Renal and Transplantation Unit, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - David Makanjuola
- South West Thames Renal and Transplantation Unit, Epsom and St. Helier University Hospitals NHS Trust, London, UK
| | - Nicholas Cole
- South West Thames Renal and Transplantation Unit, Epsom and St. Helier University Hospitals NHS Trust, London, UK
| | - Jian Chen
- Renal Service, Barts Health NHS Trust, London, UK
| | - Sofia Nyberg
- Renal Service, Barts Health NHS Trust, London, UK
| | | | | | - Faryal Zaman
- Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Hugh Cairns
- Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Claire Sharpe
- Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Kate Bramham
- Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | | | | | - Tayeba Roper
- Royal Free London NHS Foundation Trust, London, UK
| | - Alan D Salama
- Department of Renal Medicine, University College London, UK
| | - Debasish Banerjee
- Renal and Transplantation Unit, St. George's University Hospitals NHS Foundation Trust, London, UK
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19
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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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20
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Tillmann FP, Figiel L, Ricken J, Still H, Korte C, Plaßmann G, Harth A, Jörres A, von Landenberg P. Effect of Third and Fourth mRNA-Based Booster Vaccinations on SARS-CoV-2 Neutralizing Antibody Titer Formation, Risk Factors for Non-Response, and Outcome after SARS-CoV-2 Omicron Breakthrough Infections in Patients on Chronic Hemodialysis: A Prospective Multicenter Cohort Study. J Clin Med 2022; 11:jcm11113187. [PMID: 35683580 PMCID: PMC9181211 DOI: 10.3390/jcm11113187] [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: 04/10/2022] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 02/06/2023] Open
Abstract
The aim of this study is to determine the effect of repeated vaccinations on neutralizing SARS-CoV-2 IgG antibody titers, evaluate risk factors for immunological non-response, and to report breakthrough infections in chronic hemodialysis patients. Methods: A prospective, multi-center cohort study in 163 chronic hemodialysis patients was conducted. Antibody titers were measured three months after second, third, and fourth (10 pts) booster vaccinations. SARS-CoV-2 neutralizing antibody titers in BAU/mL and % inhibition were divided into three categories (<216, 216–433, >433 and <33, 33–66, and >66%). Somers’s test, paired t-test, and univariable and multivariable logistic regression analysis were applied to evaluate differences in antibody levels and search for risk factors for vaccination failure defined as neutralizing titers <50% and/or need for repeated booster vaccinations. Furthermore, we report on a case series to describe characteristics of patients after four vaccinations (n = 10) and breakthrough infections (n = 20). Results: Third dose boosters resulted in higher proportions of patients with neutralizing antibody levels >66% as compared to after the second dose (64.7% after second dose vs. 88.9% after third dose, p = 0.003), as well as in a respective increase in neutralizing titer levels in % from 68 ± 33% to 89 ± 24 (p < 0.001). The proportion of patients with IgG-titers below 216 BAU/mL decreased from 38.6 to 10.5% (p ≤ 0.001). Age (p = 0.004, OR 1.066, 95% CI 1.020–1.114) and presence of immunosuppressive medications (p = 0.002, OR 8.267, 95% CI 2.206–30.975) were identified as major risk factors for vaccination failure. Repeated booster vaccinations ≥4 times were effective in 8 out of 10 former low-responders (80%) without any side effects or safety concerns. Breakthrough infections showed a clinically mild course but were associated with prolonged viral shedding on PCR-testing ranging 7–29 (mean 13) days. Conclusions: Third and fourth mRNA-based booster vaccinations resulted in higher and longer lasting SARS-CoV-2 antibody levels as compared to after two dosages. The presence of immunosuppressive medication and repeat vaccinations are major potentially modifiable measures to increase antibody levels in non-or low-responders. Breakthrough infections with SARS-CoV-2 Omicron were associated with prolonged viral shedding but clinically mild disease courses.
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Affiliation(s)
- Frank-Peter Tillmann
- Department of Medicine I—Nephrology, Transplantation & Medical Intensive Care, Medical Center Cologne-Merheim, University Witten/Herdecke, Ostmerheimer Str. 200, D-51109 Cologne, Germany; (A.H.); (A.J.)
- Nephrologisches Zentrum Ibbenbüren, Gravenhorsterstr. 1, D-49477 Ibbenbüren, Germany;
- Correspondence:
| | - Lars Figiel
- Nephrologisches Zentrum Emsdetten, Nordwalderstr. 48-50, D-48282 Emsdetten, Germany; (L.F.); (C.K.)
| | - Johannes Ricken
- Nephrologisches Zentrum Rheine, Neuenkirchenerstr. 104, D-48431 Rheine, Germany; (J.R.); (G.P.)
| | - Hermann Still
- Nephrologisches Zentrum Ibbenbüren, Gravenhorsterstr. 1, D-49477 Ibbenbüren, Germany;
| | - Christoph Korte
- Nephrologisches Zentrum Emsdetten, Nordwalderstr. 48-50, D-48282 Emsdetten, Germany; (L.F.); (C.K.)
| | - Grete Plaßmann
- Nephrologisches Zentrum Rheine, Neuenkirchenerstr. 104, D-48431 Rheine, Germany; (J.R.); (G.P.)
| | - Ana Harth
- Department of Medicine I—Nephrology, Transplantation & Medical Intensive Care, Medical Center Cologne-Merheim, University Witten/Herdecke, Ostmerheimer Str. 200, D-51109 Cologne, Germany; (A.H.); (A.J.)
| | - Achim Jörres
- Department of Medicine I—Nephrology, Transplantation & Medical Intensive Care, Medical Center Cologne-Merheim, University Witten/Herdecke, Ostmerheimer Str. 200, D-51109 Cologne, Germany; (A.H.); (A.J.)
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Shields AM, Faustini SE, Hill HJ, Al-Taei S, Tanner C, Ashford F, Workman S, Moreira F, Verma N, Wagg H, Heritage G, Campton N, Stamataki Z, Drayson MT, Klenerman P, Thaventhiran JED, Elkhalifa S, Goddard S, Johnston S, Huissoon A, Bethune C, Elcombe S, Lowe DM, Patel SY, Savic S, Richter AG, Burns SO. Increased Seroprevalence and Improved Antibody Responses Following Third Primary SARS-CoV-2 Immunisation: An Update From the COV-AD Study. Front Immunol 2022; 13:912571. [PMID: 35720400 PMCID: PMC9201027 DOI: 10.3389/fimmu.2022.912571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background Patients with primary and secondary antibody deficiency are vulnerable to COVID-19 and demonstrate diminished responses following two-dose SARS-CoV-2 vaccine schedules. Third primary vaccinations have been deployed to enhance their humoral and cellular immunity. Objectives To determine the immunogenicity of the third primary SARS-CoV-2 immunisation in a heterogeneous cohort of patients with antibody deficiency. Methods Participants enrolled in the COV-AD study were sampled before and after their third vaccine dose. Serological and cellular responses were determined using ELISA, live-virus neutralisation and ELISPOT assays. Results Following a two-dose schedule, 100% of healthy controls mounted a serological response to SARS-CoV-2 vaccination, however, 38.6% of individuals with antibody deficiency remained seronegative. A third primary SARS-CoV-2 vaccine significantly increased anti-spike glycoprotein antibody seroprevalence from 61.4% to 76.0%, the magnitude of the antibody response, its neutralising capacity and induced seroconversion in individuals who were seronegative after two vaccine doses. Vaccine-induced serological responses were broadly cross-reactive against the SARS-CoV-2 B.1.1.529 variant of concern, however, seroprevalence and antibody levels remained significantly lower than healthy controls. No differences in serological responses were observed between individuals who received AstraZeneca ChAdOx1 nCoV-19 and Pfizer BioNTech 162b2 during their initial two-dose vaccine schedule. SARS-CoV-2 infection-naive participants who had received a heterologous vaccine as a third dose were significantly more likely to have a detectable T cell response following their third vaccine dose (61.5% vs 11.1%). Conclusion These data support the widespread use of third primary immunisations to enhance humoral immunity against SARS-CoV-2 in individuals with antibody deficiency.
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Affiliation(s)
- Adrian M. Shields
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
- Department of Clinical Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Sian E. Faustini
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Harriet J. Hill
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Saly Al-Taei
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Chloe Tanner
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Fiona Ashford
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Sarita Workman
- Department of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Fernando Moreira
- Department of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Nisha Verma
- Department of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Hollie Wagg
- Institute of Translational Medicine, University of Birmingham, Birmingham, United Kingdom
| | - Gail Heritage
- Institute of Translational Medicine, University of Birmingham, Birmingham, United Kingdom
| | - Naomi Campton
- Institute of Translational Medicine, University of Birmingham, Birmingham, United Kingdom
| | - Zania Stamataki
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Mark T. Drayson
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Paul Klenerman
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Shuayb Elkhalifa
- Department of Immunology, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Sarah Goddard
- Department of Clinical Immunology, University Hospitals North Midlands, Stoke-on-Trent, United Kingdom
| | - Sarah Johnston
- Department of Clinical Immunology, North Bristol NHS Trust, Bristol, United Kingdom
| | - Aarnoud Huissoon
- Department of Clinical Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Claire Bethune
- Department of Allergy and Clinical Immunology, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Suzanne Elcombe
- Department of Allergy and Clinical Immunology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - David M. Lowe
- Department of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
- Institute of Immunity and Transplantation, University College London, London, United Kingdom
| | - Smita Y. Patel
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) Oxford Biomedical Centre, University of Oxford, Oxford, United Kingdom
| | - Sinisa Savic
- Department of Allergy and Clinical Immunology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Alex G. Richter
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
- Department of Clinical Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Siobhan O. Burns
- Department of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
- Institute of Immunity and Transplantation, University College London, London, United Kingdom
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22
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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: 75] [Impact Index Per Article: 37.5] [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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23
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Humoral response after a fourth "booster" dose of a Covid-19 vaccine following a 3-dose regimen of mRNA-based vaccination in dialysis patients. Kidney Int 2022; 101:1289-1290. [PMID: 35421509 PMCID: PMC9001011 DOI: 10.1016/j.kint.2022.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022]
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24
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Spensley KJ, Gleeson S, Martin P, Thomson T, Clarke CL, Pickard G, Thomas D, McAdoo SP, Randell P, Kelleher P, Bedi R, Lightstone L, Prendecki M, Willicombe M. Comparison of vaccine effectiveness against the Omicron (B.1.1.529) variant in haemodialysis patients. Kidney Int Rep 2022; 7:1406-1409. [PMID: 35434428 PMCID: PMC9006399 DOI: 10.1016/j.ekir.2022.04.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022] Open
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25
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Montez-Rath ME, Garcia P, Han J, Cadden L, Hunsader P, Morgan C, Kerschmann R, Beyer P, Dittrich M, Block GA, Anand S, Parsonnet J, Chertow GM. SARS-CoV-2 infection during the Omicron surge among patients receiving dialysis: the role of circulating receptor-binding domain antibodies and vaccine doses. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.03.15.22272426. [PMID: 35313586 PMCID: PMC8936102 DOI: 10.1101/2022.03.15.22272426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background It is unclear whether a third dose of mRNA platform vaccines, or antibody response to prior infection or vaccination confer protection from the Omicron variant among patients receiving dialysis. Methods Monthly since February 2021, we tested plasma from 4,697 patients receiving dialysis for antibodies to the receptor-binding domain (RBD) of SARS-CoV-2. We assessed semiquantitative median IgG index values over time among patients vaccinated with at least one dose of the two mRNA vaccines. We ascertained documented COVID-19 diagnoses after December 25, 2021 and up to January 31, 2022. We estimated the relative risk for documented SARS-CoV-2 infection by vaccination status using a log-binomial model accounting for age, sex, and prior clinical COVID-19. Among patients with RBD IgG index value available during December 1-December 24, 2021, we also evaluated the association between the circulating RBD IgG titer and risk for Omicron variant SARS-CoV-2 infection. Results Of the 4,697 patients we followed with monthly RBD assays, 3576 are included in the main analysis cohort; among these, 852 (24%) were unvaccinated. Antibody response to third doses was robust (median peak index IgG value at assay limit of 150, equivalent to 3270 binding antibody units/mL). Between December 25-January 31, 2022, SARS-CoV-2 infection was documented 340 patients (7%), 115 (36%) of whom were hospitalized. The final doses of vaccines were given a median of 272 (25 th , 75 th percentile, 245-303) days and 58 (25 th , 75 th percentile, 51-95) days prior to infection for the 1-2 dose and 3 dose vaccine groups respectively. Relative risks for infection were higher among patients without vaccination (RR 2.1 [95%CI 1.6, 2.8]), and patients with 1-2 doses (RR 1.3 [95%CI 1.0, 1.8]), compared with patients with three doses of the mRNA vaccines. Relative risks for infection were higher among patients with RBD index values < 23 (506 BAU/mL), compared with RBD index value ≥ 23 (RR 2.4 [95%CI 1.9, 3.0]). The higher risk for infection among patients with RBD index values < 23 was present among patients who received three doses (RR 2.1 [95%CI 1.3, 3.4]). Conclusions Among patients receiving hemodialysis, patients unvaccinated, without a third mRNA vaccine dose, or those lacking robust circulating antibody response are at higher risk for Omicron variant infection. Low circulating antibodies could identify the subgroup needing intensified surveillance, prophylaxis or treatment in this patient population.
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Affiliation(s)
| | - Pablo Garcia
- Department of Medicine (Nephrology), Stanford University
| | - Jialin Han
- Department of Medicine (Nephrology), Stanford University
| | | | | | | | | | | | | | | | - Shuchi Anand
- Department of Medicine (Nephrology), Stanford University
| | - Julie Parsonnet
- Departments of Medicine (Infectious Diseases and Geographic Medicine), and Epidemiology and Population Health, Stanford University
| | - Glenn M Chertow
- Departments of Medicine (Nephrology), and Epidemiology and Population Health, Stanford University
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26
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Tiecco G, Storti S, Degli Antoni M, Focà E, Castelli F, Quiros-Roldan E. Omicron Genetic and Clinical Peculiarities That May Overturn SARS-CoV-2 Pandemic: A Literature Review. Int J Mol Sci 2022; 23:1987. [PMID: 35216104 PMCID: PMC8876558 DOI: 10.3390/ijms23041987] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 02/04/2023] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic poses a great threat to global public health. The original wild-type strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has genetically evolved, and several variants of concern (VOC) have emerged. On 26 November 2021, a new variant named Omicron (B.1.1.529) was designated as the fifth VOC, revealing that SARS-CoV-2 has the potential to go beyond the available therapies. The high number of mutations harboured on the spike protein make Omicron highly transmissible, less responsive to several of the currently used drugs, as well as potentially able to escape immune protection elicited by both vaccines and previous infection. We reviewed the latest publication and the most recent available literature on the Omicron variant, enlightening both reasons for concern and high hopes for new therapeutic strategies.
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Affiliation(s)
| | | | | | | | | | - Eugenia Quiros-Roldan
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali Civili di Brescia and University of Brescia, 25123 Brescia, Italy; (G.T.); (S.S.); (M.D.A.); (E.F.); (F.C.)
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27
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Wang X, Han M, Fuentes LR, Thwin O, Grobe N, Wang K, Wang Y, Kotanko P. SARS-CoV-2 neutralizing antibody response after three doses of mRNA1273 vaccine and COVID-19 in hemodialysis patients. FRONTIERS IN NEPHROLOGY 2022; 2:926635. [PMID: 36106337 PMCID: PMC9470295 DOI: 10.3389/fneph.2022.926635] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND In hemodialysis patients, a third vaccination is frequently administered to augment protection against coronavirus disease 2019 (COVID-19). However, the newly emerged B.1.1.159 (Omicron) variant may evade vaccinal protection more easily than previous strains. It is of clinical interest to better understand the neutralizing activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants after booster vaccine or COVID-19 infection in these mostly immunocompromised patients. METHODS Hemodialysis patients from four dialysis centers were recruited between June 2021 and February 2022. Each patient provided a median of six serum samples. SARS-CoV-2 neutralizing antibodies (nAbs) against wild type (WT) or Omicron were measured using the GenScript SARS-CoV-2 Surrogate Virus Neutralization Test Kit. RESULTS Forty-two patients had three doses of mRNA1273. Compared to levels prior to the third dose, nAb-WT increased 18-fold (peak at day 23) and nAb-Omicron increased 23-fold (peak at day 24) after the third dose. Peak nAb-WT exceeded peak nAb-Omicron 27-fold. Twenty-one patients had COVID-19 between December 24, 2021, and February 2, 2022. Following COVID-19, nAb-WT and nAb-Omicron increased 12- and 40-fold, respectively. While levels of vaccinal and post-COVID nAb-WT were comparable, post-COVID nAb-Omicron levels were 3.2 higher than the respective peak vaccinal nAb-Omicron. Four immunocompromised patients having reasons other than end-stage kidney disease have very low to no nAb after the third dose or COVID-19. CONCLUSIONS Our results suggest that most hemodialysis patients have a strong humoral response to the third dose of vaccination and an even stronger post-COVID-19 humoral response. Nevertheless, nAb levels clearly decay over time. These findings may inform ongoing discussions regarding a fourth vaccination in hemodialysis patients.
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Affiliation(s)
- Xiaoling Wang
- Renal Research Institute, New York, NY, United States
- CORRESPONDENCE: Xiaoling Wang,
| | - Maggie Han
- Renal Research Institute, New York, NY, United States
| | | | - Ohnmar Thwin
- Renal Research Institute, New York, NY, United States
| | - Nadja Grobe
- Renal Research Institute, New York, NY, United States
| | - Kevin Wang
- College of Creative Studies, University of California at Santa Barbara, Santa Barbara, CA, United States
| | - Yuedong Wang
- Department of Statistics and Applied Probability, University of California at Santa Barbara, Santa Barbara, CA, United States
| | - Peter Kotanko
- Renal Research Institute, New York, NY, United States
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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28
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Chimon A, Ferrière E, Lammouchi MA, Jouan N, Michel PA, Saloum K, Morand-Joubert L, Schnuriger A, Leruez-Ville M, Fourgeaud J, Dahmane D, Bentaarit B, Guéry B, Fessi H, Kazdaghli H, Sounni F, Fearon T, Boudhabhay I, Pawlotsky JM, El Karoui K, Fourati S, Sakhi H. OUP accepted manuscript. Clin Kidney J 2022; 15:1785-1788. [PMID: 35999965 PMCID: PMC9383950 DOI: 10.1093/ckj/sfac137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | | | | | | | - Kenda Saloum
- Virology Department, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | | | - Aurélie Schnuriger
- Virology Department, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | | | - Jacques Fourgeaud
- Virology Department, Necker Hospital, APHP, University of Paris, Paris, France
| | - Djamal Dahmane
- Nephrology Department, Mondor Hospital, APHP, University Paris Est, Créteil, France
| | - Boutheina Bentaarit
- Nephrology Department, Mondor Hospital, APHP, University Paris Est, Créteil, France
| | - Bruno Guéry
- Nephrology Department, Necker Hospital, APHP, University of Paris, Paris, France
| | - Hafedh Fessi
- Nephrology Department, Tenon Hospital, APHP, Sorbonne University, Paris, France
| | - Hajer Kazdaghli
- Nephrology Department, Tenon Hospital, APHP, Sorbonne University, Paris, France
| | - Farah Sounni
- Nephrology Department, Tenon Hospital, APHP, Sorbonne University, Paris, France
| | - Timothée Fearon
- Nephrology Department, Tenon Hospital, APHP, Sorbonne University, Paris, France
| | - Idris Boudhabhay
- Nephrology Department, Necker Hospital, APHP, University of Paris, Paris, France
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