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Reis CA, Ristagno EH, Madigan T. SARS-CoV-2 Vaccination Rates and Uptake of Tixagevimab-Cilgavimab Among a Cohort of Pediatric Solid Organ Transplant Recipients. Clin Transplant 2024; 38:e15407. [PMID: 39033503 DOI: 10.1111/ctr.15407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/20/2024] [Accepted: 06/30/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION There is a lack of data regarding SARS-CoV-2 vaccination rates and tixagevimab-cilgavimab (TC) uptake among pediatric solid organ transplant recipients. The purpose of our study was to assess these rates. MATERIALS AND METHODS We reviewed vaccination records of pediatric recipients of heart, kidney, and liver transplants at Mayo Clinic, Rochester, MN, who received a transplant between January 2011 and December 2021. All SARS-CoV-2 vaccines and doses of TC received on or before September 1, 2022, the date of approval of the bivalent SARS-CoV2 vaccine, were included. We also assessed whether patients had been seen by an infectious diseases physician (ID) in the preceding 6 months. RESULTS Our study included 110 patients: 47 kidney, 36 heart, and 27 liver transplant recipients. All vaccine doses recorded were monovalent SARS-CoV-2 vaccines. Sixty-eight (61.8%) patients received at least one vaccine. This varied by age group, with f of ≥12 years olds, 40.9% of 5-11 year olds and 14.3% of under 5 year olds (p = 0.001). Seven patients (6.4%) were up-to-date (UTD) for age. There was no difference in UTD status by organ type (p = 0.335). Patients who saw ID were significantly more likely to be UTD (13.2% versus 2.8%; p = 0.047). Among those eligible, 14 (18.2%) received TC, with rates not different based on transplanted organ type (p = 0.158) or whether they saw ID (p = 0.273). CONCLUSIONS Despite the availability of vaccines, nearly 40% of pediatric solid organ transplant recipients remained unvaccinated against SARS-CoV-2 at time of the bivalent vaccine release. Less than a fifth of eligible patients received TC. Strategies to increase uptake of SARS-CoV-2 vaccines as well as adjunctive agents among this vulnerable group should be further explored.
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Affiliation(s)
- Christopher A Reis
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth H Ristagno
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Theresa Madigan
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Alshami A, Bahbah H, Al Attas R, Aldokhi F, Azzam A. The humoral immune response to the BNT 162B2 vaccine in pediatrics on renal replacement therapy. Pediatr Transplant 2024; 28:e14712. [PMID: 38553800 DOI: 10.1111/petr.14712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 12/16/2023] [Accepted: 01/28/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Since the start of the COVID-19 pandemic, data published on the immunogenicity of the SARS-CoV-2 BNT 162B2 vaccine in pediatric patients receiving renal replacement therapy are scant. Our primary objective is to study this population's humoral immune response to the COVID-19 vaccine. METHODS Pediatric kidney transplant recipients (PKTRs) and hemodialysis recipients (HR) at our center who received two doses of the SARS-CoV-2 BNT 162B2 vaccine were included. Transplant and HR who had PCR-positive COVID-19 infections during the study, regardless of their vaccine status, were also included. SARS-CoV-2 anti-spike protein (S1/S2) IgG was measured after the second dose of the vaccine and after any PCR-positive COVID-19 infection as routine clinical practice. Data on demographics, induction, maintenance immunosuppressants, type of transplant, and posttransplant or dialysis duration were included. RESULTS Of the 61 patients included, 19 were dialysis recipients who received two doses of vaccine without subsequent infection (HV), and 42 were kidney transplant recipients. All dialysis patients and 33 (78.6%) transplant recipients received two doses of the SARS-CoV-2 BNT 162b2 vaccine. A total of 33.3% (11/33) of the transplant recipients who received vaccination developed COVID-19 infection (KTH) at a median time of 13 days after the second dose of vaccine. Nine transplant patients had pure COVID-19 infection without vaccination (KTI). The seroconversion rate in the HV group was 94.7% (18/19) compared to 50% (11/22) in the kidney transplant vaccine recipients who did not develop subsequent COVID-19 infection (KTV) (p < .001). The median S1/S2 IgG titers for the HV group were 400 AU/mL versus 15 AU/mL in the KTV group (p < .0001). There was no significant difference in the duration of the test from the second dose of the vaccine between HV and KTV (55 vs. 33.5 days, p = .095). The KTH had higher titers than KTV group (370 vs. 15 p < .0001). The median duration of the test after vaccination in the vaccine group and those with hybrid immunity was similar (35 vs. 33.5 days, p = .2).There were no clear predictors for seroconversion in the PKTRs. Natural infection alone was as good as the vaccine in eliciting humoral immune response. CONCLUSION The humoral immune response to two doses of the SARS-CoV-2 BNT 162B2 vaccine in PKTRs without subsequent COVID-19 infection is suboptimal compared to that in hemodialysis recipients and in PKTRs with hybrid immunity from both infection and vaccination.
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Affiliation(s)
- Alanoud Alshami
- Division of Pediatric Nephrology and Kidney Transplant, Multiorgan Transplant Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Hebattallah Bahbah
- Division of Pediatric Nephrology and Kidney Transplant, Multiorgan Transplant Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Rabab Al Attas
- Division of Immunology, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Fatimah Aldokhi
- Division of Pediatric Nephrology and Kidney Transplant, Multiorgan Transplant Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ahmad Azzam
- Division of Pediatric Nephrology and Kidney Transplant, Multiorgan Transplant Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Roznik K, Xue J, Stavrakis G, Johnston TS, Kalluri D, Ohsie R, Qin CX, McAteer J, Segev DL, Mogul D, Werbel WA, Karaba AH, Thompson EA, Cox AL. COVID-19 vaccination induces distinct T-cell responses in pediatric solid organ transplant recipients and immunocompetent children. NPJ Vaccines 2024; 9:73. [PMID: 38580714 PMCID: PMC10997632 DOI: 10.1038/s41541-024-00866-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 03/19/2024] [Indexed: 04/07/2024] Open
Abstract
Immune responses to COVID-19 vaccination are attenuated in adult solid organ transplant recipients (SOTRs) and additional vaccine doses are recommended for this population. However, whether COVID-19 mRNA vaccine responses are limited in pediatric SOTRs (pSOTRs) compared to immunocompetent children is unknown. Due to SARS-CoV-2 evolution and mutations that evade neutralizing antibodies, T cells may provide important defense in SOTRs who mount poor humoral responses. Therefore, we assessed anti-SARS-CoV-2 IgG titers, surrogate neutralization, and spike (S)-specific T-cell responses to COVID-19 mRNA vaccines in pSOTRs and their healthy siblings (pHCs) before and after the bivalent vaccine dose. Despite immunosuppression, pSOTRs demonstrated humoral responses to both ancestral strain and Omicron subvariants following the primary ancestral strain monovalent mRNA COVID-19 series and multiple booster doses. These responses were not significantly different from those observed in pHCs and significantly higher six months after vaccination than responses in adult SOTRs two weeks post-vaccination. However, pSOTRs mounted limited S-specific CD8+ T-cell responses and qualitatively distinct CD4+ T-cell responses, primarily producing IL-2 and TNF with less IFN-γ production compared to pHCs. Bivalent vaccination enhanced humoral responses in some pSOTRs but did not shift the CD4+ T-cell responses toward increased IFN-γ production. Our findings indicate that S-specific CD4+ T cells in pSOTRs have distinct qualities with unknown protective capacity, yet vaccination produces cross-reactive antibodies not significantly different from responses in pHCs. Given altered T-cell responses, additional vaccine doses in pSOTRs to maintain high titer cross-reactive antibodies may be important in ensuring protection against SARS-CoV-2.
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Affiliation(s)
- Katerina Roznik
- Johns Hopkins Bloomberg School of Public Health, Department of Molecular Microbiology and Immunology, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
| | - Jiashu Xue
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
| | - Georgia Stavrakis
- Johns Hopkins Bloomberg School of Public Health, Department of Molecular Microbiology and Immunology, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
| | - T Scott Johnston
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
| | - Divya Kalluri
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD, USA
| | - Rivka Ohsie
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD, USA
| | - Caroline X Qin
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD, USA
| | - John McAteer
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD, USA
| | - Dorry L Segev
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD, USA
- NYU Grossman School of Medicine, Department of Surgery, New York, NY, USA
| | - Douglas Mogul
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD, USA
| | - William A Werbel
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
| | - Andrew H Karaba
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
| | - Elizabeth A Thompson
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
| | - Andrea L Cox
- Johns Hopkins Bloomberg School of Public Health, Department of Molecular Microbiology and Immunology, Baltimore, MD, USA.
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA.
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Feldman AG, Beaty B, Everitt M, Goebel J, Kempe A, Pratscher L, Danziger-Isakov LA. Survey of pediatric transplant center practices regarding COVID-19 vaccine mandates for transplant candidates and living donors and use of COVID-19-positive deceased organs. Pediatr Transplant 2023; 27:e14513. [PMID: 36939212 PMCID: PMC10509306 DOI: 10.1111/petr.14513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/27/2022] [Accepted: 11/28/2022] [Indexed: 03/21/2023]
Abstract
BACKGROUND COVID-19 vaccine is recommended for individuals ages ≥6 months; however, whether vaccination should be mandated for transplant candidates and living donors remains controversial. This study assessed COVID-19 policies at US pediatric solid organ transplant centers. METHODS A 79-item survey was emailed between March and April 2022 to 200 UNOS Medical Directors detailing center COVID-19 vaccine policies for transplant candidates and living donors and use of grafts from COVID-19-positive deceased donors. RESULTS The response rate was 77% (154/200). For children aged 5-15 years, 23% (35/154 centers) have a COVID-19 vaccine mandate, 27% (42/154) anticipate implementing a future mandate, and 47% (72/154) have not considered or do not anticipate implementing a mandate. For children ≥16 years, 32% (50/154 centers) have a COVID-19 vaccine mandate, 25% (39/154) anticipate implementing a future mandate, and 40% (62/154) have not considered or do not anticipate implementing a mandate. The top two reasons for not implementing a COVID-19 vaccine mandate were concerns about penalizing a child for their parent's decision and worsening inequities in transplant. Of 85 kidney and liver living donor centers, 32% (27/85) require vaccination of donors. Twenty percent (31/154) of centers accept organs from COVID-19-positive deceased donors. CONCLUSIONS There is great variation among pediatric SOT centers in both the implementation and details of COVID-19 vaccine mandates for candidates and living donors. To guide more uniform policies, further data are needed on COVID-19 disease, vaccine efficacy, and use of grafts from donors positive for COVID-19 in the pediatric transplant population.
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Affiliation(s)
- Amy G. Feldman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric Liver Transplant Center, Digestive Health Institute, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Brenda Beaty
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Melanie Everitt
- Pediatric Heart Transplant Program, Section of Pediatric Cardiology, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Jens Goebel
- Pediatrics and Human Development, Section of Pediatric Nephrology, Helen DeVos Children’s Hospital, Michigan State University, Grand Rapids, Michigan, USA
| | - Allison Kempe
- Department of Pediatrics, Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA
| | | | - Lara A. Danziger-Isakov
- Immunocompromised Host Infectious Disease, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
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Lalia JK, Schild R, Lütgehetmann M, Dunay GA, Kallinich T, Kobbe R, Massoud M, Oh J, Pietzsch L, Schulze-Sturm U, Schuetz C, Sibbertsen F, Speth F, Thieme S, Witkowski M, Berner R, Muntau AC, Gersting SW, Toepfner N, Pagel J, Paul K. Reduced Humoral and Cellular Immune Response to Primary COVID-19 mRNA Vaccination in Kidney Transplanted Children Aged 5-11 Years. Viruses 2023; 15:1553. [PMID: 37515239 PMCID: PMC10384144 DOI: 10.3390/v15071553] [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: 06/15/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
The situation of limited data concerning the response to COVID-19 mRNA vaccinations in immunocom-promised children hinders evidence-based recommendations. This prospective observational study investigated humoral and T cell responses after primary BNT162b2 vaccination in secondary immunocompromised and healthy children aged 5-11 years. Participants were categorized as: children after kidney transplantation (KTx, n = 9), proteinuric glomerulonephritis (GN, n = 4) and healthy children (controls, n = 8). Expression of activation-induced markers and cytokine secretion were determined to quantify the T cell response from PBMCs stimulated with peptide pools covering the spike glycoprotein of SARS-CoV-2 Wuhan Hu-1 and Omicron BA.5. Antibodies against SARS-CoV-2 spike receptor-binding domain were quantified in serum. Seroconversion was detected in 56% of KTx patients and in 100% of the GN patients and controls. Titer levels were significantly higher in GN patients and controls than in KTx patients. In Ktx patients, the humoral response increased after a third immunization. No differences in the frequency of antigen-specific CD4+ and CD8+ T cells between all groups were observed. T cells showed a predominant anti-viral capacity in their secreted cytokines; however, this capacity was reduced in KTx patients. This study provides missing evidence concerning the humoral and T cell response in immunocompromised children after COVID-19 vaccination.
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Affiliation(s)
- Jasmin K Lalia
- University Children's Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Raphael Schild
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Inhoffenstr. 7, 38124 Brauschweig, Germany
| | - Gabor A Dunay
- University Children's Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Tilmann Kallinich
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Robin Kobbe
- Institute for Infection Research and Vaccine Development (IIRVD), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
- Department of Infectious Disease Epidemiology, Bernhard-Nocht-Institute for Tropical Medicine, Bernhard-Nocht-Straße 74, 20359 Hamburg, Germany
| | - Mona Massoud
- Therapeutic Gene Regulation, Deutsches Rheuma-Forschungszentrum (DRFZ), An Institute of the Leibniz Association, Charitéplatz 1, 10117 Berlin, Germany
| | - Jun Oh
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Leonora Pietzsch
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Ulf Schulze-Sturm
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Catharina Schuetz
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Freya Sibbertsen
- University Children's Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Fabian Speth
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Sebastian Thieme
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Mario Witkowski
- Institute of Microbiology, Infectious Diseases and Immunology, Laboratory of Innate Immunity, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Mucosal and Developmental Immunology, Deutsches Rheuma-Forschungszentrum (DRFZ), An Institute of the Leibniz Association, Charitéplatz 1, 10117 Berlin, Germany
| | - Reinhard Berner
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Ania C Muntau
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Søren W Gersting
- University Children's Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Nicole Toepfner
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Julia Pagel
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Inhoffenstr. 7, 38124 Brauschweig, Germany
- Division of Pediatric Stem Cell Transplantation, Immunology and Rheumatology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Kevin Paul
- University Children's Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Nel I, Parmentier C, Dehoux L, Minier M, Duneton C, Charbit M, Baudouin V, Bidet P, Carol A, Cheyssac E, Delbet JD, Guérin-El Khourouj V, Louillet F, Ulinski T, Delaugerre C, Carcelain G, Hogan J. Optimizing COVID-19 Vaccination Strategy in Pediatric Kidney Transplant Recipients: Humoral and Cellular Response to SARS-CoV-2 mRNA Vaccination. Transpl Int 2023; 36:11153. [PMID: 37252612 PMCID: PMC10213233 DOI: 10.3389/ti.2023.11153] [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: 12/27/2022] [Accepted: 04/27/2023] [Indexed: 05/31/2023]
Abstract
In this retrospective cohort study, we analyze the early humoral and cellular response in 64 adolescents KTx recipients, after two or three doses of mRNA vaccine BNT162b2 against different variants of COVID-19. After 2 doses, 77.8% % of children with no history of infection had a positive humoral response with a median anti-S IgG level of 1107 (IQR, 593-2,658) BAU/mL. All the patients with a history of infection responded with a higher median IgG level (3,265 (IQR, 1,492-8,178) BAU/mL). In non-responders after 2 doses, 75% responded after a third dose with a median Ab titer at 355 (IQR, 140-3,865 BAU/mL). Neutralizing activity was significantly lower against the delta and the omicron variants compared to the wild-type strain and did not improve after a 3rd dose, while infection did provide higher levels of neutralizations against the variants. T cell specific response correlated with humoral response and no patient displayed a cellular response without a humoral response. Adolescent KTx recipients exhibit a high seroconversion rate after only two doses. A third injection, induces a response in the majority of the non-responders patients but did not counterbalance the strong decrease in neutralizing antibody activities against variants highlighting the need for boosters with specific vaccines.
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Affiliation(s)
- Isabelle Nel
- Immunology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris Cité, INSERM U976, Paris, France
| | - Cyrielle Parmentier
- Pediatric Nephrology Department, Armand Trousseau Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Laurène Dehoux
- Pediatric Nephrology Department, Necker Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marine Minier
- Virology Department, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Charlotte Duneton
- Immunology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris Cité, INSERM U976, Paris, France
- Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marina Charbit
- Pediatric Nephrology Department, Necker Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Véronique Baudouin
- Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Philippe Bidet
- Microbiology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Agnès Carol
- Microbiology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Elodie Cheyssac
- Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jean-Daniel Delbet
- Pediatric Nephrology Department, Armand Trousseau Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Férielle Louillet
- Pediatric Nephrology Department, Charles Nicolle Hospital, Rouen, France
| | - Tim Ulinski
- Pediatric Nephrology Department, Armand Trousseau Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Constance Delaugerre
- Virology Department, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Guislaine Carcelain
- Immunology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris Cité, INSERM U976, Paris, France
| | - Julien Hogan
- Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris Cité, Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Paris, France
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7
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Ziv N, Gimelraikh Y, Ashkenazi-Hoffnung L, Alfandary H, Borovitz Y, Dagan A, Levi S, Hamdani G, Levy-Erez D, Landau D, Koren G, Talgam-Horshi E, Haskin O. Serologic response to COVID-19 infection or vaccination in pediatric kidney transplant recipients compared to healthy children. Transpl Immunol 2023; 78:101839. [PMID: 37076050 PMCID: PMC10110277 DOI: 10.1016/j.trim.2023.101839] [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: 12/10/2022] [Revised: 04/15/2023] [Accepted: 04/16/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Differences in serologic response to COVID-19 infection or vaccination were reported in adult kidney transplant recipients (KTR) compared to non-immunocompromised patients. This study aims to compare the serologic response of naturally infected or vaccinated pediatric KTR to that of controls. METHODS Thirty-eight KTR and 42 healthy children were included; aged ≤18 years, with a previously confirmed COVID-19 infection or post COVID-19 vaccination. Serological response was measured by anti-spike protein IgG antibody titers. Response post third vaccine was additionally assessed in KTR. RESULTS Fourteen children in each group had previously confirmed infection. KTR were significantly older and developed a 2-fold higher antibody titer post-infection compared to controls [median (interquartile range [IQR]) age: 14.9 (7.8, 17.5) vs. 6.3 (4.5, 11.5) years, p = 0.02; median (IQR) titer: 1695 (982, 3520) vs. 716 (368, 976) AU/mL, p = 0.03]. Twenty-four KTR and 28 controls were vaccinated. Antibody titer was lower in KTR than in controls [median (IQR): 803 (206, 1744) vs. 8023 (3032, 30,052) AU/mL, p < 0.001]. Fourteen KTR received third vaccine. Antibody titer post booster in KTR reached similar levels to those of controls post two doses [median (IQR) 5923 (2295, 12,278) vs. 8023 (3034, 30,052) AU/mL, p = 0.37] and to KTR post natural infection [5282 AU/mL (2583, 13,257) p = 0.8]. CONCLUSION Serologic response to COVID-19 infection was significantly higher in KTR than in controls. Antibody level in KTR was higher in response to infection vs. vaccination, contrary to reports in the general population. Response to vaccination in KTR reached levels comparable to controls only after third vaccine.
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Affiliation(s)
- Noa Ziv
- Department of Pediatrics "C", Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yulia Gimelraikh
- Department of Pediatric Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Liat Ashkenazi-Hoffnung
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Infectious Disease Unit, Day Hospitalization Department, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Hadas Alfandary
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Yael Borovitz
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Amit Dagan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Shelly Levi
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Gilad Hamdani
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Daniella Levy-Erez
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Daniel Landau
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Gili Koren
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Efrat Talgam-Horshi
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Orly Haskin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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8
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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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9
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Crane C, Phebus E, Ingulli E. Antibody response to 2- and 3-dose SARS-CoV-2 mRNA vaccination in pediatric and adolescent kidney transplant recipients. Pediatr Nephrol 2023; 38:611-614. [PMID: 35759003 PMCID: PMC9244318 DOI: 10.1007/s00467-022-05661-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/21/2022] [Accepted: 06/06/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Additional "booster" doses of mRNA SARS-CoV-2 vaccines have become standard of care for immunosuppressed patients, including kidney transplant recipients (KTR). While these additional doses have been shown to be efficacious in the adult KTR population, there is paucity of data for pediatric and adolescent KTR. METHODS We conducted a retrospective single-center observational study to determine the proportion of pediatric and adolescent KTR who seroconverted following two- and three-dose regimens of an mRNA SARS-CoV-2 vaccine series. RESULTS Forty-three pediatric and adolescent KTR at our center received at least two doses of an mRNA SARS-CoV-2 vaccine. Seroconversion was noted in 56% of those who received a 2-dose series and increased to 85% in those who received a third dose. In the 16 patients who did not seroconvert after a two-dose series, 12 (75%) seroconverted following the third dose. No serious adverse effects of immunization were noted. CONCLUSIONS Our results demonstrate that additional SARS-CoV-2 vaccine doses are not only safe and efficacious in pediatric and adolescent KTR, but may be necessary to optimize antibody response. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Clarkson Crane
- Department of Pediatrics, Division of Pediatric Nephrology, Rady Children's Hospital, University of California at San Diego, 3020 Children's Way MC 5173, San Diego, CA, 92123, USA.
| | - Erin Phebus
- Kidney Transplant Program, Rady Children's Hospital, San Diego, CA, USA
| | - Elizabeth Ingulli
- Department of Pediatrics, Division of Pediatric Nephrology, Rady Children's Hospital, University of California at San Diego, 3020 Children's Way MC 5173, San Diego, CA, 92123, USA
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10
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Buonsenso D, Cusenza F, Passadore L, Bonanno F, De Guido C, Esposito S. Duration of immunity to SARS-CoV-2 in children after natural infection or vaccination in the omicron and pre-omicron era: A systematic review of clinical and immunological studies. Front Immunol 2023; 13:1024924. [PMID: 36713374 PMCID: PMC9874918 DOI: 10.3389/fimmu.2022.1024924] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023] Open
Abstract
Background Duration of humoral and cellular memory in children previously infected SARS-CoV-2 or vaccinated and subsequent risk of reinfection is still not fully elucidated. Methods Systematic review of studies retrieved from medical databases and article reference lists. Results From 2420 identified articles, 24 met the inclusion criteria. Children infected during the pre-omicron era developed long lasting (at least 10-12 months) humoral and cellular immunity against pre-Omicron SARS-CoV-2 variants, but have reduced in vitro cross-reactivity against Omicron. Conversely, although vaccination has a limited efficacy in preventing new infection with pre-Omicron and Omicron variants, in vitro studies suggested that vaccine-induced immunity provides better in vitro cross-neutralization against pre-Omicron and Omicron variants. Preprints published after the period of inclusion of our review suggested that overall risk of infection after Omicron infection is reduced, but children developed weak neutralizing responses in about half cases. Conclusions Available evidence, although limited, suggested a long-lasting but unperfect protection of previous infections or vaccination against pre-Omicron and Omicron variants. Based on our findings, it might be reasonable to offer families of children infected before Omicron a booster vaccination. A similar indication should be proposed also for those infected with Omicron, specifically for more fragile children at higher risk of COVID-19-related complications, based on better cross-variant neutralisation induced by vaccination. Systematic review registration PROSPERO, identifier ID 353189.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy,Centro di Salute Globale, Università Cattolica del Sacro Cuore, Roma, Italy,*Correspondence: Danilo Buonsenso,
| | - Francesca Cusenza
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Lucrezia Passadore
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesca Bonanno
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Claudia De Guido
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
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11
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Bratic JS, Gans HA, Chen SF, Banaei N, Johnston EM, Sear K, Samreth S, Nadimpalli SS. Pediatric solid organ transplant recipients demonstrate robust cell-mediated and humoral responses to three doses of mRNA SARS-CoV-2 vaccine. Am J Transplant 2022; 22:3047-3052. [PMID: 36083190 PMCID: PMC9539089 DOI: 10.1111/ajt.17195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 08/17/2022] [Accepted: 09/02/2022] [Indexed: 01/25/2023]
Abstract
Pediatric solid organ transplant recipients (pSOTR) often demonstrate suboptimal vaccine responses and are not included in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine efficacy trials. This population has shown variable humoral immunity following SARS-CoV-2 vaccination, and no studies have assessed cell-mediated responses after SARS-CoV-2 vaccination in pSOTR. SARS-CoV-2-specific interferon-gamma release assay (IGRA), immunoglobulin G (IgG), and receptor-binding domain (RBD)-angiotensin-converting enzyme 2 (ACE2) blocking antibody (Ab) were measured in pSOTR aged 5-17 years after 2-3 doses of SARS-CoV-2 mRNA vaccine. In all, 33 subjects were included, with 25 tested after the second dose of mRNA vaccine (V2) and 21 tested after the third dose of mRNA vaccine (V3). Of the 19 subjects who had IgG testing after V3, 100.0% (19/19) had a positive IgG response. Of the 17 subjects who had IGRA testing after V3, 94.1% (16/17) had a positive IGRA response. RBD-ACE2 blocking antibody increased significantly from V2 to V3 (p = .007). Subjects <1 year from transplant demonstrated a significantly larger increase in RBD-ACE2 blocking Ab from V2 to V3 than did those >1 year from transplant (p = .05). SARS-CoV-2 vaccination induces humoral and cell-mediated responses in the majority of pSOTR, with improved quantitative humoral response after three doses.
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Affiliation(s)
- Julia S. Bratic
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Hayley A. Gans
- Division of Infectious Diseases, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Sharon F. Chen
- Division of Infectious Diseases, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Niaz Banaei
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Erica M. Johnston
- Stanford Maternal and Child Health Research Institute, Stanford, California, USA
| | - Katherine Sear
- Division of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Sarah Samreth
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Sruti S. Nadimpalli
- Division of Infectious Diseases, Department of Pediatrics, Stanford University, Stanford, California, USA,Correspondence Sruti S. Nadimpalli, Division of Infectious Diseases, Department of Pediatrics, Stanford University, Stanford, CA, USA.
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12
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Meshram HS, Kute V, Rane H, Dave R, Banerjee S, Mishra V, Chauhan S. Humoral and cellular response of COVID-19 vaccine among solid organ transplant recipients: A systematic review and meta-analysis. Transpl Infect Dis 2022; 24:e13926. [PMID: 35924679 PMCID: PMC9538045 DOI: 10.1111/tid.13926] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/29/2022] [Accepted: 07/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND We aimed to analyze the humoral and cellular response to standard and booster (additional doses) COVID-19 vaccination in solid organ transplantation (SOT) and the risk factors involved for an impaired response. METHODS We did a systematic review and meta-analysis of studies published up until January 11, 2022, that reported immunogenicity of COVID-19 vaccine among SOT. The study is registered with PROSPERO, number CRD42022300547. RESULTS Of the 1527 studies, 112 studies, which involved 15391 SOT and 2844 healthy controls, were included. SOT showed a low humoral response (effect size [ES]: 0.44 [0.40-0.48]) in overall and in control studies (log-Odds-ratio [OR]: -4.46 [-8.10 to -2.35]). The humoral response was highest in liver (ES: 0.67 [0.61-0.74]) followed by heart (ES: 0.45 [0.32-0.59]), kidney (ES: 0.40 [0.36-0.45]), kidney-pancreas (ES: 0.33 [0.13-0.53]), and lung (0.27 [0.17-0.37]). The meta-analysis for standard and booster dose (ES: 0.43 [0.39-0.47] vs. 0.51 [0.43-0.54]) showed a marginal increase of 18% efficacy. SOT with prior infection had higher response (ES: 0.94 [0.92-0.96] vs. ES: 0.40 [0.39-0.41]; p-value < .01). The seroresponse with mRNA-12723 mRNA was highest 0.52 (0.40-0.64). Mycophenolic acid (OR: 1.42 [1.21-1.63]) and Belatacept (OR: 1.89 [1.3-2.49]) had highest risk for nonresponse. SOT had a parallelly decreased cellular response (ES: 0.42 [0.32-0.52]) in overall and control studies (OR: -3.12 [-0.4.12 to -2.13]). INTERPRETATION Overall, SOT develops a suboptimal response compared to the general population. Immunosuppression including mycophenolic acid, belatacept, and tacrolimus is associated with decreased response. Booster doses increase the immune response, but further upgradation in vaccination strategy for SOT is required.
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Affiliation(s)
| | - Vivek Kute
- Department of NephrologyIKDRC‐ITSAhmedabadIndia
| | - Hemant Rane
- Department of AnaesthesiaIKDRC‐ITSAhmedabadIndia
| | - Ruchir Dave
- Department of NephrologyIKDRC‐ITSAhmedabadIndia
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13
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Sánchez-Zapardiel E, Alós M, Nozal P, González-Muñoz M, Frauca-Remacha E, Gavilán LB, Quiles MJ, Hierro L, López-Granados E. Humoral and cellular immune responses to Pfizer-BioNTech BNT162b2 SARS-CoV-2 vaccine in adolescents with liver transplantation: Single center experience. Front Immunol 2022; 13:1049188. [PMID: 36505469 PMCID: PMC9727154 DOI: 10.3389/fimmu.2022.1049188] [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: 09/20/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Immune responses to vaccines against severe acute respiratory syndrome (SARS)-coronavirus (CoV)-2 are variable. In the absence of disease, youngsters are expected to better react to vaccines than adults. Nevertheless, chronic immunosuppression in transplant recipients may impair their capability to generate protection. We aim to explore immune responses after BNT162b2 SARS-CoV-2 vaccination in our cohort of young liver-transplanted patients. Methods A prospective study of adolescent liver-transplanted patients (n=33) in the long-term follow-up was performed. Immune responses after receiving Pfizer-BioNTech BNT162b2 vaccine were analyzed at two time-points: baseline and 30 days after the second dose. Humoral responses were measured by fluoroenzyme-immunoassay and T-cell responses by interferon-γ-release assay. Post-vaccine coronavirus disease (COVID-19) events were recorded by a survey. Results Pre-vaccine SARS-CoV-2-specific antibodies were undetectable in 27/32 (84.4%), negative/indeterminate in 3/32 (9.4%) and positive in 2/32 (6.3%) patients. Cellular responses at baseline were negative in 12/18 (66.6%), positive in 3/18 (16.6%) and indeterminate in 3/18 (16.6%) recipients. None of the baseline positives recalled any symptoms. Post-vaccine antibodies were detected in all patients and 92.6% showed levels >816 BAU/mL. Twenty (71.4%) recipients had positive T-cell responses. Regarding post-vaccine SARS-Cov-2 infection, 10 (30.3%) patients reported COVID-19 without hospitalization and 21 (63.6%) did not notify any infection. Negative and positive cell-response groups after vaccination showed statistically significant differences regarding COVID-19 cases (62.5% vs 22.2%, respectively; p=0.046). Conclusions Adolescents and young adults with liver transplantation responded to SARS-Cov-2 vaccine, generating both humoral and cellular responses. Recipients developing cellular responses after vaccination had a lower incidence of COVID-19.
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Affiliation(s)
- Elena Sánchez-Zapardiel
- Department of Immunology, La Paz University Hospital, Madrid, Spain,Lymphocyte Pathophysiology in Immunodeficiency Group, La Paz Biomedical Research Institute (IdiPAZ), La Paz University Hospital, Madrid, Spain,European Reference Network (ERN) Transplant-Child, Madrid, Spain,*Correspondence: Elena Sánchez-Zapardiel,
| | - María Alós
- European Reference Network (ERN) Transplant-Child, Madrid, Spain,Department of Pediatric Hepatology, La Paz University Hospital, Madrid, Spain
| | - Pilar Nozal
- Department of Immunology, La Paz University Hospital, Madrid, Spain,Diagnosis and Treatment of Pathologies Associated with Alterations of the Complement System Group, La Paz Biomedical Research Institute (IdiPAZ), La Paz University Hospital, Madrid, Spain,Rare Diseases Networking Biomedical Research Centre (CIBERER U754), Madrid, Spain
| | - Miguel González-Muñoz
- Department of Immunology, La Paz University Hospital, Madrid, Spain,Patient Safety and Quality Research Group, La Paz Biomedical Research Institute (IdiPAZ), La Paz University Hospital, Madrid, Spain
| | - Esteban Frauca-Remacha
- European Reference Network (ERN) Transplant-Child, Madrid, Spain,Department of Pediatric Hepatology, La Paz University Hospital, Madrid, Spain
| | | | - María José Quiles
- Department of Pediatric Hepatology, La Paz University Hospital, Madrid, Spain
| | - Loreto Hierro
- European Reference Network (ERN) Transplant-Child, Madrid, Spain,Department of Pediatric Hepatology, La Paz University Hospital, Madrid, Spain
| | - Eduardo López-Granados
- Department of Immunology, La Paz University Hospital, Madrid, Spain,Lymphocyte Pathophysiology in Immunodeficiency Group, La Paz Biomedical Research Institute (IdiPAZ), La Paz University Hospital, Madrid, Spain,European Reference Network (ERN) Transplant-Child, Madrid, Spain,Rare Diseases Networking Biomedical Research Centre (CIBERER U767), Madrid, Spain
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14
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Stich M, Di Cristanziano V, Tönshoff B, Weber LT, Dötsch J, Rammer MT, Rieger S, Heger E, Garbade SF, Burgmaier K, Benning L, Speer C, Habbig S, Haumann S. Humoral immune response and live-virus neutralization of the SARS-CoV-2 omicron (BA.1) variant after COVID-19 mRNA vaccination in children and young adults with chronic kidney disease. Pediatr Nephrol 2022; 38:1935-1948. [PMID: 36409368 PMCID: PMC9684918 DOI: 10.1007/s00467-022-05806-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Data on humoral immune response to standard COVID-19 vaccination are scarce in adolescent patients and lacking for children below 12 years of age with chronic kidney disease including kidney transplant recipients. METHODS We therefore investigated in this retrospective two-center study (DRKS00024668; registered 23.03.2021) the humoral immune response to a standard two-dose mRNA vaccine regimen in 123 CKD patients aged 5-30 years. A live-virus assay was used to assess the serum neutralizing activity against the SARS-CoV-2 omicron (BA.1) variant. RESULTS Children aged 5-11 years had a comparable rate and degree of immune response to adolescents despite lower vaccine doses (10 µg vs. 30 µg BNT162b2). Treatment with two (odds ratio 9.24) or three or more (odds ratio 17.07) immunosuppressants was an independent risk factor for nonresponse. The immune response differed significantly among three patient cohorts: 48 of 77 (62.3%) kidney transplant recipients, 21 of 26 (80.8%) patients on immunosuppressive therapy, and 19 of 20 (95.0%) patients with chronic kidney disease without immunosuppressive therapy responded. In the kidney transplant recipients, immunosuppressive regimens comprising mycophenolate mofetil, an eGFR of < 60 mL/min/1.73 m2, and female sex were independent risk factors for nonresponse. Two of 18 (11.1%) and 8 of 16 (50.0%) patients with an anti-S1-RBD IgG of 100-1411 and > 1411 BAU/mL, respectively, showed a neutralization activity against the omicron variant. CONCLUSION A standard mRNA vaccine regimen in immunosuppressed children and adolescents with kidney disease elicits an attenuated humoral immune response with effective live virus neutralization against the omicron variant in approximately 10% of the patients, underlying the need for omicron-adapted vaccination. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Maximilian Stich
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Veronica Di Cristanziano
- Institute of Virology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Lutz Thorsten Weber
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Jörg Dötsch
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Marian Theodor Rammer
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Susanne Rieger
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Eva Heger
- Institute of Virology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Sven F Garbade
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Kathrin Burgmaier
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
- Faculty of Applied Healthcare Science, Deggendorf Institute of Technology, Deggendorf, Germany
| | - Louise Benning
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Claudius Speer
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Sandra Habbig
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - Sophie Haumann
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
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15
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Immunogenicity of an mRNA-Based COVID-19 Vaccine among Adolescents with Obesity or Liver Transplants. Vaccines (Basel) 2022; 10:vaccines10111867. [PMID: 36366375 PMCID: PMC9693317 DOI: 10.3390/vaccines10111867] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
There are limited data regarding the immunogenicity of mRNA-based SARS-CoV-2 vaccine BNT162b2 among immunosuppressed or obese adolescents. We evaluated the humoral immune response in adolescents with obesity and adolescent liver transplant recipients (LTRs) after receiving two BNT162b2 doses. Sixty-eight participants (44 males; mean age 14.9 ± 1.7 years), comprising 12 LTRs, 24 obese, and 32 healthy adolescents, were enrolled. Immunogenicity was evaluated by anti-SARS-CoV-2 spike protein immunoassay and surrogate viral neutralization tests (sVNT) against the Delta and Omicron (BA.1) variants. At 27.1 ± 3.2 days after the second dose, the antibody levels were 1476.6 ± 1185.4, 2999.4 ± 1725.9, and 4960.5 ± 2644.1 IU/mL in the LTRs, obese adolescents, and controls, respectively (p < 0.001). Among obese individuals, liver stiffness <5.5 kPa was associated with higher antibody levels. The %inhibition of sVNT was significantly lower for the Omicron than that for the Delta variant. Injection site pain was the most common local adverse event. Nine participants (three obese and six controls) developed COVID-19 at 49 ± 11 days after the second vaccination; four were treated with favipiravir. All infections were mild, and the patients recovered without any consequences. Our study supports the need for the booster regimen in groups with an inferior immunogenic response, including LTRs and obese individuals.
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16
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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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17
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Qin CX, Auerbach SR, Charnaya O, Danziger-Isakov LA, Ebel NH, Feldman AG, Hsu EK, McAteer J, Mohammad S, Perito ER, Thomas AM, Chiang TP, Garonzik-Wang JM, Segev DL, Mogul DB. Antibody response to three SARS-CoV-2 mRNA vaccines in adolescent solid organ transplant recipients. Am J Transplant 2022; 22:2481-2483. [PMID: 35510786 PMCID: PMC9348453 DOI: 10.1111/ajt.17085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/08/2022] [Accepted: 05/02/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Caroline X. Qin
- Division of Gastroenterology, Hepatology, and Nutrition Department of Pediatrics Johns Hopkins Children’s Center Johns Hopkins University School of Medicine Baltimore, Maryland USA
- Department of Surgery The Johns Hopkins Hospital Johns Hopkins University School of Medicine Baltimore, Maryland USA
| | - Scott R. Auerbach
- Division of Cardiology Department of Pediatrics Children’s Hospital Colorado University of Colorado School of Medicine Aurora, Colorado USA
| | - Olga Charnaya
- Division of Nephrology Department of Pediatrics Johns Hopkins Children’s Center Johns Hopkins University School of Medicine Baltimore, Maryland USA
| | - Lara A. Danziger-Isakov
- Division of Infectious Diseases Department of Pediatrics Cincinnati Children’s Hospital Medical Center University of Cincinnati College of Medicine Cincinnati, Ohio USA
| | - Noelle H. Ebel
- Division of Gastroenterology, Hepatology and Nutrition Department of Pediatrics Lucile Packard Children’s Hospital Stanford Stanford University School of Medicine Palo Alto, California USA
| | - Amy G. Feldman
- Section of Gastroenterology, Hepatology and Nutrition Digestive Health Institute Children’s Hospital Colorado University of Colorado School of Medicine Aurora, Colorado USA
| | - Evelyn K. Hsu
- Division of Gastroenterology, Hepatology and Nutrition Department of Pediatrics Seattle Children’s Hospital University of Washington School of Medicine Seattle, Washington USA
| | - John McAteer
- Division of Nephrology Department of Pediatrics Johns Hopkins Children’s Center Johns Hopkins University School of Medicine Baltimore, Maryland USA
- Division of Infectious Diseases Department of Pediatrics Johns Hopkins Children’s Center Johns Hopkins University School of Medicine Baltimore, Maryland USA
| | - Saeed Mohammad
- Division of Gastroenterology, Hepatology and Nutrition Department of Pediatrics Ann & Robert H. Lurie Children’s Hospital of Chicago Northwestern University Feinberg School of Medicine Chicago, Illinois USA
| | - Emily R. Perito
- Division of Gastroenterology, Hepatology and Nutrition Department of Pediatrics University of California San Francisco Benioff Children’s Hospital University of California San Francisco School of Medicine San Francisco, California USA
| | - Ashley M. Thomas
- Division of Gastroenterology, Hepatology, and Nutrition Department of Pediatrics Johns Hopkins Children’s Center Johns Hopkins University School of Medicine Baltimore, Maryland USA
| | - Teresa P.Y. Chiang
- Department of Surgery The Johns Hopkins Hospital Johns Hopkins University School of Medicine Baltimore, Maryland USA
| | - Jacqueline M. Garonzik-Wang
- Department of Surgery University of Wisconsin Health University Hospital University of Wisconsin School of Medicine and Public Health Madison, Wisconsin USA
| | - Dorry L. Segev
- Department of Surgery The Johns Hopkins Hospital Johns Hopkins University School of Medicine Baltimore, Maryland USA
- Department of Surgery New York University Langone Health New York University Grossman School of Medicine New York, New York USA
| | - Douglas B. Mogul
- Division of Gastroenterology, Hepatology, and Nutrition Department of Pediatrics Johns Hopkins Children’s Center Johns Hopkins University School of Medicine Baltimore, Maryland USA
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18
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Safety and Humoral and Cellular Immunogenicity of the BNT162b2 SARS-CoV-2 Vaccine in Liver-Transplanted Adolescents Compared to Healthy Adolescents. Vaccines (Basel) 2022; 10:vaccines10081324. [PMID: 36016212 PMCID: PMC9413008 DOI: 10.3390/vaccines10081324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022] Open
Abstract
Since BNT162b2 was approved to prevent COVID-19 in children, we aim to compare the safety and immunogenicity of the BNT162b2 vaccine in liver-transplanted (LT) and healthy adolescents. LT and healthy adolescents received two doses of 30 µg of BNT162b2. All were evaluated for total COVID-19 antibodies directed against the receptor-binding domain (RBD) and interferon-γ using the ELISpot at all time points; anti-nucleocapsid immunoglobulin was evaluated at week 8 and the surrogate virus-neutralizing antibody (sVN) to Omicron at day 0 and week 8. Adverse effects were recorded during days 0−7. In total, 16 LT and 27 healthy adolescents were enrolled (aged 14.78 ± 1.70 years). After completion, all LT and healthy adolescents were positive for anti-RBD immunoglobulin, with geometric mean titers of 1511.37 (95% CI 720.22−3171.59) and 6311.90 (95% CI 4955.46−8039.64)) U/mL (p < 0.001). All tested negative for anti-nucleocapsid immunoglobulin, indicating no COVID-19 infection after vaccination. However, the sVNs to Omicron were positive in only nine (33.33%) healthy adolescents and none of the LT adolescents. Interferon-γ-secreting cells were lower in LT adolescents than healthy adolescents. The LT adolescents had a lower immunogenic response to BNT162b2 than the healthy adolescents. Administrating two doses of BNT162b2 was safe, but was less effective against the Omicron variant.
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19
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Dulek DE, Ardura MI, Green M, Michaels MG, Chaudhuri A, Vasquez L, Danziger-Isakov L, Posfay-Barbe KM, McCulloch MI, L'Huillier AG, Benden C. Update on COVID-19 vaccination in pediatric solid organ transplant recipients. Pediatr Transplant 2022; 26:e14235. [PMID: 35060251 DOI: 10.1111/petr.14235] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND COVID-19 vaccination has been successful in decreasing rates of SARS-CoV-2 infection in areas with high vaccine uptake. Cases of breakthrough SARS-CoV-2 infection remain infrequent among immunocompetent vaccine recipients who are protected from severe COVID-19. Robust data demonstrate the safety, immunogenicity, and effectiveness of several COVID-19 vaccine formulations. Importantly, Pfizer-BioNTech BNT162b2 mRNA COVID-19 vaccine studies have now included children as young as 5 years of age with safety, immunogenicity, and effectiveness data publicly available. In the United States, emergency use authorization by the Federal Drug Administration and approval from the Centers for Disease Control/Advisory Committee on Immunization Practices have been provided for the 5- to 11-year-old age group. METHODS Members of the International Pediatric Transplant Association (IPTA) provide an updated review of current COVID-19 vaccine data with focus on pediatric solid organ transplant (SOT)-specific issues. RESULTS This review provides an overview of current COVID-19 immunogenicity, safety, and efficacy data from key studies, with focus on data of importance to pediatric SOT recipients. Continued paucity of data in the setting of pediatric transplantation remains a challenge. CONCLUSIONS Further studies of COVID-19 vaccination in pediatric SOT recipients are needed to better understand post-vaccine COVID-19 T-cell and antibody kinetics and determine the optimal vaccine schedule. Increased COVID-19 vaccine acceptability, uptake, and worldwide availability are needed to limit the risk that COVID-19 poses to pediatric solid organ transplant recipients.
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Affiliation(s)
- Daniel E Dulek
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Monica I Ardura
- Nationwide Children's Hospital & The Ohio State University, Columbus, Ohio, USA
| | - Michael Green
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marian G Michaels
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | - Klara M Posfay-Barbe
- Children's Hospital of Geneva, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Mignon I McCulloch
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Arnaud G L'Huillier
- Children's Hospital of Geneva, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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20
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Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has significantly impacted all aspects of healthcare including solid organ transplantation. In this review, we discuss the specific impact of COVID-19 on the pediatric solid organ transplant population including access to grafts for pediatric transplant candidates as well as COVID-19 disease manifestations in pediatric transplant recipients. We address the current knowledge of prevention and management of COVID-19 in pediatric transplant recipients and provide additional information regarding social distancing, infection prevention and return to school.
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Affiliation(s)
- Amy G Feldman
- Pediatric Liver Transplant Center, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Digestive Health Institute, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Lara A Danziger-Isakov
- Immunocompromised Host Infectious Disease, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7017, Cincinnati, OH 45229, United States.
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21
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Kakos CD, Ziogas IA, Tsoulfas G. Pediatric transplantation during the COVID-19 pandemic. World J Transplant 2022; 12:88-99. [PMID: 35663540 PMCID: PMC9136715 DOI: 10.5500/wjt.v12.i5.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/16/2022] [Accepted: 04/20/2022] [Indexed: 02/06/2023] Open
Abstract
Children infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seem to have a better prognosis than adults. Nevertheless, pediatric solid organ transplantation (SOT) has been significantly affected by the unprecedented coronavirus disease 2019 (COVID-19) pandemic during the pre-, peri-, and post-transplant period. Undoubtedly, immunosuppression constitutes a real challenge for transplant clinicians as increased immunosuppression may prolong disease recovery, while its decrease can contribute to more severe symptoms. To date, most pediatric SOT recipients infected by SARS-CoV-2 experience mild disease with only scarce reports of life-threatening complications. As a consequence, after an initial drop during the early phase of the pandemic, pediatric SOTs are now performed with the same frequency as during the pre-pandemic period. This review summarizes the currently available evidence regarding pediatric SOT during the COVID-19 pandemic.
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Affiliation(s)
| | - Ioannis A Ziogas
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Georgios Tsoulfas
- Department of Transplantation Surgery, Aristotle University School of Medicine, Thessaloniki 54622, Greece
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22
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Feingold B, Berman P, Moninger A, Huston A, Stinner B, West SC, Rose‐Felker K, Zinn MD, Miller SA, Michaels MG. Responsiveness to second and third dose of mRNA COVID-19 vaccination in adolescent and young adult heart transplant recipients. Pediatr Transplant 2022; 26:e14272. [PMID: 35340096 PMCID: PMC9115437 DOI: 10.1111/petr.14272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Third-dose mRNA COVID-19 vaccine is currently recommended in the United States for SOT recipients based in part on data showing diminished immune response, including Ab production, after a two-dose regimen. Data on vaccine response in adolescent and young adult SOT recipients are limited, including no data reported on third-dose responsiveness. METHODS Results of serologic testing in a convenience sample of 28 vaccinated adolescent and young adult HT recipients at a single institution were collected from the medical record and summarized. RESULTS At a median of 98.5 days (IQR 59-150) after second dose, 17 (61%) had an Ab response. Among 12 who had serology before and after third-dose vaccination, four of seven who were negative prior to third dose became positive at a median of 34 days (IQR 31-39.5) following third dose. No myocarditis, acute rejection, graft dysfunction, graft loss, or deaths were observed. CONCLUSIONS These findings support recommendations for the routine administration of three doses of mRNA vaccines in adolescent and young adult HT recipients and show a potential subpopulation in whom the fourth dose should be contemplated.
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Affiliation(s)
- Brian Feingold
- Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA,Clinical and Translational ScienceUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA,Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Pamela Berman
- Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Allison Moninger
- Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Allison Huston
- Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Brenda Stinner
- Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Shawn C. West
- Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA,Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Kirsten Rose‐Felker
- Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA,Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Matthew D. Zinn
- Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA,Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Susan A. Miller
- Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA,Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Marian G. Michaels
- Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA,Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
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23
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Downes KJ, Statler VA, Orscheln RC, Cousino MK, Green M, Michaels MG, Muller WJ, Sharma TS, Danziger-Isakov LA, Ardura MI. Return to School and COVID-19 Vaccination for Pediatric Solid Organ Transplant Recipients in the United States: Expert Opinion for 2021-2022. J Pediatric Infect Dis Soc 2022; 11:43-54. [PMID: 34734268 PMCID: PMC8689907 DOI: 10.1093/jpids/piab098] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/24/2021] [Indexed: 01/07/2023]
Abstract
The COVID-19 pandemic continues to generate challenges for pediatric solid organ transplant (SOT) recipients and their families. As rates of COVID-19 fluctuate, new SARS-CoV-2 variants emerge, and adherence to and implementation of mitigation strategies vary from community to community, questions remain about the best and safest practices to prevent COVID-19 in vulnerable patients. Notably, decisions about returning to school remain difficult. We assembled a team of specialists in pediatric infectious diseases, transplant infectious diseases, public health, transplant psychology, and infection prevention and control to re-address concerns about school re-entry, as well as COVID-19 vaccines, for pediatric SOT recipients in the United States in 2021. Based on available literature and guidance from national organizations, we generated expert statements specific to pediatric SOT recipients focused on school attendance in 2021.
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Affiliation(s)
- Kevin J Downes
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Victoria A Statler
- Division of Infectious Diseases, Norton Children’s Hospital, Louisville, Kentucky, USA
- Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA
| | - Rachel C Orscheln
- Division of Pediatric Infectious Diseases, St. Louis Children’s Hospital, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University, St. Louis, Missouri, USA
| | - Melissa K Cousino
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
- University of Michigan Transplant Center, Ann Arbor, Michigan, USA
| | - Michael Green
- Division of Pediatric Infectious Diseases, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Departments of Pediatrics and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marian G Michaels
- Division of Pediatric Infectious Diseases, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Departments of Pediatrics and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - William J Muller
- Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tanvi S Sharma
- Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Lara A Danziger-Isakov
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Monica I Ardura
- Division of Infectious Diseases and Host Defense, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
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24
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Kehar M, Ebel N, Ng V, Lobritto S, Martinez M. Updates From the NASPGHAN/SPLIT SARS-CoV2 International Registry. J Pediatr Gastroenterol Nutr 2022; 74:e43-e44. [PMID: 34654794 PMCID: PMC8788628 DOI: 10.1097/mpg.0000000000003326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Mohit Kehar
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Vicky Ng
- Hospital for Sick Children, Toronto, Ontario, Canada
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25
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Considering a COVID-19 vaccine mandate for pediatric kidney transplant candidates. Pediatr Nephrol 2022; 37:2559-2569. [PMID: 35333972 PMCID: PMC8949834 DOI: 10.1007/s00467-022-05511-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 12/02/2022]
Abstract
The world continues to face the effects of the SARS-CoV-2 pandemic. COVID-19 vaccines are safe and effective in protecting recipients, decreasing the risk of COVID-19 acquisition, transmission, hospitalization, and death. Transplant recipients may be at greater risk for severe SARS-CoV-2 infection. As a result, transplant programs have begun instituting mandates for COVID-19 vaccine for transplant candidacy. While the question of mandating COVID-19 vaccine for adult transplant candidates has garnered attention in the lay and academic press, these discussions have not explicitly addressed children who may be otherwise eligible for kidney transplants. In this paper we seek to examine the potential ethical justifications of a COVID-19 vaccine mandate for pediatric kidney transplant candidacy through an examination of relevant ethical principles, analogous cases of the use of mandates, differences between adult and pediatric kidney transplant candidates, and the role of gatekeeping in transplant vaccine mandates. At present, it does not appear that pediatric kidney transplant centers are justified to institute a COVID-19 vaccine mandate for candidates. Finally, we will offer suggestions to be considered prior to the implementation of a COVID-19 vaccine mandate.
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