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Karunathilake RP, Kumara RA, Karunathilaka A, Wazil AWM, Nanayakkara N, Bandara CK, Abeysekera RA, Noordeen F, Gawarammana IB, Ratnatunga CN. 18-month longitudinal SARS COV-2 neutralizing antibody dynamics in haemodialysis patients receiving heterologous 3-dose vaccination (AZD-1222- AZD-1222- BNT162b2) in a lower middle income setting. BMC Nephrol 2024; 25:176. [PMID: 38778281 PMCID: PMC11112903 DOI: 10.1186/s12882-024-03599-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Patients with chronic kidney disease on haemodialysis (HD) were given priority COVID-19 vaccination due to increased disease risk. The immune response to COVID-19 vaccination in patients on HD was diminished compared to healthy individuals in 2-dose studies. This study aimed to evaluate seroconversion rate, neutralizing antibody (nAB) levels and longitudinal antibody dynamics to 3-dose heterologous vaccination against COVID-19 in a cohort of HD patients compared to healthy controls and assess patient factors associated with antibody levels. METHODS This study was a case-control longitudinal evaluation of nAB dynamics in 74 HD patients compared to 37 healthy controls in a low/middle income setting. Corresponding samples were obtained from the two cohorts at time-points (TP) 1-1-month post 2nd dose of AZD1222 vaccine, TP2- 4 months post 2nd dose, TP4- 2 weeks post 3rd dose with BNT162b2 vaccine, TP5-5 months post 3rd dose and TP6-12 months post 3rd dose. Additional data is available at TP0- pre 2nd dose and TP3- 6 months post 2nd dose in HC and HD cohorts respectively. Anti-SARS-CoV-2 nAB were detected using Genscript cPassTM pseudoviral neutralization kit. Demographic and clinical details were obtained using an interviewer administered questionnaire. RESULTS Cohorts were gender matched while mean age of the HD cohort was 54.1yrs (vs HCs mean age, 42.6yrs, p < 0.05). Percentage seroconverted and mean/median antibody level (MAB) in the HD cohort vs HCs at each sampling point were, TP1-83.7% vs 100% (p < 0.05), MAB-450 IU/ml vs 1940 IU/ml (p < 0.0001); TP2-71.4% vs 100%, (p < 0.001), MAB- 235 IU/ml vs 453 IU/ml, (p < 0.05); TP4-95.2% vs 100% (p > 0.05), MAB-1029 IU/ml vs 1538 IU/ml (p < 0.0001); TP5-100% vs 100%, MAB-1542 IU/ml vs 1741IU/ml (p > 0.05); TP6-100% vs 100%, MAB-1961 IU/ml vs 2911 IU/ml (p > 0.05). At TP2, patients aged < 60 years (p < 0.001) were associated with maintaining seropositivity compared to patients > 60 years. CONCLUSION Two dose vaccination of haemodialysis patients provided poor nAB levels which improved markedly following 3rd dose vaccination, the effect of which was long- lasting with high nAB levels in both patients and controls detectable at 1 year follow-up.
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Affiliation(s)
| | - Roshan Athula Kumara
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Amali Karunathilaka
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | | | | | | | - Rajitha Asanga Abeysekera
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
- Center for Education, Research and Training in Kidney Disease (CERTKiD), University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Faseeha Noordeen
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
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2
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Ahmed LA, Mansour HH, Elshennawy SI, Ramadan MA, Kamal MA, Mohamed SS, Ali OM, Ibrhim AH. Two versus three doses of COVID-19 vaccine and post-vaccination COVID-19 infection in hemodialysis patients. Infect Prev Pract 2024; 6:100338. [PMID: 38304200 PMCID: PMC10831178 DOI: 10.1016/j.infpip.2024.100338] [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: 07/09/2023] [Accepted: 12/18/2023] [Indexed: 02/03/2024] Open
Abstract
Background and aim Patients with chronic kidney disease including those undergoing hemodialysis (HD) constitute a particularly challenging group regarding COVID-19 vaccination. The present study aimed to compare the rate of reinfection after two and three doses of Sinopharm COVID-19 vaccine in HD patients. Patients and methods The study included 80 HD patients who received three doses of Sinopharm COVID-19 vaccine. In addition, there were another 80 patients who received only two doses of the vaccine. Patients in the latter group were selected based on propensity matching score with 1:1 ratio. Patients were monitored for post-vaccination COVID-19 infection using PCR examination of nasopharyngeal swabs. Patients were also monitored for post-vaccination complications including general complaints (headache, fever, fatigue), injection site complaints (arm pain, swelling, itching, rash), musculoskeletal complaints (muscle spasm or pain, joint pain) and others. All patients were followed for six months. Results The present study included 80 patients submitted to COVID-19 vaccination with two doses of Sinopharm vaccine (GI) and other 80 patients who received three doses of the same vaccine (GII). At the end of follow up, 11 patients (13.8 %) in GI caught COVID-19 infection. In contrast, no patient in GII had infection (P<0.001). Comparison between patients who had COVID-19 infection and those without infection revealed that the former subgroup had significantly lower BMI (23.3 ± 2.3 versus 27.5 ± 8.1 Kg/m2), higher frequency of associated Hepatitis C (HCV) infection (54.6 % versus 2.9 %, P<0.001) and higher serum ferritin levels [median (IQR): 1101.0 (836.0-1564.0) versus 675.0 (467.0-767.7) ng/mL, P=0.01]. Binary logistic regression analysis identified high serum ferritin levels [OR (95% CI): 0.014 (0.001-0.15), P<0.001] and associated HCV infection [OR (95% CI): 0.99 (0.98-1.01), P=0.02] as significant predictors of post-vaccination COVID-19 infection in multivariate analysis. Conclusions A three dose regime of Sinopharm COVID-19 vaccine associated with significantly lower rate of reinfection COVID-19 infection in HD patients. Infected patients had significantly lower BMI, higher frequency of HCV and higher ferritin levels.
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Affiliation(s)
- Laila A. Ahmed
- Internal Medicine Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Hayam H. Mansour
- Internal Medicine Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Salwa I. Elshennawy
- Clinical Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Marwa A.A. Ramadan
- Clinical Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed A.M. Kamal
- Clinical Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Soso S. Mohamed
- Community and Occupational Medicine Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Omaima Mohamed Ali
- Internal Medicine Department, Faculty of Medicine, Aswan University, Aswan, Egypt
| | - Amal H. Ibrhim
- Internal Medicine Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
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Werzowa J, Behanova M, Handisurya A, Heger F, Indra A, Holzer B, Dechat T, Spitzer S, Lederer S, Kraus DA, Zwerina J, Fritsch-Stork RDE. Response to Immunization against SARS-CoV-2 and Risk of Omicron Infection in Dialysis Patients: A Prospective Cohort Study. J Clin Med 2023; 12:4983. [PMID: 37568385 PMCID: PMC10419800 DOI: 10.3390/jcm12154983] [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: 07/11/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
It is not well established to what extent previous immunizations offer protection against infections with the SARS-CoV-2 Omicron variant in dialysis patients. We aimed to define the relevant humoral response in dialysis patients using a SARS-CoV-2 IgG chemiluminescence microparticle immunoassay (CMIA) compared to the activity of neutralizing antibodies assessed by a virus neutralization test. Next, we aimed to determine differences in humoral and cellular response levels over time among patients infected or not infected by the Omicron variant of SARS-CoV-2. Immunological parameters of cellular and humoral response to SARS-CoV-2 were analyzed at baseline and after 3 (T3), 6 (T6) and 14 months (T14). In this monocentric cohort study, we followed 110 dialysis patients (mean age 68.4 ± 13.7 years, 60.9% male) for a median of 545 days. We determined an anti-SARS-CoV-2 IgG level of 56.7 BAU/mL as an ideal cut-off value with a J-index of 90.7. Patients infected during the Omicron era had significantly lower (p < 0.001) mean antibody levels at T0 (3.5 vs. 111.2 BAU/mL), T3 (269.8 vs. 699.8 BAU/mL) and T6 (260.2 vs. 513.9 BAU/mL) than patients without Omicron infection. Patients who developed higher antibody levels at the time of the basic immunizations were less likely to become infected with SARS-CoV-2 during the Omicron era. There is a need to adjust the cut-off values for anti-SARS-CoV-2 IgG levels in dialysis patients.
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Affiliation(s)
- Johannes Werzowa
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1140 Vienna, Austria; (J.W.); (T.D.); (S.S.); (D.A.K.); (J.Z.)
- 1st Medical Department, Hanusch Hospital, 1140 Vienna, Austria; (A.H.); (S.L.)
| | - Martina Behanova
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1140 Vienna, Austria; (J.W.); (T.D.); (S.S.); (D.A.K.); (J.Z.)
| | - Ammon Handisurya
- 1st Medical Department, Hanusch Hospital, 1140 Vienna, Austria; (A.H.); (S.L.)
| | - Florian Heger
- Austrian Agency for Health and Food Safety (AGES), 1090 Vienna, Austria; (F.H.); (A.I.)
| | - Alexander Indra
- Austrian Agency for Health and Food Safety (AGES), 1090 Vienna, Austria; (F.H.); (A.I.)
| | - Barbara Holzer
- Institute for Veterinary Disease Control, Austrian Agency for Health and Food Safety (AGES), 2340 Moedling, Austria;
| | - Thomas Dechat
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1140 Vienna, Austria; (J.W.); (T.D.); (S.S.); (D.A.K.); (J.Z.)
| | - Silvia Spitzer
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1140 Vienna, Austria; (J.W.); (T.D.); (S.S.); (D.A.K.); (J.Z.)
| | - Sandra Lederer
- 1st Medical Department, Hanusch Hospital, 1140 Vienna, Austria; (A.H.); (S.L.)
| | - Daniel A. Kraus
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1140 Vienna, Austria; (J.W.); (T.D.); (S.S.); (D.A.K.); (J.Z.)
- 1st Medical Department, Hanusch Hospital, 1140 Vienna, Austria; (A.H.); (S.L.)
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1140 Vienna, Austria; (J.W.); (T.D.); (S.S.); (D.A.K.); (J.Z.)
- 1st Medical Department, Hanusch Hospital, 1140 Vienna, Austria; (A.H.); (S.L.)
| | - Ruth D. E. Fritsch-Stork
- Medical Center Mariahilf of OEGK, 1060 Vienna, Austria;
- Medical Faculty, Sigmund Freud Private University, 1020 Vienna, Austria
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Kanai D, Wakui H, Hanaoka M, Haze T, Azushima K, Shinoda S, Tsukamoto S, Taguchi S, Kinguchi S, Kanaoka T, Toya Y, Hirawa N, Kato H, Watanabe F, Hanaoka K, Mitsuhashi H, Yamaguchi S, Ohnishi T, Tamura K. Blunted humoral immune response to the fourth dose of BNT162b2 COVID-19 vaccine in patients undergoing hemodialysis. Clin Exp Nephrol 2023:10.1007/s10157-023-02342-0. [PMID: 36977892 PMCID: PMC10047466 DOI: 10.1007/s10157-023-02342-0] [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: 12/24/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND We aimed to investigate the impact of a fourth dose of BNT162b2 vaccine (Comirnaty®, Pfizer-BioNTech) on anti-SARS-CoV-2 (anti-S IgG) antibody titers in patients receiving hemodialysis (HD) and healthcare workers (HCWs). METHODS A multi-institutional retrospective study at five dialysis clinics in Japan was conducted using 238 HD patients and 58 HCW controls who received four doses of the BNT162b2 mRNA vaccine. Anti-S IgG titers were measured at 1, 3, and 6 months after the second dose, at 1 and 5/6 months after the third dose, and at 1 month after the fourth dose of vaccine. RESULTS The log anti-S IgG titers of the HD patients after the second vaccination were significantly lower than those of the control group, but equalized 1 month after the third vaccination: 9.94 (95% CI 9.82-10.10) vs. 9.81 (95% CI 9.66-9.96), (P = 0.32). In both groups, the fold-increase in anti-S IgG titers was significantly lower after the fourth dose than after the third dose of vaccine. In addition, there was a strong negative correlation between antibody titers 1 month after the fourth vaccination and antibody titers immediately before the vaccination. In both groups, the waning rate of anti-S IgG titers from the post-vaccination peak level after the third vaccine dose was significantly slower than that after the second dose. CONCLUSIONS These findings suggest that the humoral immune response was blunted after the fourth dose of the conventional BNT162b2 vaccine. However, multiple vaccinations could extend the window of humoral immune protection.
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Affiliation(s)
- Daisuke Kanai
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Hiromichi Wakui
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Masaaki Hanaoka
- Kohsaikai Kamioooka Jinsei Clinic, Yokohama, Kanagawa, Japan
| | - Tatsuya Haze
- YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Kengo Azushima
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Satoru Shinoda
- Department of Biostatistics, School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Shunichiro Tsukamoto
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Shinya Taguchi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Sho Kinguchi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Tomohiko Kanaoka
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Yoshiyuki Toya
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Nobuhito Hirawa
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Hideaki Kato
- Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | | | - Kanako Hanaoka
- Kohsaikai Kamioooka Jinsei Clinic, Yokohama, Kanagawa, Japan
| | | | | | | | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan.
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5
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Sannier G, Nicolas A, Dubé M, Marchitto L, Nayrac M, Tastet O, Chatterjee D, Tauzin A, Lima-Barbosa R, Laporte M, Cloutier R, Sreng Flores AM, Boutin M, Gong SY, Benlarbi M, Ding S, Bourassa C, Gendron-Lepage G, Medjahed H, Goyette G, Brassard N, Delgado GG, Niessl J, Gokool L, Morrisseau C, Arlotto P, Rios N, Tremblay C, Martel-Laferrière V, Prat A, Bélair J, Beaubien-Souligny W, Goupil R, Nadeau-Fredette AC, Lamarche C, Finzi A, Suri RS, Kaufmann DE. A third SARS-CoV-2 mRNA vaccine dose in people receiving hemodialysis overcomes B cell defects but elicits a skewed CD4 + T cell profile. Cell Rep Med 2023; 4:100955. [PMID: 36863335 PMCID: PMC9902290 DOI: 10.1016/j.xcrm.2023.100955] [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: 08/08/2022] [Revised: 12/27/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
Cellular immune defects associated with suboptimal responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccination in people receiving hemodialysis (HD) are poorly understood. We longitudinally analyze antibody, B cell, CD4+, and CD8+ T cell vaccine responses in 27 HD patients and 26 low-risk control individuals (CIs). The first two doses elicit weaker B cell and CD8+ T cell responses in HD than in CI, while CD4+ T cell responses are quantitatively similar. In HD, a third dose robustly boosts B cell responses, leads to convergent CD8+ T cell responses, and enhances comparatively more T helper (TH) immunity. Unsupervised clustering of single-cell features reveals phenotypic and functional shifts over time and between cohorts. The third dose attenuates some features of TH cells in HD (tumor necrosis factor alpha [TNFα]/interleukin [IL]-2 skewing), while others (CCR6, CXCR6, programmed cell death protein 1 [PD-1], and HLA-DR overexpression) persist. Therefore, a third vaccine dose is critical to achieving robust multifaceted immunity in hemodialysis patients, although some distinct TH characteristics endure.
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Affiliation(s)
- Gérémy Sannier
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Alexandre Nicolas
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Mathieu Dubé
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Lorie Marchitto
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Manon Nayrac
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Olivier Tastet
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Debashree Chatterjee
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Alexandra Tauzin
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | | | - Mélanie Laporte
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Rose Cloutier
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Alina M Sreng Flores
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Marianne Boutin
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Shang Yu Gong
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Department of Microbiology and Immunology, McGill University, Montreal, QC H3A 2B4, Canada
| | - Mehdi Benlarbi
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Shilei Ding
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Catherine Bourassa
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Gabrielle Gendron-Lepage
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Halima Medjahed
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Guillaume Goyette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Nathalie Brassard
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Gloria-Gabrielle Delgado
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Julia Niessl
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Laurie Gokool
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Chantal Morrisseau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Pascale Arlotto
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Norka Rios
- Research Institute of the McGill University Health Centre, Montreal, QC H3H 2L9, Canada
| | - Cécile Tremblay
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Valérie Martel-Laferrière
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Alexandre Prat
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Département de Neurosciences, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Justin Bélair
- Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - William Beaubien-Souligny
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Nephrology Division, Centre Hospitalier de l'Université de Montréal, Montreal, QC H3X 3E4, Canada
| | - Rémi Goupil
- Centre de Recherche of the Hôpital du Sacré-Cœur de Montréal, Montreal, QC H4J 1C5, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Annie-Claire Nadeau-Fredette
- Nephrology Division, Centre Hospitalier de l'Université de Montréal, Montreal, QC H3X 3E4, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada; Centre de Recherche of the Hôpital Maisonneuve-Rosemont, Montreal, QC H1T 2M4, Canada
| | - Caroline Lamarche
- Nephrology Division, Centre Hospitalier de l'Université de Montréal, Montreal, QC H3X 3E4, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada; Centre de Recherche of the Hôpital Maisonneuve-Rosemont, Montreal, QC H1T 2M4, Canada
| | - Andrés Finzi
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada; Department of Microbiology and Immunology, McGill University, Montreal, QC H3A 2B4, Canada.
| | - Rita S Suri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Research Institute of the McGill University Health Centre, Montreal, QC H3H 2L9, Canada; Division of Nephrology, Department of Medicine, McGill University, Montreal, QC H3G 2M1, Canada.
| | - Daniel E Kaufmann
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Département de Médecine, Université de Montréal, Montréal, QC H3T 1J4, Canada; Division of Infectious Diseases, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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6
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Real-World Effectiveness of SARS-CoV-2 Vaccine Booster in Hemodialysis Patients with COVID-19 Receiving Molnupiravir. Viruses 2023; 15:v15020543. [PMID: 36851757 PMCID: PMC9967999 DOI: 10.3390/v15020543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine booster is one of the most essential strategies against coronavirus disease 2019 (COVID-19) in the era of emerging variants. However, the effectiveness of SARS-CoV-2 vaccine boosters has not much been investigated in hemodialysis (HD) patients receiving oral antiviral agents. In this retrospective study involving 258 HD patients with COVID-19 receiving molnupiravir, we stratified the study cohort according to vaccination status and compared the baseline characteristics and risks of 30-day composite events (COVID-19-related acute care visits, hospitalization, or mortality) among groups. Our analysis demonstrated that the SARS-CoV-2 vaccine boosters markedly decreased the risk of composite events in HD patients (hazard ratio (95% confidence interval), 0.163 (0.063-0.423) for three vs. ≤ two doses of vaccination, p < 0.001; 0.309 (0.115-0.830) for four vs. ≤ two doses of vaccination, p = 0.020). The benefits of vaccine boosters were similar between patients receiving mRNA-based and protein-based boosters and between those with post-booster intervals of ≤ 120 and > 120 days. In conclusion, for HD patients with initially mild or asymptomatic COVID-19 receiving molnupiravir, the benefits of SARS-CoV-2 vaccine boosters are prominent, irrespective of booster vaccine types.
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Mavrovouniotis I, Fylaktou A, Stagou M, Ouranos K, Lioulios G, Evgenikaki E, Exindari M, Gioula G. Cellular and Humoral Responses in Dialysis Patients after Vaccination with the BNT162b2 or mRNA-1273 Vaccines. Life (Basel) 2023; 13:life13020474. [PMID: 36836831 PMCID: PMC9967689 DOI: 10.3390/life13020474] [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: 12/22/2022] [Revised: 01/24/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
The outbreak of SARS-CoV-2 has raised considerable concern about the detrimental effects it can induce in public health, with the interest of the scientific community being focused on the development of preventive and therapeutic approaches. Patients with end-stage renal disease (ESRD) are amongst vulnerable populations for critical illness owing to the presence of other comorbidities, their defective immune system, and their inability of self-isolation. To date, vaccination constitutes the most promising method to manage viral dispersion. Therefore, it is particularly important to investigate the effectiveness of available vaccines against SARS-CoV-2 in this risk group. Here, we summarize initial experience regarding the humoral and cellular immune responses elicited in dialysis patients after completion of the recommended vaccination regimen, as well as after booster dose administration, with one of the two mRNA vaccines, namely, BNT162b2 and mRNA-1273. In conclusion, a significantly diminished and delayed immune pattern was observed in ESRD patients compared to healthy population, with a peak in antibody titers occurring 3-5 weeks after the second dose. A booster dose significantly augmented the immune response in dialysis patients with either mRNA-based vaccine. Variables adversely correlating with the weak immunogenicity observed in dialysis patients include immunosuppressive therapy, older age, comorbidities, longer time in hemodialysis treatment, and higher body mass index. On the contrary, previous COVID-19 infection and administration of the mRNA-1273 vaccine are deemed to induce a more favorable immune response. Further investigation is needed to thoroughly understand the efficacy of mRNA-based vaccines in hemodialysis patients and define predictive factors that can influence it.
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Affiliation(s)
- Ilias Mavrovouniotis
- Microbiology Department, Medical School, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Asimina Fylaktou
- National Peripheral Histocompatibility Center, Immunology Department, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Maria Stagou
- Department of Nephrology, School of Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, 54642 Thessaloniki, Greece
| | - Konstantinos Ouranos
- Microbiology Department, Medical School, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
- Correspondence:
| | - Georgios Lioulios
- Department of Nephrology, School of Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, 54642 Thessaloniki, Greece
| | - Efthimia Evgenikaki
- National Peripheral Histocompatibility Center, Immunology Department, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Maria Exindari
- Microbiology Department, Medical School, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Georgia Gioula
- Microbiology Department, Medical School, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
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Yang X, Zhang H, Bao W, Fu S, Jin H. Immunogenicity Rates after SARS-CoV-2 Three-Dose Vaccination in Patients under Dialysis: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2022; 10:vaccines10122070. [PMID: 36560480 PMCID: PMC9782384 DOI: 10.3390/vaccines10122070] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Considering the indeterminate effects following the administration of three doses of the SARS-CoV-2 vaccine to patients under dialysis, the present study aimed to evaluate the immunogenicity rates of patients who received the three-dose vaccine. METHODS MEDLINE, Web of Science, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register for Controlled Trials were searched to select the relevant literature to perform the present review. We included randomized controlled trials, non-randomized trials, prospective, observational cohort, and case-control studies to assess the humoral and cellular immune responses following the administration of the three-dose SARS-CoV-2 vaccine to patients receiving dialysis. RESULTS Overall, 38 studies are included in the meta-analysis presented in this paper. For patients on dialysis, the overall humoral antibody response rate is 97% following three doses of mRNA or viral vector vaccines and 100% following four doses of the SARS-CoV-2 vaccine. A subgroup analysis shows that the antibody response rate is 96% for patients on hemodialysis (HD) and 100% for those receiving peritoneal dialysis (PD). The antibody response rate in the different immunogen-vaccinated groups tends to be higher than that in the same immunogen-vaccinated group (99% vs. 96%). For those who exhibit no response following two doses of the vaccine, the third and fourth doses can elevate the antibody response rate to 81%, and that number for low responders increases to 96%. However, the pooled results obtained from the relatively few trials conducted indicate that the positive T-cell response rate only increases to 59% following three doses of the vaccine. The antibody response rate is not different between dialysis and non-dialysis groups (relative risk = 0.95, 95% CI 0.90-1.02) following three doses of the vaccine. The relative risks for a SARS-CoV-2 breakthrough infection, all-cause mortality, and hospital admissions are 0.59 (95% CI 0.30-1.04), 0.63 (95% CI 0.35-1.12), and 0.53 (95% CI 0.37-0.74), respectively, when comparing three doses with two doses of the vaccine administered to the dialysis population. CONCLUSIONS The third or fourth dose of the SARS-CoV-2 vaccine significantly increases the immunogenicity rates in dialysis patients, and this beneficial effect does not vary with the type of vaccine (the same or different immunogen vaccination), dialysis modality (HD or PD), or previous low response following the administration two doses of the vaccine. We believe that healthcare workers should encourage patients receiving dialysis to receive a third or fourth vaccine dose to strengthen their immunity against SARS-CoV-2.
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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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