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Wall N, Godlee A, Geh D, Jones C, Faustini S, Harvey R, Penn R, Chanouzas D, Nightingale P, O’Shea M, Richter A, Moss P, Cunningham A, Harper L. Latent Cytomegalovirus Infection and Previous Capsular Polysaccharide Vaccination Predict Poor Vaccine Responses in Older Adults, Independent of Chronic Kidney Disease. Clin Infect Dis 2021; 73:e880-e889. [PMID: 33728434 PMCID: PMC8366832 DOI: 10.1093/cid/ciab078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) are more prone to severe infection. Vaccination is a key strategy to reduce this risk. Some studies suggest vaccine efficacy may be reduced in patients with CKD, despite preserved maintenance of long-term responses to some pathogens and vaccines. Here, we investigated immune responses to 2 vaccines in patients with CKD to identify predictors of immunological responsiveness. METHODS Individuals >65 years old, with or without nondialysis CKD (n = 36 and 29, respectively), were vaccinated with a nonadjuvanted seasonal influenza vaccine (T-dependent) and Pneumovax23 (23-valent pneumococcal polysaccharide [PPV23], T-independent). Humoral responses were measured at baseline, day 28, and 6 months. Lymphocyte subset and plasma cell/blast analyses were performed using flow cytometry. Cytomegalovirus (CMV) serotyping was assessed by enzyme-linked immunosorbent assay. RESULTS Only modest responsiveness was observed to both vaccines, independent of CKD status (25% adequate response in controls vs. 12%-18% in the CKD group). Unexpectedly, previous immunization with PPV23 (median 10-year interval) and CMV seropositivity were associated with poor PPV23 responsiveness in both study groups (P < .001 and .003, respectively; multivariable linear regression model). Patients with CKD displayed expanded circulating populations of T helper 2 and regulatory T cells, which were unrelated to vaccine responses. Despite fewer circulating B cells, patients with CKD were able to mount a similar day 7 plasma cell/blast response to controls. CONCLUSION Patients with nondialysis CKD can respond similarly to vaccines as age- and sex-matched healthy individuals. CKD patients display an immune signature that is independent of vaccine responsiveness. Prior PPV23 immunization and CMV infection may influence responsiveness to vaccination. Clinical Trials Registration. NCT02535052.
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Affiliation(s)
- Nadezhda Wall
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Alexandra Godlee
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Daniel Geh
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Charlotte Jones
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Sian Faustini
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Ruth Harvey
- National Institute for Biological Standards and Control, Potters Bar, UK
| | - Rebecca Penn
- National Institute for Biological Standards and Control, Potters Bar, UK
| | - Dimitrios Chanouzas
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Peter Nightingale
- Institute Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - Matthew O’Shea
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Alex Richter
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Adam Cunningham
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Lorraine Harper
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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Clarke CL, Prendecki M, Dhutia A, Gan J, Edwards C, Prout V, Lightstone L, Parker E, Marchesin F, Griffith M, Charif R, Pickard G, Cox A, McClure M, Tedder R, Randell P, Greathead L, Guckian M, McAdoo SP, Kelleher P, Willicombe M. Longevity of SARS-CoV-2 immune responses in hemodialysis patients and protection against reinfection. Kidney Int 2021; 99:1470-1477. [PMID: 33774082 PMCID: PMC7992297 DOI: 10.1016/j.kint.2021.03.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 01/19/2023]
Abstract
Patients with end stage kidney disease receiving in-center hemodialysis (ICHD) have had high rates of SARS-CoV-2 infection. Following infection, patients receiving ICHD frequently develop circulating antibodies to SARS-CoV-2, even with asymptomatic infection. Here, we investigated the durability and functionality of the immune responses to SARS-CoV-2 infection in patients receiving ICHD. Three hundred and fifty-six such patients were longitudinally screened for SARS-CoV-2 antibodies and underwent routine PCR-testing for symptomatic and asymptomatic infection. Patients were regularly screened for nucleocapsid protein (anti-NP) and receptor binding domain (anti-RBD) antibodies, and those who became seronegative at six months were screened for SARS-CoV-2 specific T-cell responses. One hundred and twenty-nine (36.2%) patients had detectable antibody to anti-NP at time zero, of whom 127 also had detectable anti-RBD. Significantly, at six months, 71/111 (64.0%) and 99/116 (85.3%) remained anti-NP and anti-RBD seropositive, respectively. For patients who retained antibody, both anti-NP and anti-RBD levels were reduced significantly after six months. Eleven patients who were anti-NP seropositive at time zero, had no detectable antibody at six months; of whom eight were found to have SARS-CoV-2 antigen specific T cell responses. Independent of antibody status at six months, patients with baseline positive SARS-CoV-2 serology were significantly less likely to have PCR confirmed infection over the following six months. Thus, patients receiving ICHD mount durable immune responses six months post SARS-CoV-2 infection, with fewer than 3% of patients showing no evidence of humoral or cellular immunity.
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Affiliation(s)
- Candice L Clarke
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK; Imperial College Renal and Transplant Centre, Division of Medicine, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
| | - Maria Prendecki
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK; Imperial College Renal and Transplant Centre, Division of Medicine, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Amrita Dhutia
- Imperial College Renal and Transplant Centre, Division of Medicine, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Jaslyn Gan
- Imperial College Renal and Transplant Centre, Division of Medicine, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Claire Edwards
- Imperial College Renal and Transplant Centre, Division of Medicine, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Virginia Prout
- Imperial College Renal and Transplant Centre, Division of Medicine, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Liz Lightstone
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK; Imperial College Renal and Transplant Centre, Division of Medicine, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Eleanor Parker
- Immunology of Infection Group, Department of Infectious Diseases, Imperial College London, London, UK
| | - Federica Marchesin
- Immunology of Infection Group, Department of Infectious Diseases, Imperial College London, London, UK
| | - Megan Griffith
- Imperial College Renal and Transplant Centre, Division of Medicine, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Rawya Charif
- Imperial College Renal and Transplant Centre, Division of Medicine, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Graham Pickard
- Department of Infection and Immunity, North West London Pathology NHS Trust, London, UK
| | - Alison Cox
- Department of Infection and Immunity, North West London Pathology NHS Trust, London, UK
| | - Myra McClure
- Immunology of Infection Group, Department of Infectious Diseases, Imperial College London, London, UK
| | - Richard Tedder
- Immunology of Infection Group, Department of Infectious Diseases, Imperial College London, London, UK
| | - Paul Randell
- Department of Infection and Immunity, North West London Pathology NHS Trust, London, UK
| | - Louise Greathead
- Department of Infection and Immunity, North West London Pathology NHS Trust, London, UK
| | - Mary Guckian
- Department of Infection and Immunity, North West London Pathology NHS Trust, London, UK
| | - Stephen P McAdoo
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK; Imperial College Renal and Transplant Centre, Division of Medicine, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Peter Kelleher
- Immunology of Infection Group, Department of Infectious Diseases, Imperial College London, London, UK; Department of Infection and Immunity, North West London Pathology NHS Trust, London, UK
| | - Michelle Willicombe
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK; Imperial College Renal and Transplant Centre, Division of Medicine, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
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