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Benning L, Bartenschlager M, Kim H, Morath C, Zeier M, Schnitzler P, Bartenschlager R, Speer C. Durability of Humoral Responses after an Adapted SARS-CoV-2 mRNA Vaccine Dose in Hemodialysis Patients. Vaccines (Basel) 2024; 12:738. [PMID: 39066376 PMCID: PMC11281374 DOI: 10.3390/vaccines12070738] [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: 04/28/2024] [Revised: 06/24/2024] [Accepted: 06/29/2024] [Indexed: 07/28/2024] Open
Abstract
We recently showed that an adapted SARS-CoV-2 vaccine with wildtype and BA.4/BA.5 Omicron subtype epitopes induced a broad short-term immune response in hemodialysis patients. Antibodies with protective capacity were boosted significantly after a follow-up period of 3 weeks following a fifth vaccine dose. However, data on the longevity of the humoral response after bivalent vaccination are lacking but urgently needed to make recommendations for further booster vaccinations in this patient group. This study is an extension of our previously published data including 40 patients on hemodialysis with a follow-up period of 12 months after an adapted booster vaccine dose. We performed a detailed characterization of humoral immune responses and assessed breakthrough infections. In addition, the severity of breakthrough infections was assessed using an established grading system. Anti-S1 IgG and surrogate neutralizing antibodies significantly decreased during the period of 12 months (p < 0.01 and p < 0.001, respectively). Live-virus neutralizing antibodies against the wildtype and the BA.5 subtype also significantly decreased over time (p < 0.01 and p < 0.01, respectively). However, even 12 months after administration of the adapted vaccine dose, all 40/40 (100%) of hemodialysis patients showed detectable SARS-CoV-2 wildtype neutralization activity, with 35/40 (88%) also exhibiting detectable BA.5 subtype neutralization activity. During follow-up, 13/40 (33%) patients contracted a SARS-CoV-2 breakthrough infection, among which 12 cases were categorized as asymptomatic or mild, while only 1 case was classified as moderate disease activity. Thus, bivalent booster vaccination seems to induce a sustained immune response in hemodialysis patients over a period of 12 months with breakthrough infections occurring frequently but predominantly manifesting as asymptomatic or mild.
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Affiliation(s)
- Louise Benning
- Department of Nephrology, Heidelberg University, 69120 Heidelberg, Germany (C.M.); (M.Z.)
| | - Marie Bartenschlager
- Medical Faculty Heidelberg, Department of Infectious Diseases, Molecular Virology, Heidelberg University, 69120 Heidelberg, Germany; (M.B.); (H.K.); (R.B.)
| | - Heeyoung Kim
- Medical Faculty Heidelberg, Department of Infectious Diseases, Molecular Virology, Heidelberg University, 69120 Heidelberg, Germany; (M.B.); (H.K.); (R.B.)
| | - Christian Morath
- Department of Nephrology, Heidelberg University, 69120 Heidelberg, Germany (C.M.); (M.Z.)
| | - Martin Zeier
- Department of Nephrology, Heidelberg University, 69120 Heidelberg, Germany (C.M.); (M.Z.)
| | - Paul Schnitzler
- Medical Faculty Heidelberg, Department of Infectious Diseases, Virology, Heidelberg University, 69120 Heidelberg, Germany;
| | - Ralf Bartenschlager
- Medical Faculty Heidelberg, Department of Infectious Diseases, Molecular Virology, Heidelberg University, 69120 Heidelberg, Germany; (M.B.); (H.K.); (R.B.)
- German Center for Infection Research (DZIF), 69120 Heidelberg, Germany
- Division Virus-Associated Carcinogenesis, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Claudius Speer
- Department of Nephrology, Heidelberg University, 69120 Heidelberg, Germany (C.M.); (M.Z.)
- Medical Faculty Heidelberg, Department of Internal Medicine III (Cardiology, Angiology, and Pneumology), Heidelberg University, 69120 Heidelberg, Germany
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Goggins E, Sharma B, Ma JZ, Gautam J, Bowman B. Humoral immunity trends in a hemodialysis cohort following SARS-CoV-2 mRNA booster: A cohort study. Health Sci Rep 2024; 7:e1858. [PMID: 38357484 PMCID: PMC10864730 DOI: 10.1002/hsr2.1858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/24/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
Background and Aims Patients with end stage kidney disease on hemodialysis are vulnerable to SARS-CoV-2 infection. Current guidelines recommend boosters of SARS-CoV-2 mRNA-based vaccines. The long-term humoral response of hemodialysis patients infected with SARS-CoV-2 after receiving a booster of SARS-CoV-2 mRNA-based vaccines has been incompletely characterized. Here, we determined the long-term humoral response of hemodialysis patients to two and three doses of the Pfizer BioNTech (BNT162b2) mRNA SARS-CoV-2 vaccine and investigated the effect of postbooster SARS-CoV-2 infection on antibody levels over time. Methods Samples were collected on a monthly basis and tested for anti-SARS-CoV-2 antibodies against anti-spike S1 domain. Thirty-five hemodialysis patients were enrolled in the original study and 27 of these received a booster. Patients were followed up to 6 months after the first two doses and an additional 7 months after the third BNT162b2 dose. Results are presented as the internationally harmonized binding antibody units (BAU/mL). Results Antibody level significantly increased from prebooster to 2 weeks postbooster, with a median [25th, 75th percentile] rise from 52.72 [28.55, 184.7] to 6216 [3806, 11,730] BAU/mL in the total population. Of patients with a negative or borderline detectable antibody level 6 months after vaccination who received a third dose, 89% developed positive antibody levels 2 weeks postbooster. Postbooster antibody levels declined an average rate of 29% per month in infection-naïve patients. Antibody levels spiked in patients infected with SARS-CoV-2 after receiving a booster but declined rapidly. No patients infected postbooster required hospitalization. Conclusions A third dose of BNT162b2 restores antibody levels to high levels in dialysis patients but levels decline over time. A third dose did not necessarily prevent infection, but no patients suffered severe infection or required hospitalization. SARS-CoV-2 recovered patients appear to have a blunted rise in antibody levels after a third dose. Although patients infected with SARS-CoV-2 postbooster had an immediate spike in antibody levels, these declined over time.
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Affiliation(s)
- Eibhlin Goggins
- Division of NephrologyUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Binu Sharma
- Division of NephrologyUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Jennie Z. Ma
- Division of NephrologyUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
- Public Health SciencesUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Jitendra Gautam
- Division of NephrologyUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Brendan Bowman
- Division of NephrologyUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
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Benning L, Bartenschlager M, Kim H, Kälble F, Nusshag C, Buylaert M, Reichel P, Schaier M, Morath C, Zeier M, Schnitzler P, Bartenschlager R, Speer C. Live-virus serum neutralization after bivalent SARS-CoV-2 mRNA vaccination in hemodialysis patients. J Med Virol 2023; 95:e29303. [PMID: 38082556 DOI: 10.1002/jmv.29303] [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: 09/15/2023] [Revised: 11/09/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023]
Abstract
The development of bivalent booster vaccines addresses the ongoing evolution of the emerging B.1.1.529 (omicron) variant subtypes that are known to escape vaccine-induced neutralizing antibody response. Little is known about the immunogenicity and reactogenicity of bivalent mRNA vaccines in hemodialysis patients with impaired vaccine response. In this prospective, observational cohort study, we analyzed SARS-CoV-2 anti-S1 IgG, surrogate neutralizing antibodies (SNA), and live-virus neutralization against the SARS-CoV-2 wildtype and the BA.5 variant in 42 hemodialysis patients with and without prior SARS-CoV-2 infection before and after an additional fifth bivalent vaccine dose. Anti-S1 IgG and SNA were significantly higher in hemodialysis patients with prior infection than in patients without infection (p < 0.001 and p < 0.01, respectively). In patients without prior infection, both antibody levels increased, and live-virus neutralizing antibodies against the wildtype and the BA.5 variant were correspondingly significantly higher after bivalent booster vaccination (p < 0.001 for both). Conversely, in patients with prior infection, anti-S1 IgG and SNA did not alter significantly, and bivalent booster vaccination did not induce additional humoral immune response against the SARS-CoV-2 wildtype and the BA.5 variant. Thus, bivalent mRNA vaccines might increase humoral responses in hemodialysis patients without prior infection. Larger clinical trials are needed to help guide vaccination strategies in these immunocompromised individuals.
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Affiliation(s)
- Louise Benning
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Marie Bartenschlager
- Department of Infectious Diseases, Molecular Virology, University of Heidelberg, Heidelberg, Germany
| | - Heeyoung Kim
- Department of Infectious Diseases, Molecular Virology, University of Heidelberg, Heidelberg, Germany
| | - Florian Kälble
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Christian Nusshag
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Mirabel Buylaert
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Paula Reichel
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Matthias Schaier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Christian Morath
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Paul Schnitzler
- Department of Infectious Diseases, Virology, University of Heidelberg, Heidelberg, Germany
| | - Ralf Bartenschlager
- Department of Infectious Diseases, Molecular Virology, University of Heidelberg, Heidelberg, Germany
- German Center for Infection Research (DZIF), Heidelberg partner site, Heidelberg, Germany
- Division Virus-Associated Carcinogenesis, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Claudius Speer
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
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Chen TH, Ho Y, Tai HL, Chu YC, Lin YP, Yang CY, Tseng WC, Ou SM, Tsai MT, Chen JY, Wu TH, Lee KH, Chen FY, Li SY, Lin CC, Tarng DC. Survival benefit of a third dose of the COVID-19 vaccine among hemodialysis patients: A prospective cohort study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:1198-1206. [PMID: 37770324 DOI: 10.1016/j.jmii.2023.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/19/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Hemodialysis (HD) patients are particularly vulnerable to severe coronavirus disease 2019 (COVID-19) due to their immunocompromised state and comorbid conditions. Timely vaccination could be the most effective strategy to reduce morbidity and mortality. However, data on the survival benefit of the COVID-19 vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and death among HD patients are limited, especially during the Omicron-dominant period. METHODS In this prospective hospital-based cohort study, we identified HD patients from July 1, 2021, to April 29, 2022. The patients were divided into fully vaccinated and partially vaccinated groups. We compared the humoral response, risk of developing SARS-CoV-2 infection, and all-cause mortality between the two groups. RESULTS Among the 440 HD patients included, 152 patients were fully vaccinated, and 288 patients were partially vaccinated. Patients in the fully vaccinated group exhibited higher anti-spike protein receptor-binding domain (S protein RBD) antibody levels and lower risks of all-cause mortality (adjusted hazard ratio, 0.35; 95% confidence interval, 0.17-0.73; p = 0.005) than the partially vaccinated group. However, the risk for SARS-CoV-2 infection did not significantly differ between the two groups. Irrespective of the number of vaccinations, the risk of all-cause mortality was lower in patients with anti-S protein RBD antibody levels in the higher tertile. CONCLUSION A third dose of the COVID-19 vaccine was associated with a decreased risk of all-cause mortality among HD patients during the Omicron-dominant period. A higher post-vaccination anti-S protein RBD antibody level was also associated with a lower risk of mortality.
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Affiliation(s)
- Tz-Heng Chen
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yang Ho
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Clinical Toxicology and Occupational Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Ling Tai
- Department of Business Administration, National Taiwan University of Science and Technology, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taiwan
| | - Yuan-Chia Chu
- Information Management Office, Taipei Veterans General Hospital, Taipei, Taiwan; Big Data Center, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yao-Ping Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Yu Yang
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Cheng Tseng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shuo-Ming Ou
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Tsun Tsai
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jinn-Yang Chen
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tsai-Hung Wu
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuo-Hua Lee
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fan-Yu Chen
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Szu-Yuan Li
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Der-Cherng Tarng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan; Department and Institute of Physiology, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Viganò M, Beretta M, Lepore M, Abete R, Benatti SV, Grassini MV, Camagni S, Chiodini G, Vargiu S, Vittori C, Iachini M, Terzi A, Neri F, Pinelli D, Casotti V, Di Marco F, Ruggenenti P, Rizzi M, Colledan M, Fagiuoli S. Vaccination Recommendations in Solid Organ Transplant Adult Candidates and Recipients. Vaccines (Basel) 2023; 11:1611. [PMID: 37897013 PMCID: PMC10611006 DOI: 10.3390/vaccines11101611] [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: 07/21/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Prevention of infections is crucial in solid organ transplant (SOT) candidates and recipients. These patients are exposed to an increased infectious risk due to previous organ insufficiency and to pharmacologic immunosuppression. Besides infectious-related morbidity and mortality, this vulnerable group of patients is also exposed to the risk of acute decompensation and organ rejection or failure in the pre- and post-transplant period, respectively, since antimicrobial treatments are less effective than in the immunocompetent patients. Vaccination represents a major preventive measure against specific infectious risks in this population but as responses to vaccines are reduced, especially in the early post-transplant period or after treatment for rejection, an optimal vaccination status should be obtained prior to transplantation whenever possible. This review reports the currently available data on the indications and protocols of vaccination in SOT adult candidates and recipients.
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Affiliation(s)
- Mauro Viganò
- Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy (S.F.)
| | - Marta Beretta
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (M.B.); (F.D.M.)
| | - Marta Lepore
- Unit of Nephrology and Dialysis, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (M.L.); (P.R.)
| | - Raffaele Abete
- Cardiology Division, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy (C.V.)
| | - Simone Vasilij Benatti
- Infectious Diseases Unit, ASST Papa Giovanni XXII, 24127 Bergamo, Italy; (S.V.B.); (M.R.)
| | - Maria Vittoria Grassini
- Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy (S.F.)
- Section of Gastroenterology & Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90128 Palermo, Italy
| | - Stefania Camagni
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (S.C.); (F.N.); (D.P.); (M.C.)
| | - Greta Chiodini
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (M.B.); (F.D.M.)
| | - Simone Vargiu
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (M.B.); (F.D.M.)
| | - Claudia Vittori
- Cardiology Division, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy (C.V.)
| | - Marco Iachini
- Unit of Nephrology and Dialysis, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (M.L.); (P.R.)
| | - Amedeo Terzi
- Cardiothoracic Department, ASST Papa Giovanni XXII, 24127 Bergamo, Italy;
| | - Flavia Neri
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (S.C.); (F.N.); (D.P.); (M.C.)
| | - Domenico Pinelli
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (S.C.); (F.N.); (D.P.); (M.C.)
| | - Valeria Casotti
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, ASST Papa Giovanni XXII, 24127 Bergamo, Italy;
| | - Fabiano Di Marco
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (M.B.); (F.D.M.)
- Department of Health Sciences, University of Milan, 20158 Milan, Italy
| | - Piero Ruggenenti
- Unit of Nephrology and Dialysis, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (M.L.); (P.R.)
- Department of Renal Medicine, Clinical Research Centre for Rare Diseases “Aldo e Cele Daccò”, Institute of Pharmacologic Research “Mario Negri IRCCS”, Ranica, 24020 Bergamo, Italy
| | - Marco Rizzi
- Infectious Diseases Unit, ASST Papa Giovanni XXII, 24127 Bergamo, Italy; (S.V.B.); (M.R.)
| | - Michele Colledan
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (S.C.); (F.N.); (D.P.); (M.C.)
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy (S.F.)
- Department of Medicine, University of Milan Bicocca, 20126 Milan, Italy
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Changsirikulchai S, Sangthawan P, Janma J, Rajborirug S, Ingviya T. COVID-19 incidence and outcomes among patients with kidney replacement therapy. Kidney Res Clin Pract 2023; 42:649-659. [PMID: 37813525 PMCID: PMC10565457 DOI: 10.23876/j.krcp.22.240] [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: 10/24/2022] [Revised: 02/03/2023] [Accepted: 02/20/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND We aimed to investigate the incidence, fatality, and associated factors in patients with hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT) hospitalized for coronavirus disease 2019 (COVID-19) infection and reimbursed from the National Health Security Office (NHSO). METHODS The retrospective cohort analysis was conducted from an electronic-claimed database, and COVID-19 vaccination status was evaluated in patients with HD, PD, and KT from January 2020 to December 2021. There were 85,305 patients reimbursed for HD, PD, and KT by the NHSO. The rates of COVID-19 infection, COVID-19 vaccination, comorbidities, fatalities, and the cost of treatment were evaluated. RESULTS COVID-19 infection was observed in 1,799 of 36,982 HD cases (4.9%), 1,531 of 45,453 PD cases (3.4%), and 95 of 2,870 KT cases (3.3%). Patients receiving COVID-19 vaccinations were most common in the KT group, followed by those with HD and PD (76.93% vs. 70.65% vs. 51.34%, respectively). KT patients had a lower fatality rate compared to those with PD and HD (8.42% vs. 18.41% vs. 21.40%, respectively). Advanced age, diabetes, cardiovascular diseases, and COVID-19 vaccination status were associated with fatality. The adjusted odds ratios of fatality after receiving one or two doses of vaccines were 0.7 (95% confidence interval [CI], 0.6-0.9) and 0.3 (95% CI, 0.2-0.4), respectively. The cost of treatment was highest in patients with HD, followed by PD and KT. CONCLUSION The incidence of COVID-19 infection was higher in patients with HD than in those with PD or KT. COVID-19 vaccination following the national health policy should be encouraged for these patients to prevent fatality.
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Affiliation(s)
- Siribha Changsirikulchai
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhonnayok, Thailand
| | - Pornpen Sangthawan
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Jirayut Janma
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhonnayok, Thailand
| | - Songyos Rajborirug
- Department of Epidemiology, Faculty of Medicine, Prince of Songkhla University, Songkhla, Thailand
| | - Thammasin Ingviya
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Rouphael N, Bausch-Jurken M. COVID-19 Vaccination Among Patients Receiving Maintenance Renal Replacement Therapy: Immune Response, Real-World Effectiveness, and Implications for the Future. J Infect Dis 2023; 228:S46-S54. [PMID: 37539761 PMCID: PMC10401621 DOI: 10.1093/infdis/jiad162] [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] [Indexed: 08/05/2023] Open
Abstract
Chronic kidney disease affects more than 800 million people worldwide and often progresses to end-stage renal disease, which requires maintenance dialysis. Patients receiving dialysis are at higher risk for severe respiratory infections, including SARS-CoV-2 (the causative agent of COVID-19). In addition, many patients who receive dialysis also receive immunosuppressive treatments for conditions such as systemic vasculitis, systemic lupus erythematosus, or malignancies. Many studies have shown that while mRNA COVID-19 vaccines induce some level of immune response in patients receiving dialysis, the magnitude of response is often lower than that of healthy individuals, and responses rapidly wane. Importantly, the risk of COVID-19-related hospitalization and mortality for patients receiving dialysis is 4- to 8-fold higher compared with the general population. In this article, we summarize recent immunogenicity and real-world outcomes of COVID-19 mRNA vaccination among patients receiving dialysis, with a focus on the 3-dose extended primary series and additional (fourth) doses.
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Affiliation(s)
- Nadine Rouphael
- Correspondence: Nadine Rouphael, MD, Division of Infectious Diseases, Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, USA (); Mary Bausch-Jurken, PhD, Moderna, Inc., 200 Technology Square, Cambridge, MA 02139, USA ()
| | - Mary Bausch-Jurken
- Correspondence: Nadine Rouphael, MD, Division of Infectious Diseases, Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, USA (); Mary Bausch-Jurken, PhD, Moderna, Inc., 200 Technology Square, Cambridge, MA 02139, USA ()
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8
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Beilhack G, Monteforte R, Frommlet F, Reindl-Schwaighofer R, Strassl R, Vychytil A. Durable Anti-SARS-CoV-2 Antibody Response after mRNA-1273 Booster in Peritoneal Dialysis Patients during the Omicron Wave. Vaccines (Basel) 2023; 11:1121. [PMID: 37376510 DOI: 10.3390/vaccines11061121] [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: 05/12/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Anti-SARS-CoV-2 vaccination of dialysis patients has been proven to be safe and effective to reduce COVID-19-related morbidity and mortality. However, data on the durability of anti-SARS-CoV-2 antibodies post-vaccination in peritoneal dialysis (PD) patients are scarce. In this prospective single-center cohort study we measured anti-SARS-CoV-2 RBD antibodies 3 and 6 months after the 3rd dose of the mRNA-1273 vaccine in 27 adult PD patients and recorded breakthrough infections. Furthermore, in a mixed model analysis, we analyzed potential factors influencing the humoral response following vaccination. Anti-SARS-CoV-2 RBD antibody levels declined from 21,424 BAU/mL at 1 month to 8397 BAU/mL at 3 months and to 5120 BAU/mL at 6 months after the 3rd dose, but remained higher than pre-3rd dose levels (212 BAU/mL). Eight patients (29.6%) were infected with SARS-CoV-2 within six months from the 3rd dose during the Omicron wave. Previous high antibody levels, high glomerular filtration rate (GFR) and low Davies Comorbidity Score were associated with higher anti-SARS-CoV-2 antibody levels after the booster. In conclusion, PD patients exhibited a robust and durable humoral response after a third dose of the mRNA-1273 vaccine. A high GFR and low comorbidity as well as previous high antibody levels predicted a better humoral response to vaccination.
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Affiliation(s)
- Georg Beilhack
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Rossella Monteforte
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Florian Frommlet
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, 1090 Vienna, Austria
| | - Roman Reindl-Schwaighofer
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Robert Strassl
- Division of Clinical Virology, Medical University of Vienna, 1090 Vienna, Austria
| | - Andreas Vychytil
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, 1090 Vienna, Austria
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Willetts J, Ficociello LH, Johnson CD, Alexander SE, Mullon C, Hymes JL. Antibody levels following booster SARS-CoV-2 vaccination among dialysis patients initially vaccinated with adenovirus vector-based vaccine. J Nephrol 2023; 36:609-611. [PMID: 36689169 PMCID: PMC9869304 DOI: 10.1007/s40620-022-01559-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/18/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Joanna Willetts
- Global Medical Office, Fresenius Medical Care, Waltham, MA USA
| | | | | | | | - Claudy Mullon
- Global Medical Office, Fresenius Medical Care, Waltham, MA USA
| | - Jeffrey L. Hymes
- Global Medical Office, Fresenius Medical Care, Waltham, MA USA ,Fresenius Medical Care, 1000 Corporate Centre Drive, Suite 400, Franklin, TN 37067 USA
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10
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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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Montez-Rath ME, Garcia P, Han J, Cadden L, Hunsader P, Morgan C, Kerschmann R, Beyer P, Dittrich M, Block GA, Parsonnet J, Chertow GM, Anand S. SARS-CoV-2 Infection during the Omicron Surge among Patients Receiving Dialysis: The Role of Circulating Receptor-Binding Domain Antibodies and Vaccine Doses. J Am Soc Nephrol 2022; 33:1832-1839. [PMID: 35973733 PMCID: PMC9528334 DOI: 10.1681/asn.2022040504] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/17/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND It is unclear whether circulating antibody levels conferred protection against SARS-CoV-2 infection among patients receiving dialysis during the Omicron-dominant period. METHODS We followed monthly semiquantitative SARS-CoV-2 RBD IgG index values in a randomly selected nationwide cohort of patients receiving dialysis and ascertained SARS-CoV-2 infection during the Omicron-dominant period of December 25, 2021 to January 31, 2022 using electronic health records. We estimated the relative risk for documented SARS-CoV-2 infection by vaccination status and by circulating RBD IgG using a log-binomial model accounting for age, sex, and prior COVID-19. RESULTS Among 3576 patients receiving dialysis, 901 (25%) received a third mRNA vaccine dose as of December 24, 2021. Early antibody responses to third doses were robust (median peak index IgG value at assay limit of 150). During the Omicron-dominant period, SARS-CoV-2 infection was documented in 340 (7%) patients. Risk for infection was higher among patients without vaccination and with one to two doses (RR, 2.1; 95% CI, 1.6 to 2.8, and RR, 1.3; 95% CI, 1.0 to 1.8 versus three doses, respectively). Irrespective of the number of vaccine doses, risk for infection was higher among patients with circulating RBD IgG <23 (506 BAU/ml) (RR range, 2.1 to 3.2, 95% CI, 1.3 to 3.4 and 95% CI, 2.2 to 4.5, respectively) compared with RBD IgG ≥23. CONCLUSIONS Among patients receiving dialysis, a third mRNA vaccine dose enhanced protection against SARS-CoV-2 infection during the Omicron-dominant period, but a low circulating RBD antibody response was associated with risk for infection independent of the number of vaccine doses. Measuring circulating antibody levels in this high-risk group could inform optimal timing of vaccination and other measures to reduce risk of SARS-CoV-2 infection.
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Affiliation(s)
| | - Pablo Garcia
- Department of Medicine (Nephrology), Stanford University, Palo Alto, California
| | - Jialin Han
- Department of Medicine (Nephrology), Stanford University, Palo Alto, California
| | | | | | - Curt Morgan
- Ascend Clinical Laboratory, Redwood City, California
| | | | - Paul Beyer
- Ascend Clinical Laboratory, Redwood City, California
| | | | | | - Julie Parsonnet
- Department of Medicine (Infectious Diseases and Geographic Medicine), Stanford University, Palo Alto, California
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California
| | - Glenn M. Chertow
- Department of Medicine (Nephrology), Stanford University, Palo Alto, California
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California
| | - Shuchi Anand
- Department of Medicine (Nephrology), Stanford University, Palo Alto, California
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12
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Cantarelli C, Angeletti A, Perin L, Russo LS, Sabiu G, Podestà MA, Cravedi P. Immune responses to SARS-CoV-2 in dialysis and kidney transplantation. Clin Kidney J 2022; 15:1816-1828. [PMID: 36147709 PMCID: PMC9384565 DOI: 10.1093/ckj/sfac174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Indexed: 11/15/2022] Open
Abstract
Despite progressive improvements in the management of patients with coronavirus disease 2019 (COVID-19), individuals with end-stage kidney disease (ESKD) are still at high risk of infection-related complications. Although the risk of infection in these patients is comparable to that of the general population, their lower rate of response to vaccination is a matter of concern. When prevention strategies fail, infection is often severe. Comorbidities affecting patients on maintenance dialysis and kidney transplant recipients clearly account for the increased risk of severe COVID-19, while the role of uremia and chronic immunosuppression is less clear. Immune monitoring studies have identified differences in the innate and adaptive immune response against the virus that could contribute to the increased disease severity. In particular, individuals on dialysis show signs of T cell exhaustion that may impair antiviral response. Similar to kidney transplant recipients, antibody production in these patients occurs, but with delayed kinetics compared with the general population, leaving them more exposed to viral expansion during the early phases of infection. Overall, unique features of the immune response during COVID-19 in individuals with ESKD may occur with severe comorbidities affecting these individuals in explaining their poor outcomes.
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Affiliation(s)
- Chiara Cantarelli
- UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma , Parma , Italy
| | - Andrea Angeletti
- Division of Nephrology, Dialysis, Transplantation, IRCCS Istituto Giannina Gaslini
| | - Laura Perin
- GOFARR Laboratory for Organ Regenerative Research and Cell Therapeutics in Urology, Saban Research Institute, Division of Urology, Children's Hospital Los Angeles , Los Angeles, CA , USA ; , Los Angeles, CA
- Department of Urology, Keck School of Medicine, University of Southern California , Los Angeles, CA , USA ; , Los Angeles, CA
| | - Luis Sanchez Russo
- Department of Medicine, Icahn School of Medicine at Mount Sinai , New York, NY
| | - Gianmarco Sabiu
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Università degli Studi di Milano , Italy
| | - Manuel Alfredo Podestà
- Nephrology Unit, Department of Health Sciences, Università degli Studi di Milano , Italy
| | - Paolo Cravedi
- Department of Medicine, Icahn School of Medicine at Mount Sinai , New York, NY
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Wang X, Han M, Fuentes LR, Thwin O, Grobe N, Wang K, Wang Y, Kotanko P. SARS-CoV-2 neutralizing antibody response after three doses of mRNA1273 vaccine and COVID-19 in hemodialysis patients. FRONTIERS IN NEPHROLOGY 2022; 2:926635. [PMID: 36106337 PMCID: PMC9470295 DOI: 10.3389/fneph.2022.926635] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND In hemodialysis patients, a third vaccination is frequently administered to augment protection against coronavirus disease 2019 (COVID-19). However, the newly emerged B.1.1.159 (Omicron) variant may evade vaccinal protection more easily than previous strains. It is of clinical interest to better understand the neutralizing activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants after booster vaccine or COVID-19 infection in these mostly immunocompromised patients. METHODS Hemodialysis patients from four dialysis centers were recruited between June 2021 and February 2022. Each patient provided a median of six serum samples. SARS-CoV-2 neutralizing antibodies (nAbs) against wild type (WT) or Omicron were measured using the GenScript SARS-CoV-2 Surrogate Virus Neutralization Test Kit. RESULTS Forty-two patients had three doses of mRNA1273. Compared to levels prior to the third dose, nAb-WT increased 18-fold (peak at day 23) and nAb-Omicron increased 23-fold (peak at day 24) after the third dose. Peak nAb-WT exceeded peak nAb-Omicron 27-fold. Twenty-one patients had COVID-19 between December 24, 2021, and February 2, 2022. Following COVID-19, nAb-WT and nAb-Omicron increased 12- and 40-fold, respectively. While levels of vaccinal and post-COVID nAb-WT were comparable, post-COVID nAb-Omicron levels were 3.2 higher than the respective peak vaccinal nAb-Omicron. Four immunocompromised patients having reasons other than end-stage kidney disease have very low to no nAb after the third dose or COVID-19. CONCLUSIONS Our results suggest that most hemodialysis patients have a strong humoral response to the third dose of vaccination and an even stronger post-COVID-19 humoral response. Nevertheless, nAb levels clearly decay over time. These findings may inform ongoing discussions regarding a fourth vaccination in hemodialysis patients.
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Affiliation(s)
- Xiaoling Wang
- Renal Research Institute, New York, NY, United States
- CORRESPONDENCE: Xiaoling Wang,
| | - Maggie Han
- Renal Research Institute, New York, NY, United States
| | | | - Ohnmar Thwin
- Renal Research Institute, New York, NY, United States
| | - Nadja Grobe
- Renal Research Institute, New York, NY, United States
| | - Kevin Wang
- College of Creative Studies, University of California at Santa Barbara, Santa Barbara, CA, United States
| | - Yuedong Wang
- Department of Statistics and Applied Probability, University of California at Santa Barbara, Santa Barbara, CA, United States
| | - Peter Kotanko
- Renal Research Institute, New York, NY, United States
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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