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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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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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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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Hsu CM, Weiner DE, Manley HJ, Li NC, Miskulin D, Harford A, Sanders R, Ladik V, Frament J, Argyropoulos C, Abreo K, Chin A, Gladish R, Salman L, Johnson D, Lacson EK. Serial SARS-CoV-2 Antibody Titers in Vaccinated Dialysis Patients: Prevalence of Unrecognized Infection and Duration of Seroresponse. Kidney Med 2023; 5:100718. [PMID: 37786901 PMCID: PMC10542005 DOI: 10.1016/j.xkme.2023.100718] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Rationale & Objective Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections are likely underdiagnosed, but the degree of underdiagnosis among patients receiving maintenance dialysis is unknown. The durability of the immune response after the third vaccine dose in this population also remains uncertain. This descriptive study tracked antibody levels to (1) assess the rate of undiagnosed infections and (2) characterize seroresponse durability after the third dose. Study Design Retrospective observational study. Setting & Participants SARS-CoV-2-vaccinated patients receiving maintenance dialysis through a national dialysis provider. Immunoglobulin G spike antibodies [anti-spike immunoglobulin (Ig) G] titers were assessed monthly after vaccination. Exposures Two and 3 doses of SARS-CoV-2 vaccine. Outcomes Undiagnosed and diagnosed SARS-CoV-2 infections; anti-spike IgG titers over time. Analytical Approach Undiagnosed SARS-CoV-2 infections were identified as an increase in anti-spike IgG titer of ≥100 BAU/mL, not associated with receipt of vaccine or diagnosed SARS-CoV-2 infection (by polymerase chain reaction test or antigen test). In descriptive analyses, anti-spike IgG titers were followed over time. Results Among 2,703 patients without previous coronavirus disease 2019 (COVID-19) who received an initial 2-dose vaccine series, 271 had diagnosed SARS-CoV-2 infections (3.4 per 10,000 patient-days) and 129 had undiagnosed SARS-CoV-2 infections (1.6 per 10,000 patient-days). Among 1,894 patients without previous COVID-19 who received a third vaccine dose, 316 had diagnosed SARS-CoV-2 infections (7.0 per 10,000 patient-days) and 173 had undiagnosed SARS-CoV-2 infections (3.8 per 10,000 patient-days). In both cohorts, anti-spike IgG levels declined over time. Of the initial 2-dose cohort, 66% had a titer of ≥500 BAU/mL in the first month, with 24% maintaining a titer of ≥500 BAU/mL at 6 months. Of the third dose cohort, 95% had a titer of ≥500 BAU/mL in the first month after the third dose, with 77% maintaining a titer of ≥500 BAU/mL at 6 months. Limitations The assays used had upper limits. Conclusions Among patients receiving maintenance dialysis, about 1 in every 3 SARS-CoV-2 infections was undiagnosed. Given this population's vulnerability to COVID-19, ongoing infection control measures are needed. A 3-dose primary mRNA vaccine series optimizes seroresponse rate and durability. Plain-Language Summary Patients receiving maintenance dialysis have been particularly vulnerable to COVID-19. Using serially measured antibodies, we found that a substantial proportion (about one-third) of SARS-CoV-2 infections among this population had been missed, both among those who had completed a 2-dose vaccine series and among those who had received a third vaccine dose. Such missed infections likely had only mild or minimal symptoms, but this failure to recognize all infections is concerning. Furthermore, vaccines have been effective among patients receiving dialysis, but our study additionally shows that the immune response wanes over time, even after a third dose. There is therefore a role for ongoing vigilance against this highly transmissible infection.
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Affiliation(s)
| | | | | | | | - Dana Miskulin
- Division of Nephrology, Tufts Medical Center, Boston, MA
| | - Antonia Harford
- Division of Nephrology, University of New Mexico, Albuquerque, NM
| | | | | | | | | | - Kenneth Abreo
- Division of Nephrology, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Andrew Chin
- Division of Nephrology, University of California, Davis, Sacramento, CA
| | | | - Loay Salman
- Division of Nephrology, Albany Medical College, Albany, NY
| | | | - Eduardo K. Lacson
- Division of Nephrology, Tufts Medical Center, Boston, MA
- Dialysis Clinic Inc, Nashville, TN
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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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Hsu CM, Weiner DE, Manley HJ, Miskulin D, Ladik V, Frament J, Argyropoulos C, Abreo K, Chin A, Gladish R, Salman L, Johnson D, Lacson EK. Serial SARS-CoV-2 antibody titers in vaccinated dialysis patients: prevalence of unrecognized infection and duration of seroresponse. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.16.23287322. [PMID: 36993760 PMCID: PMC10055593 DOI: 10.1101/2023.03.16.23287322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Rationale & Objective SARS-CoV-2 infections are likely underdiagnosed, but the degree of underdiagnosis among maintenance dialysis patients is unknown. Durability of the immune response after third vaccine doses in this population also remains uncertain. This study tracked antibody levels to 1) assess the rate of undiagnosed infections and 2) characterize seroresponse durability after third doses. Study Design Retrospective observational study. Setting & Participants SARS-CoV-2 vaccinated patients receiving maintenance dialysis through a national dialysis provider. Immunoglobulin G spike antibodies (anti-spike IgG) titers were assessed monthly following vaccination. Exposures Two and three doses of SARS-CoV-2 vaccine. Outcomes Undiagnosed and diagnosed SARS-CoV-2 infections; anti-spike IgG titers over time. Analytical Approach "Undiagnosed" SARS-CoV-2 infections were identified as an increase in anti-spike IgG titer of ≥ 100 BAU/mL, not associated with receipt of vaccine or "diagnosed" SARS-CoV-2 infection (by PCR or antigen test). In descriptive analyses, anti-spike IgG titers were followed over time. Results Among 2660 patients without prior COVID-19 who received an initial two-dose vaccine series, 371 (76%) SARS-CoV-2 infections were diagnosed and 115 (24%) were undiagnosed. Among 1717 patients without prior COVID-19 who received a third vaccine dose, 155 (80%) SARS-CoV-2 infections were diagnosed and 39 (20%) were undiagnosed. In both cohorts, anti-spike IgG levels declined over time. Of the initial two-dose cohort, 66% had a titer ≥ 500 BAU/mL in the first month, with 23% maintaining a titer ≥ 500 BAU/mL at six months. Of the third dose cohort, 95% had a titer ≥ 500 BAU/mL in the first month after the third dose, with 76% maintaining a titer ≥ 500 BAU/mL at six months. Limitations Assays used had upper limits. Conclusions Among maintenance dialysis patients, 20-24% of SARS-CoV-2 infections were undiagnosed. Given this population's vulnerability to COVID-19, ongoing infection control measures are needed. A three-dose primary mRNA vaccine series optimizes seroresponse rate and durability.
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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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