Little information is available for antibody levels against SARS‐CoV‐2 variants of concern induced by Omicron breakthrough infection and a third booster with an inactivated vaccine (InV) or Ad5‐nCoV in people with completion of two InV doses. Plasma was collected from InV pre‐vaccinated Omicron‐infected patients (OIPs), unvaccinated OIPs between 0 and 22 days, and healthy donors (HDs) 14 days or 6 months after the second doses of an InV and 14 days after a homogenous booster or heterologous booster of Ad5‐nCoV. Anti‐Wuhan‐, Anti‐Delta‐, and Anti‐Omicron‐receptor binding domain (RBD)‐IgG titers were detected using enzyme‐linked immunosorbent assay. InV pre‐vaccinated OIPs had higher anti‐Wuhan‐, anti‐Delta‐, and anti‐Omicron‐RBD‐IgG titers compared to unvaccinated OIPs. Anti‐Wuhan‐RBD‐IgG titers sharply increased in InV pre‐vaccinated OIPs 0–5 days postinfection (DPI), while the geometric mean titers (GMTs) of anti‐Delta‐ and anti‐Omicron‐RBD‐IgG were 3.3‐fold and 12.0‐fold lower. Then, the GMT of anti‐Delta‐ and anti‐Omicron‐RBD‐IgG increased to 35 112 and 28 186 during 11–22 DPI, about 2.6‐fold and 3.2‐fold lower, respectively, than the anti‐Wuhan‐RBD‐IgG titer. The anti‐Wuhan‐, anti‐Delta‐, and anti‐Omicron‐RBD‐IgG titers declined over time in HDs after two doses of an InV, with 25.2‐fold, 5.6‐fold, and 4.5‐fold declination, respectively, at 6 months relative to the titers at 14 days after the second vaccination. Anti‐Wuhan‐, anti‐Delta‐, and anti‐Omicron‐RBD‐IgG titers elicited by a heterologous Ad5‐nCoV booster were significantly higher than those elicited by an InV booster, comparable to those in InV pre‐vaccinated OIPs. InV and Ad5‐nCoV boosters could improve humoral immunity against Omicron variants. Of these, the Ad5‐nCoV booster is a better alternative.

Purpose The immunogenicity of SARS-CoV-2 vaccines is poor in kidney transplant recipients (KTRs). The factors related to poor immunogenicity to vaccination in KTRs are not well defined. Methods An observational study was conducted in KTRs and healthy individuals who had received two doses of SARS-CoV-2 inactivated vaccine. IgG antibodies against the receptor-binding domain found in the S1 subunit of the spike protein, and against nucleocapsid protein were measured using enzyme-linked immunosorbent assay. Receptor-binding domain (RBD)-angiotensin-converting enzyme 2 interaction-blocking antibodies were measured using commercial kits. T cell responses against the spike and nucleocapsid proteins were detected using enzyme-linked immunosorbent spot assay. Results No severe adverse effects were observed in KTRs after first or second dose of SARS-CoV-2 inactivated vaccine. IgG antibodies against the receptor- binding domain, and nucleocapsid protein were not effectively induced in a majority of KTRs after second dose of inactivated vaccine. Specific T cell immunity response was detectable in 32%-40% KTRs after second doses of inactivated vaccine. KTRs who developed specific T cell immunity were more likely to be female, and have lower levels of total bilirubin, unconjugated bilirubin, and blood tacrolimus concentration. Multivariate logistic regression analysis found that blood unconjugated bilirubin was significantly negatively associated with SARS-CoV-2 specific T cell immunity response in k KTRs. Conclusions Specific T cell immunity response could be induced in 32%-40% KTRs after two doses of inactivated vaccine. Blood unconjugated bilirubin was negatively associated with specific cellular immunity response in KTRs following vaccination.

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BackgroundA third mRNA vaccine booster is recommended to improve immunity against SARS-CoV-2 in kidney transplant recipients (KTRs). However, the immunity against SARS-CoV-2 Ancestral strain and Delta and Omicron variants elicited by the third dose of inactivated booster vaccine in KTRs remains unknown.MethodsThe blood parameters related to blood cells count, hepatic function, kidney function, heart injury and immunity were explored clinically from laboratory examinations. SARS-CoV-2 specific antibody IgG titer was detected using an enzyme-linked immunosorbent assay. Cellular immunity was analyzed using interferon-γ enzyme-linked immunospot assay.ResultsThe results showed that there were no severe adverse effects and apparent changes of clinical laboratory biomarkers in KTRs and healthy volunteers (HVs) after homologous inactivated vaccine booster. A third dose of inactivated vaccine booster significantly increased anti-Ancestral-spike-trimer-IgG and anti-Ancestral-receptor binding domain (RBD)-IgG titers in KTRs and HVs compared with the second vaccination. However, the anti-Delta-RBD-IgG and anti-Omicron-RBD-IgG titers were significantly lower than anti-Ancestral-RBD-IgG titer in KTRs and HVs after the third dose. Notably, only 25.6% (10/39) and 10.3% (4/39) of KTRs had seropositivity for anti-Delta-RBD-IgG and anti-Omicron-RBD-IgG after booster, which were significantly lower than HVs (anti-Delta-RBD-IgG: 100%, anti-Omicron-RBD-IgG: 77.8%). Ancestral strain nucleocapsid protein and spike specific T cell frequency after booster was not significantly increased in KTRs compared with the second dose, significantly lower than that in HVs. Moreover, 33.3% (12/36), 14.3% (3/21) and 14.3% (3/21) of KTRs were positive for the Ancestral strain and Delta and Omicron spike-specific T cells, which were significantly lower than HVs (Ancestral: 80.8%, Delta: 53.8%, and Omicron: 57.7%).ConclusionsA third dose of inactivated booster vaccine may significantly increase humoral immunity against the Ancestral strain in KTRs, while humoral and cellular immunity against the Delta and Omicron variants were still poor in KTRs.

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The immunogenicity of SARS-CoV-2 vaccines is poor in kidney transplant recipients (KTRs). The factors related to poor immunogenicity to vaccination in KTRs are not well defined. Here, observational study demonstrated no severe adverse effects were observed in KTRs and healthy participants (HPs) after first or second dose of SARS-CoV-2 inactivated vaccine. Different from HPs with excellent immunity against SARS-CoV-2, IgG antibodies against S1 subunit of spike protein, receptor-binding domain, and nucleocapsid protein were not effectively induced in a majority of KTRs after the second dose of inactivated vaccine. Specific T cell immunity response was detectable in 40% KTRs after the second dose of inactivated vaccine. KTRs who developed specific T cell immunity were more likely to be female, and have lower levels of total bilirubin, unconjugated bilirubin, and blood tacrolimus concentrations. Multivariate logistic regression analysis found that blood unconjugated bilirubin and tacrolimus concentration were significantly negatively associated with SARS-CoV-2 specific T cell immunity response in KTRs. Altogether, these data suggest compared to humoral immunity, SARS-CoV-2 specific T cell immunity response are more likely to be induced in KTRs after administration of inactivated vaccine. Reduction of unconjugated bilirubin and tacrolimus concentration might benefit specific cellular immunity response in KTRs following vaccination.

continuous veno-venous hemodiafiltration (CVVHDF) and charcoal heamoperfusion treatment. However, she did not obtain any significant neurological recovery. Electroencephalography (EEG) showed an encephalopathic picture. Magnetic resonance imaging (MRI) showed bilateral gyriform hyperintense signal changes and multiple microhemorrhages changes. Eventually she succumbed to nosocomial infection. Discussion: High index of suspicion and active enquiry regarding SF ingestion is required for ESRF patients presenting with hiccups and seizure. Early diagnosis and treatment is important as immediate haemodialysis is potentially beneficial in starfruit neurotoxicity. Poor conscious level and seizures development in SF neurotoxicity are poor prognosis factors. Patients with renal failure should be advised to avoid starfruit ingestion.