Antibody Response to a Fourth Dose of SARS-CoV-2 Vaccine in Solid Organ Transplant Recipients: An Update

Mitchell, Jonathan; Alejo, Jennifer L; Chiang, Teresa Po‐Yu; Kim, Jake; Chang, Amy; Abedon, Aura T; Avery, Robin K.; Tobian, Aaron A.R.; Massie, Allan B.; Levan, Macey L; Warren, Daniel; Garonzik-Wang, Jacqueline M; Segev, Dorry L.; Werbel, William A

doi:10.1097/tp.0000000000004137

Cited by 25 publications

(33 citation statements)

References 6 publications

(14 reference statements)

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“…Intriguingly, the two patients who were IgG seronegative after the third dose had seroconversion. Similarly, the counterpart of subjects vaccinated with four doses reported a significant increase in anti-Spike IgG, but the two patients that were seronegative before fourth dose did not seroconvert, as reported by other researchers [ 19 ]. Concerning Spike-specific IgA secretion, we did not report any significant differences with respect to T0, but we found that recovered SOTRs showed higher levels compared to the fourth booster dose recipients.…”

Section: Discussionsupporting

confidence: 73%

“…Indeed, at T0, the median value of specific IgG was 330.2 BAU/mL (IQR, 59.02–1001; SEM = 283.7), which increased to a median value of 1020 BAU/mL at T1 (IQR, 366.6–5486; SEM = 628.1). Importantly, two patients in this cohort were seronegative for anti-Spike IgG after the third dose and did not seroconvert after the fourth dose, as reported elsewhere [ 19 ]. Conversely, we did not observe any significant change in Spike-specific IgA production after the fourth dose ( p = 0.2293).…”

Section: Resultsmentioning

confidence: 53%

“…For this reason, additional COVID-19 vaccine booster doses could be necessary to improve vaccine efficacy and protect against emerging SARS-CoV-2 variants. For this purpose, it is still not clear as to the real-life effectiveness of a fourth booster dose in SOTRs, as conflicting results have been recently reported [ 16 , 17 , 18 , 19 ]. In this paper, we analyzed humoral and cellular immune response in a small cohort of 15 SOTRs, without prior reported SARS-CoV-2 infection, almost two months after the fourth dose of mRNA vaccine.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, Kamar et al [ 16 ] and Alejo et al [ 17 ] reported a slight or no improvement of humoral response after the fourth dose among SOTRs with a weak response after 3 doses of the vaccine. Other authors, instead, indicated an adequate antibodies upsurge in seronegative or low responder patients [ 18 , 19 ]. As an example, Mitchell et al reported that in 11% of their SOTRs, seronegativity persists, while 61% of patients, who were seronegative after the third dose, seroconverted, and 84% of low responders were boosted to high antibody levels after the fourth dose of the vaccine [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…Other authors, instead, indicated an adequate antibodies upsurge in seronegative or low responder patients [ 18 , 19 ]. As an example, Mitchell et al reported that in 11% of their SOTRs, seronegativity persists, while 61% of patients, who were seronegative after the third dose, seroconverted, and 84% of low responders were boosted to high antibody levels after the fourth dose of the vaccine [ 19 ]. In our study, with the aim of assessing the effectiveness of the mRNA vaccine, we followed up on 25 SOTRs, analyzing both their humoral and cellular responses and dividing them into two groups.…”

Section: Introductionmentioning

confidence: 99%

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Immune Response after the Fourth Dose of SARS-CoV-2 mRNA Vaccine Compared to Natural Infection in Three Doses’ Vaccinated Solid Organ Transplant Recipients

Busà

Russelli

Miele

et al. 2022

Viruses

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Solid organ transplant recipients (SOTRs) show higher rates of COVID-19 breakthrough infection than the general population, and nowadays, vaccination is the key preventative strategy. Nonetheless, SOTRs show lower vaccine efficacy for the prevention of severe COVID-19. Moreover, the emergence of new SARS-CoV-2 variants of concern has highlighted the need to improve vaccine-induced immune responses by the administration of repeated booster doses. In this study, we analyzed the humoral and cellular responses in a cohort of 25 SOTRs, including 15 never-infected SOTRs who received the fourth dose of the mRNA vaccine and 10 SOTRs who contracted SARS-CoV-2 infection after the third dose. We analyzed the serum IgG and IgA levels through CLIA or ELISA, respectively, and the Spike-specific T cells by ELISpot assay. We report a significant increase in anti-Spike IgG and no differences in IgA secretion in both groups of patients before and after the booster dose or the natural infection. Still, we show higher IgA levels in recovered SOTRs compared to the fourth dose recipients. Conversely, we show the maintenance of a positive Spike-specific T-cell response in SOTRs who received the fourth dose, which, instead, was significantly increased in SOTRs who contracted the infection. Our results suggest that the booster, either through the fourth dose or natural infection, in vulnerable poor responder SOTRs, improves both humoral and cellular-specific immune responses against SARS-CoV-2.

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Section: Discussionsupporting

confidence: 73%

Section: Resultsmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Immune Response after the Fourth Dose of SARS-CoV-2 mRNA Vaccine Compared to Natural Infection in Three Doses’ Vaccinated Solid Organ Transplant Recipients

Busà

Russelli

Miele

et al. 2022

Viruses

View full text Add to dashboard Cite

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Immunogenicity, clinical efficacy and safety of additional second COVID‐19 booster vaccines against Omicron and its subvariants: A systematic review

Chenchula,

Chandra,

Adusumilli

et al. 2024

Reviews in Medical Virology

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The Omicron variant of severe acute respiratory syndrome coronavirus 2 is a new variant of concern (VOC) and an emerging subvariant that exhibits heightened infectivity, transmissibility, and immune evasion, escalating the incidence of moderate to severe coronavirus disease 2019 (COVID‐19). It resists monoclonal antibodies and diminishes vaccine efficacy. Notably, new sublineages have outpaced earlier predominant sublineages. Although the primary vaccination series and initial boosters were robust against previous VOCs, their efficacy waned against Omicron and its subvariants. In this systematic review, we assessed real‐world evidence on the immunogenicity, clinical efficacy, and safety of a second booster or fourth COVID‐19 vaccine dose against the Omicron VOC and its subvariants. A comprehensive literature search was conducted in Medline/PubMed, Google Scholar, bioRxiv, and medRxiv, and relevant studies published between 2022 and 30 May 2023 were reviewed. We found a total of 40 relevant articles focusing on a second booster dose for COVID‐19, including clinical trials and observational studies, involving 3,972,856 patients. The results consistently revealed that an additional second booster dose restored and prolonged waning immunity, activating both humoral and cellular responses against Omicron and its subvariants. A second booster treatment correlated with enduring protection against COVID‐19, notably preventing substantial symptomatic disease and mortality associated with severe Omicron infection. Both monovalent messenger RNA (mRNA) and nonmRNA vaccines demonstrated similar efficacy and safety, with bivalent mRNA vaccines exhibiting broader protection against emerging subvariants of Omicron. The safety profiles of second booster were favourable with only mild systemic and local symptoms reported in some recipients. In conclusion, this systematic review underscores the additional COVID‐19 vaccine boosters, particularly with bivalent or multivalent mRNA vaccines, for countering the highly infectious emerging subvariants of Omicron.

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Efficacy and safety of booster vaccination against SARS-CoV-2 in dialysis and renal transplant patients: systematic review and meta-analysis

Taheri

2023

Int Urol Nephrol

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Introduction Patients under renal replacement therapy are at an increased risk of severe infection with SARS-CoV-2, and have been known to have impaired response to standard vaccination. This systematic review and meta-analysis aims at evaluating the efficacy of booster dose vaccination in this population. Methods A systematic review has been conducted to find trials on the booster dose vaccination in kidney transplant recipients (KTRs) or patients under dialysis. Data of seroconversion rates at different timepoints, especially 1 month prior and post-booster dose vaccination have been collected and analyzed. Effects of different factors including type of renal replacement therapy (RRT), vaccine type and brands, magnitude of response to the standard vaccination, and immunosuppression drugs on the response rates have been investigated. Meta-analyses were performed using software Stata v.17. Results Overall 58 studies were included. Both RRT patient subgroups represented significant seroconversion, post- (versus pre-) booster dose vaccination, but only in KTRs the booster dose seroconversion surpassed that of the standard protocol. T-cell response was also significantly augmented after booster vaccination, with no difference between the RRT subgroups. mRNA and vector vaccine types had comparable immunogenicity when employed as boosters, both significantly higher than the inactivated virus vaccine, with no significant disparity regarding the vaccine brands. Patients with poor response to standard vaccination had a significant response to booster dose, with dialysis patients having stronger response. The differential effects of vaccine types and brands in the poor responders was similar to that of the overall RRT population. No rejection episodes or graft failure post-booster vaccination was reported. Conclusion In patients under RRT, booster dose vaccination against SARS-CoV-2 is safe and efficacious determined by significant seroconversion, and therefore, it should be considered to be implemented in all these patients. Since in the KTR patients, the third dose vaccination significantly increased the seroconversion rates even beyond that of the standard protocol, three dose vaccine doses is recommended to be recognized as the standard vaccination protocol in this population. The same recommendation could be considered for dialysis patients, due to their augmented risk of breakthrough infection. Supplementary Information The online version contains supplementary material available at 10.1007/s11255-023-03471-x.

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Antibody Response to a Fourth Dose of SARS-CoV-2 Vaccine in Solid Organ Transplant Recipients: An Update

Cited by 25 publications

References 6 publications

Immune Response after the Fourth Dose of SARS-CoV-2 mRNA Vaccine Compared to Natural Infection in Three Doses’ Vaccinated Solid Organ Transplant Recipients

Immune Response after the Fourth Dose of SARS-CoV-2 mRNA Vaccine Compared to Natural Infection in Three Doses’ Vaccinated Solid Organ Transplant Recipients

Immunogenicity, clinical efficacy and safety of additional second COVID‐19 booster vaccines against Omicron and its subvariants: A systematic review

Efficacy and safety of booster vaccination against SARS-CoV-2 in dialysis and renal transplant patients: systematic review and meta-analysis

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