Diminished and waning immunity to COVID-19 vaccination among hemodialysis patients in Israel: the case for a third vaccine dose

Abstract

Background Humoral responses to COVID-19 vaccines in hemodialysis patients can direct vaccination policy. Methods We compared 409 COVID-19 naïve hemodialysis patients from 13 hemodialysis units in Israel to 148 non-dialysis dependent COVID-19 naïve controls. Twenty-four previously infected (anti-nucleocapsid positive) hemodialysis patients were analyzed separately. Blood samples were obtained ≥ 14 days post vaccination (BNT162b2) to assess seroconversion-rates and titers of anti-S and neutralizing antibodies. Results Median time from vaccination to blood sample collection was 82 (IQR 64–87) and 89 (IQR 68–96) days, for hemodialysis patients and controls, respectively. Seroconversion rates were lower in hemodialysis patients compared to controls for both anti-S and neutralizing antibodies (89% and 77% vs. 99.3%, respectively, P < 0.0001). Antibody titers were also significantly lower in hemodialysis patients compared to controls: median 69.6 (IQR 33.2–120) vs. 196.5 (IQR 118.5–246), P < 0.0001; geometric mean titer 23.3 (95% CI 18.7–29.1) vs. 222.7 (95% CI 174–284), P < 0.0001, for anti-S and neutralizing antibodies, respectively. Multivariate analysis demonstrated dialysis dependence to be strongly associated with lower antibody responses and antibody titers waning with time. Age, low serum albumin and low lymphocyte count were also associated with lower seroconversion rates and antibody titers. Hemodialysis patients previously infected with SARS-COV-2 had no difference in their seroconversion rates or antibody titers compared to COVID-19 naïve patients. Conclusion This study demonstrates diminished and waning humoral responses following COVID-19 vaccination in a large and diverse cohort of hemodialysis patients, including those previously infected with SARS-CoV-2. Considering these results and reduced vaccine effectiveness against variants of concern, in addition to continued social-distancing precautions, a third booster dose should be considered in this population.

Intranasal administration of a recombinant RBD vaccine induces long-term immunity against Omicron-included SARS-CoV-2 variants

“…However, follow-up studies have reported diminished and waning immunity to the authorized COVID-19 vaccines in vaccinated individuals within several months post-immunization. 11 , 12 , 14 Moreover, the continuous emergence of novel variants significantly compromised the effectiveness of the currently available COVID-19 vaccines. 46 The highly mutated Omicron variant is recently of great concern owing to its high speed of transmission and possibility of immune escape.…”

“… 7 – 10 However, the established antiviral immunity was observed to wane or diminish in several months post-immunization, increasing the risk of breakthrough infection. 11 – 14 Humoral immune responses were substantially decreased six months after immunization with BNT162b2 vaccine, the firstly licensed mRNA vaccine of SARS-CoV-2. 12 Similarly, recent studies reported that the neutralizing antibody (NAb) responses could only last for about 2 to 3 months in most patients recovering from SARS-CoV-2 infection, making them vulnerable to re-inifection.…”

Longevity and Clinical Effectiveness of the Humoral and Cellular Responses to SARS-CoV-2 Vaccination in Hemodialysis Patients

“…A large body of evidence has documented impaired short-term immune responses to SARS-CoV-2 vaccination in hemodialysis patients (10). Emerging data reveal waning antibody levels in hemodialysis patients (4,5), but comparisons with healthy volunteers were not made. In a large cohort of hemodialysis patients, we demonstrate that hemodialysis patients maintain suboptimal humoral and cellular immunity 24 weeks after vaccination as compared to healthy volunteers.…”

SARS-CoV-2 spike protein antibody titers 6 months after SARS-CoV-2 mRNA vaccination among patients undergoing hemodialysis in Japan

“…HD patients are less likely to have an increase in SARS-CoV-2 spike protein antibody titer after vaccination compared with healthy individuals. Peak levels of SARS-CoV-2 spike protein antibody titer in HD patients after vaccination are reportedly around 1/9 to 1/3 those in healthy individuals [ 17 , 18 , 26 , 32 ]. In the present study among Japanese patients receiving HD, antibody titers 1 month after the second vaccination were significantly lower than those in healthy controls and were approximately one-third those of healthy individuals.…”