Immunogenicity of ChAdOx1 nCoV-19 vaccine after a two-dose inactivated SARS-CoV-2 vaccination of dialysis patients and kidney transplant recipients

Abstract

Vaccination with inactivated SARS-CoV-2 virus produces suboptimal immune responses among kidney transplant (KT), peritoneal dialyzed (PD), and hemodialyzed (HD) patients. Participants were vaccinated with two-dose inactivated SARS-CoV-2 vaccine (V2) and a third dose of ChAdOx1 nCoV-19 vaccine (V3) at 1–2 months after V2. We enrolled 106 participants: 31 KT, 28 PD, and 31 HD patients and 16 controls. Among KT, PD, and HD groups, median (IQR) of anti-receptor binding domain antibody levels were 1.0 (0.4–26.8), 1092.5 (606.9–1927.2), and 1740.9 (1106–3762.3) BAU/mL, and percent neutralization was 0.9 (0–9.9), 98.8 (95.9–99.5), and 99.4 (98.8–99.7), respectively, at two weeks after V3. Both parameters were significantly increased from V2 across all groups (p < 0.05). Seroconversion and neutralization positivity rates in PD, HD, and control groups were 100% but were impaired in KT patients (39% and 16%, respectively). S1-specific T-cell counts were increased in PD and HD groups (p < 0.05) but not in KT patients. The positive S1-specific T-cell responder rate was > 90% in PD, HD, and control groups, which was higher than that in KT recipients (74%, p < 0.05). The heterologous inactivated virus/ChAdOx1 nCoV-19 vaccination strategy elicited greater immunogenicity among dialysis patients; however, inadequate responses remained among KT recipients (TCTR20210226002).

Anti-SARS-CoV-2 Revaccination Success in Kidney Transplant Recipients With No Initial Humoral Response Is Linked to Primary Vaccine Type

“…The small group of KTR immunized with heterologous 2x mRNA and 1x vector vaccine showed similar immune response rates in any test system examined as unboostered KTR with only 2x mRNA. While the interpretation of these data needs to be done with caution, this limited effect as a boostering vaccine has already been described in the literature for vector vaccines and is confirmed in the present population (22).…”

Evaluation of Adenoviral Vector-Based Vaccines for Prevention of Covid-19 – An Overview

“…Another study reported that the booster dose administration facilitated an enhanced immunogenicity among end stage kidney disease (ESKD) patients undergoing dialysis. The findings of the study emphasized the importance of booster dose administration in patients with ESKD and kidney transplant due to their increased susceptibility to COVID-19-related diseases and mortality [33].…”

Durability of Humoral and Cellular Immunity after an Extended Primary Series with Heterologous Inactivated SARS-CoV-2 Prime-Boost and ChAdOx1 nCoV-19 in Dialysis Patients (ICON3)

“…They discovered that the proportion of patients with undetectable anti-RBD IgG increased over time, from 8.5% at 2–3 months to 20.2% 5–6 months later, with the lowest seronegative rate in patients receiving mRNA-1273 and the highest in patients receiving Ad26.COV2.S [ 15 ]. While the inactivated SARS-CoV-2 vaccine is widely used worldwide, it has been shown to elicit weaker HMI in immunocompromised individuals compared with other vaccine platforms [ 5 , 10 ]. Although comparing immunogenicity across studies using a variety of assays, cutoff values, and patient populations is challenging, we demonstrated with the same serological assay that our extended heterologous primary series could generate at least comparable anti-RBD IgG titer and seroconversion rate at 6 months post-vaccination to those induced by the standard two-dose mRNA vaccination [ 27 ].…”

“…We conducted a prospective cohort study from July 2021–January 2022 at the Faculty of Medicine Ramathibodi Hospital, Mahidol University in Bangkok, Thailand. Participants from the ICON1 [ 6 ] and ICON2 [ 10 ] studies were screened and enrolled. They had received a primary series of two-dose CoronaVac vaccine (3 μg inactivated SARS-CoV-2 whole virus in 0.5 mL; Sinovac Biotech Ltd., Beijing, China) (ICON1) followed by one dose of ChAdOx1 nCoV-19 vaccine (AZD1222, ChAdOx1-S at a minimum concentration of 2.5 × 10 8 infectious units per 0.5 mL), with doses administered 4 weeks apart (ICON2), referred to throughout as the extended heterologous primary series.…”

“…Hence, the World Health Organization (WHO) recommends the members of vulnerable groups receive an additional COVID-19 vaccine dose after their primary vaccination series [ 9 ]. Third-dose vaccine, either homologous or heterologous, can significantly enhance HMI and cell-mediated immunity (CMI) in both the general population and dialysis patients compared with a standard two-dose primary series [ 10 , 11 , 12 , 13 ].…”