Improved immunologic response to COVID‐19 vaccine with prolonged dosing interval in haemodialysis patients

Abstract

Vaccination against 2019 coronavirus disease (COVID‐19) can reduce disease incidence and severity. Dialysis patients demonstrate a delayed immunologic response to vaccines. We determined factors affecting the immunologic response to COVID‐19 vaccines in haemodialysis patients. All patients within a Swedish haemodialysis network, vaccinated with two doses of COVID‐19 vaccine 2‐8 weeks before inclusion, were eligible for this cross‐sectional study. Severe adult respiratory syndrome coronavirus 2 (SARS‐CoV‐2) spike protein antibody levels were determined by EliA SARS‐CoV‐2‐Sp1 IgG test (Thermo Fisher Scientific, Phadia AB) and related to clinical and demographic parameters. Eighty‐nine patients were included. Patients were vaccinated with two doses of Comirnaty (BNT162b2, 73%) or Spikevax (mRNA‐1273, 23,6%). Three patients received combinations of different vaccines. Response rate (antibody titres >7 U/mL) was 89.9%, while 39.3% developed high antibody titres (>204 U/mL), 47 (43‐50) days after the second dose. A previous COVID‐19 infection associated with higher antibody titres (median (25th‐75th percentile) 1558.5 (814.5‐3,763.8) U/mL vs 87 (26‐268) U/mL, P = .002), while time between vaccine doses did not differ between groups (P = .7). Increasing SARS‐CoV‐2 antibody titres were independently associated with increasing time between vaccine doses (B 0.241, P = .02), decreasing serum calcium levels (B −0.233, P = .007) and previous COVID‐19 (B 1.078, P < .001). In conclusion, a longer interval between COVID‐19 mRNA vaccine doses, lower calcium and a previous COVID‐19 infection were independently associated with a stronger immunologic vaccination response in haemodialysis patients. While the response rate was good, only a minority developed high antibody titres, 47 (43‐50) days after the second vaccine dose.

A third SARS-CoV-2 mRNA vaccine dose in people receiving hemodialysis overcomes B cell defects but elicits a skewed CD4+T cell profile

“…Our results show that a long 12-week interval between the first two doses is not beneficial for people receiving hemodialysis: both B cell and antibody responses in HD L after the second dose tend to be weaker to those observed in the HD S cohort. The optimal dosing interval in people receiving hemodialysis remains uncertain; another study suggests that a slightly longer interval (up to 45 days, compared to 35 days in our study) was associated with stronger humoral responses (Haarhaus et al, 2022).…”

Unveiling the intricacies of COVID‐19: Autoimmunity, multi‐organ manifestations and the role of autoantibodies

“…The implications of these findings are twofold: they underscore the need for vigilant post-vaccination surveillance for autoimmune phenomena and prompt a reevaluation of vaccine constituents to mitigate potential risks while preserving efficacy. 5 | IMMUN OSU PPR ESS IVE TREATMENT…”

“…Hopefully, the advent of COVID‐19 vaccines has curtailed both the incidence and severity of the disease. A protracted interval between COVID‐19 mRNA vaccine doses appears to augment the immunological response in haemodialysis patients 5 …”

“…A protracted interval between COVID-19 mRNA vaccine doses appears to augment the immunological response in haemodialysis patients. 5 Emerging evidence consistently portrays COVID-19 not merely as a respiratory disease but as a 'systemic disease' with far-reaching implications for multiple organs. Beyond respiratory infiltration, SARS-CoV-2 poses significant threats to the Central Nervous System (CNS), as evidenced by the onset of diverse neurological complications such as aseptic meningitis, encephalopathy, myelopathy, Guillain-Barré Syndrome and anosmia or ageusia.…”

Extending the dosing interval of COVID-19 vaccination leads to higher rates of seroconversion in people living with HIV

“…To optimize the outcomes of vaccination, considerable efforts have been devoted to the development of various vaccine strategies, such as trialing different inoculation intervals and COVID-19 vaccine types, to determine which combinations elicit the best immune responses. Administering a second dose of COVID-19 vaccines and prolonging the inoculation interval have improved vaccine immunogenicity not only in healthy controls (HC) (1) but also in patients undergoing hemodialysis (2), or those with autoimmune rheumatic disease (3) and cancer (4). People living with human immunodeficiency virus (HIV; PLWH) are a group of patients with impaired immunity.…”