Longitudinal SARS-CoV-2 seroconversion and functional heterogeneity in a pediatric dialysis unit

Canas, Jorge; Starr, Michelle C.; Hooks, Jenaya; Arregui, Samuel; Wilson, Amy C.; Carroll, Aaron E.; Saxena, Vijay; Amanat, Fatima; Krammer, Florian; Fill, Jeffrey; Schade, Andrew E.; Chambers, Antonio; Schneider, Jack G; Schwaderer, Andrew L.

doi:10.1016/j.kint.2020.11.014

Cited by 9 publications

(12 citation statements)

References 9 publications

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“…Furthermore, it has also been suggested that uremic milieu of end-stage renal disease may be associated with antibody dysfunction 20 . It is therefore tempting to speculate that one could improve immune function (and therefore response to vaccine) of MHD patients by optimizing uremic toxins elimination.…”

Section: J O U R N a L P R E -P R O O F Discussionmentioning

confidence: 99%

“…The facts that i) hemodialysis was an independent predictor of lack of seroconversion after vaccination and ii) the quality of the dialysis estimated by the Kt/V was associated with a better response to vaccine in naïve non immunosuppressed MHD suggest that uremic toxins could potentially play a detrimental role on the development of an humoral response 7 . Furthermore, it has also been suggested that uremic milieu of end-stage renal disease may be associated with antibody dysfunction 20 . It is therefore tempting to speculate that one could improve immune function (and therefore response to vaccine) of MHD patients by optimizing uremic toxins elimination.…”

Section: Discussionmentioning

confidence: 99%

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The ROMANOV study found impaired humoral and cellular immune responses to SARS-CoV-2 mRNA vaccine in virus-unexposed patients receiving maintenance hemodialysis

Espi

Charmetant

Barba

et al. 2021

Kidney International

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Section: J O U R N a L P R E -P R O O F Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The ROMANOV study found impaired humoral and cellular immune responses to SARS-CoV-2 mRNA vaccine in virus-unexposed patients receiving maintenance hemodialysis

Espi

Charmetant

Barba

et al. 2021

Kidney International

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“…Manufacturer's assay protocols were followed for the commercial ELISAs and previously published methods for our custom ELISAs ( 7 , 8 ). As previously reported, the threshold for a positive ELISA test was set using 65 pre-COVID-19 pandemic samples collected in the 2011 calendar year by the Indiana Biobank and 21 samples from patients with documented positive SARS-CoV-2 nasopharyngeal PCR samples provided by the Eli Lilly Corporation ( 8 ). IgM threshold level with an optic density (OD) of 0.140 was used as previously reported ( 2 ).…”

Section: Methodsmentioning

confidence: 99%

“…IgM threshold level with an optic density (OD) of 0.140 was used as previously reported ( 2 ). The reported sensitivity and specificity for IgM ELISA were 70.6 and 95.4%, respectively ( 8 ). A threshold OD for the IgG ELISA was 0.145, which resulted in a sensitivity of 93% [confidence interval (CI) = 70–85%] and a specificity of 94% (CI = 85–98%) with an area under the curve (AUC) of >0.9 ( Figure 1A ).…”

Section: Methodsmentioning

confidence: 99%

Placement on COVID-19 Units Does Not Increase Seroconversion Rate of Pediatric Graduate Medical Residents

et al. 2021

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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated disease COVID-19 (coronavirus disease 2019) has presented graduate medical education (GME) training programs with a unique set of challenges. One of the most pressing is how should hospital systems that rely on graduate medical residents provide appropriate care for patients while protecting trainees. This question is of particular concern as healthcare workers are at high risk of SARS-CoV-2 exposure.Objective: This cross-sectional study sought to assess the impact of hospital COVID-19 patient placement on pediatric graduate medical residents by comparing rates of SARS-CoV-2 seroconversion rates of residents who worked on designated COVID-19 teams and those who did not.Methods: Forty-four pediatric and medicine–pediatric residents at Riley Children's Hospital (Indianapolis, IN) were tested for SARS-CoV-2 immunoglobulin M (IgM) and IgG seroconversion in May 2020 using enzyme-linked immunosorbent assays (Abnova catalog no. KA5826), 2 months after the first known COVID-19 case in Indiana. These residents were divided into two groups: those residents who worked on designated COVID-19 teams, and those who did not. Groups were compared using χ2 or Fisher exact test for categorical variables, and continuous variables were compared using Student t testing.Results: Forty-four of 104 eligible residents participated in this study. Despite high rates of seroconversion, there was no difference in the risk of SARS-CoV-2 seroconversion between residents who worked on designated COVID-19 teams (26% or 8/31) and those who did not (31% or 4/13). Eleven of 44 residents (25%) tested positive for SARS-CoV-2 IgG, whereas only 5/44 (11.4%) tested positive for SARS-CoV-2 IgM, without a detectable difference between exposure groups.Conclusion: We did not observe a difference in SARS-CoV-2 seroconversion between different exposure groups. These data are consistent with growing evidence supporting the efficacy of personal protective equipment. Further population-based research on the role of children in transmitting the SARS-CoV-2 virus is needed to allow for a more evidence-based approach toward managing the COVID-19 pandemic.

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“…Impaired humoral responses are well-known in patients on chronic dialysis against vaccines as hepatitis B and in uenza [4], which may presume a poor answer against SARS-CoV-2 vaccination. Canas et al [5] also showed a lack of correlation between neutralizing activity and conventional serology testing on convalescent serum specimens from pediatric dialyzed patients. These observations raise the question of straightening SARS-CoV-2 immunization in dialyzed patients, as recommended with double-dose hepatitis B vaccination in this population [4].…”

Section: Case Presentationmentioning

confidence: 99%

Immunity to SARS-CoV-2 in a Dialyzed Patient Who Developed COVID-19 Twenty Days After the Second Dose of BNT162b2 Vaccine: a Case Report

Manni

Lotte

Bal

et al. 2021

Preprint

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IntroductionEnd stage kidney disease (ESKD) and cancer have been identified as risk factors for severe and fatal cases of COVID-19, making vaccination in these patients a priority. Patients suffering from ESKD have a significantly weaker response to common vaccines than general population. However, humoral and cellular immune responses after two doses of RNA-based vaccine BNT162b2 (Pfizer–BioNTech) have been poorly explored in this vulnerable population.Case presentationA 69-year-old male patient was followed for ESKD and myeloma. He developed a severe SARS-CoV-2 pneumonia twenty days after two doses of BNT162b2 vaccine. Whole genome sequencing found that the virus belonged to the 20I/501Y.V1 clade. A serology draws eight days after the 2nd vaccine dose showed positive RBD IgG without neutralizing activity. A serum specimen sampled thirty days after the onset of SARS-CoV-2 infection showed seroconversion against both RBD and N antigens. This specimen was shown to exhibit a frank neutralizing activity. The QuantiFERON® SARS-CoV-2 (Qiagen) showed a positive specific cellular response although the QuantiFERON monitor displayed a weak cellular response. ConclusionsImpaired immunity due to renal failure probably explain the severe pneumonia despite vaccination. The fact that the patient developpe a neutralizing activity and a cellular response after a third stimulation by infection may suggest to systemically administrate a third dose of vaccine in ESKD patients.

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Longitudinal SARS-CoV-2 seroconversion and functional heterogeneity in a pediatric dialysis unit

Cited by 9 publications

References 9 publications

The ROMANOV study found impaired humoral and cellular immune responses to SARS-CoV-2 mRNA vaccine in virus-unexposed patients receiving maintenance hemodialysis

The ROMANOV study found impaired humoral and cellular immune responses to SARS-CoV-2 mRNA vaccine in virus-unexposed patients receiving maintenance hemodialysis

Placement on COVID-19 Units Does Not Increase Seroconversion Rate of Pediatric Graduate Medical Residents

Immunity to SARS-CoV-2 in a Dialyzed Patient Who Developed COVID-19 Twenty Days After the Second Dose of BNT162b2 Vaccine: a Case Report

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