Response to tozinameran (BNT162b2) booster in twice-vaccinated kidney transplant and maintenance dialysis patients

Ben‐Dov, Iddo Z.; Tzukert, Keren; Aharon, Michal; Pri-Chen, Hadas; Oster, Yonatan; Oiknine‐Djian, Esther; Wolf, Dana; Elhalel, Michal Dranitzki

doi:10.1007/s40620-021-01235-3

Cited by 12 publications

(13 citation statements)

References 5 publications

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“…A total of 3173 articles from PubMed (1577), the Cochrane Library (191), Embase (539), medRxiv (734), Wanfang (68) and CNKI (64) were initially included. After screening 2578 titles and abstracts and 83 full-text articles, 28 studies [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ] provided data on nine combinations of COVID-19 booster vaccinations (including homologous immunization and heterologous immunization), and 5870 subjects met the eligibility criteria ( Figure 1 ). The study populations mainly included the general population, health care workers and residents of a care home, which were all without history of laboratory-confirmed COVID-19.…”

Section: Resultsmentioning

confidence: 99%

Immunogenicity and Safety of Homologous and Heterologous Prime–Boost Immunization with COVID-19 Vaccine: Systematic Review and Meta-Analysis

Cheng

Peng

et al. 2022

Vaccines

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A prime–boost strategy of COVID-19 vaccines brings hope to limit the spread of SARS-CoV-2, while the immunogenicity of the vaccines is waning over time. Whether a booster dose of vaccine is needed has become a widely controversial issue. However, no published meta-analysis has focused on the issue. Therefore, this study assessed the immunogenicity and safety of the different combinations of prime–boost vaccinations. Electronic databases including PubMed, the Cochrane Library, Embase, medRxiv, Wanfang and CNKI were used to retrieve the original studies. A total of 28 studies, 9 combinations of prime–boost vaccinations and 5870 subjects were included in the meta-analysis, and random effect models were used to estimate pooled immunogenicity and safety. The immunity against COVID-19 after the prime vaccination waned over time, especially in the populations primed with inactivated vaccines, in which the seropositive rate of antibodies was only 28% (95% CI: 17–40%). Booster vaccination could significantly increase the antibody responses, and heterologous immunization was more effective than homologous immunization (neutralization titers: 1.65 vs. 1.27; anti-RBD IgG: 1.85 vs. 1.15); in particular, the combination of inactivated–mRNA vaccines had the highest antibody responses (neutralization titers: MRAW = 3.64, 95% CI: 3.54–3.74; anti-RBD IgG: 3.73, 95% CI: 3.59–3.87). Moreover, compared with the initial two doses of vaccines, a booster dose did not induce additional or severe adverse events. The administration of the booster dose effectively recalled specific immune responses to SARS-CoV-2 and increased antibody levels, especially in heterologous immunization. Considering the long-term immunogenicity and vaccine equity, we suggest that now, only individuals primed with inactivated vaccines require a booster dose.

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Section: Resultsmentioning

confidence: 99%

Immunogenicity and Safety of Homologous and Heterologous Prime–Boost Immunization with COVID-19 Vaccine: Systematic Review and Meta-Analysis

Cheng

Peng

et al. 2022

Vaccines

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“…Besides, uremic toxins, oxidative stress, endothelial dysfunction, low-grade inflammation, as well as mineral and bone disorders are involved and may contribute to the impaired immune system in these patients (5). It is therefore not surprising that HD patients have a weaker immunological response to COVID-19 vaccines compared to the general population (6).…”

Section: Introductionmentioning

confidence: 99%

“…Few studies have studied both the humoral (B-cell) and cellular (T-cell) response concomitantly in HD patients after three doses of SARS-CoV-2 BNT162b2 mRNA vaccine. One recent study reported that the third dose of SARS-CoV-2 BNT162b2 mRNA vaccine generates a higher serological response than the second vaccine dose in HD patients (6). The rate of decline of the immune response after three doses of vaccine remains to be investigated.…”

Section: Introductionmentioning

confidence: 99%

A third dose SARS‑CoV‑2 BNT162b2 mRNA vaccine results in improved immune response in hemodialysis patients

Melin

Svensson

Albinsson

et al. 2022

ujms

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Background: The hemodialysis (HD) population has been a vulnerable group during the coronavirus disease 2019 (COVID-19) pandemic. Advanced chronic kidney disease with uremia is associated with weaker immune response to infections and an attenuated response to vaccines. The aim of this study was to study the humoral and cellular response to the second and third doses of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‑CoV‑2) BNT162b2 mRNA vaccine in HD patients and to follow the response over time. Methods: The patients received their first two vaccine doses from 28 December 2020 within a 4-week interval and the third dose in September 2021 and were followed-up for humoral and cellular immune response at 1) 7–15 weeks and 2) 6–8 months after dose two (no t-cell reactivity measured), and 3) 3 weeks and 4) 3 months after dose three. Fifty patients were initially enrolled, and 40 patients were followed during the entire study. Levels of COVID-19 (SARS-CoV-2) IgG antibody against the Spike antigen (anti-S) and T-cell reactivity testing against the Spike protein using Enzyme-Linked ImmunoSpot (ELISPOT) technology were evaluated. Results: IgG antibodies to anti-S were detected in 35 (88%) of the 40 patients 7–15 weeks after vaccine dose two, 31 (78%) were positive, and 4 (10%) borderline. The median anti-S titer was 606 Abbott Units/milliliter (AU/mL) (interquartile range [IQR] 134–1,712). Three months after the third dose, anti-S was detected in 38 (95%) of 40 patients (P < 0.01 compared to after dose two), and the median anti-S titer was 9,910 AU/mL (IQR 2,325–26,975). Cellular reactivity was detected in 22 (55%), 34 (85%), and 28 (71%) of the 40 patients, and the median T-cell response was 9.5 (IQR 3.5–80), 51.5 (14.8–132), and 19.5 (8.8–54.2) units, respectively, for 6–8 months after dose two, 3 weeks, and 3 months after dose three. Conclusions: Our data show that a third dose of SARS‑CoV‑2 BNT162b2 mRNA vaccine gives a robust and improved immunological response in HD patients, but a few patients did not develop any anti-S response during the entire study, indicating the importance to monitor the vaccine response since those who do not respond could now be given monoclonal antibodies if they contract a COVID-19 infection or in the future antivirals.

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“…In one study, 93% of dialysis patients who received a third dose of BNT162b2 vaccine achieved antibody levels associated with protection, compared with only 35% pre-booster. 8 Recently, the Centers for Disease Control recommended a fourth dose of mRNA vaccine for select populations. 2 The utility of such a strategy in dialysis patients remains unclear but the humoral antibody waning seen in dialysis populations may support additional boosters.…”

mentioning

confidence: 99%

SARS-CoV-2 Booster Effect and Waning Immunity in Hemodialysis Patients

Goggins

Sharma

Gautam

et al. 2022

Preprint

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Background: Dialysis patients are extremely vulnerable to SARS-CoV-2 infection. We recently reported the results of a prospective cohort study measuring serial monthly semi quantitative IgG antibody levels to the SARS-CoV-2 spike protein receptor binding domain in fully vaccinated in-center hemodialysis patients after receiving the BNT162b2 (Pfizer-BioNTech) mRNA vaccination. Methods: Prospective cohort study measuring the serologic response of hemodialysis patients to a booster dose of BNT162b2 vaccine at an average of 2, 6 and 11 weeks post vaccination. Results: Of 35 hemodialysis patients in the original cohort, 27 (77.1%) received a third dose of BNT162b2. Antibody level significantly increased from pre-booster to 2 weeks post-booster (median (25th, 75th percentile) from 59.94 (29.69, 177.8) to 6216 (3806, 11730)), an average increase of 112 fold. Antibody levels dropped to a median of 2654 BAU/mL (1650, 8340) 6 weeks post-booster and to a median of 1444 BAU/mL (1102, 2020) between weeks 6 and 11 post-booster. Antibody levels at 11 weeks remained an average of 40 fold higher than pre-booster levels. Overall, antibody levels declined 47% month to month post-booster. Nine (33%) patients had negative or borderline detectable antibody levels pre-booster and 8 of 9 developed positive (>35.2 BAU/mL) antibody levels post-booster. Those with prior infection had a lower proportional increase in antibody level (51 fold) compared with the median change in COVID naive patients (144 fold) from pre-booster to 2 weeks post-booster. Conclusions: Our data demonstrates that hemodialysis patients obtain a robust humoral response from a third dose of the BNT162b2 vaccine although antibody levels wane over time.

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Response to tozinameran (BNT162b2) booster in twice-vaccinated kidney transplant and maintenance dialysis patients

Cited by 12 publications

References 5 publications

Immunogenicity and Safety of Homologous and Heterologous Prime–Boost Immunization with COVID-19 Vaccine: Systematic Review and Meta-Analysis

Immunogenicity and Safety of Homologous and Heterologous Prime–Boost Immunization with COVID-19 Vaccine: Systematic Review and Meta-Analysis

A third dose SARS‑CoV‑2 BNT162b2 mRNA vaccine results in improved immune response in hemodialysis patients

SARS-CoV-2 Booster Effect and Waning Immunity in Hemodialysis Patients

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