A Third Dose of SARS-CoV-2 mRNA Vaccine Improves Immune Response in Chronic Kidney Disease Patients

Poli, Cecilia; Víal, Pablo A.; Rey-Jurado, Emma; González, Natalia; Cortés, Jimena; Hormazábal, Juan; Ramírez-Riffo, Carolina; Cruz, Javiera de la; Ulloa, Camilo

doi:10.3390/vaccines11051012

Cited by 5 publications

(7 citation statements)

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“…The third vaccine dose given more than three months after the primary vaccination has been shown in patients with RD to increase the RBD-IgG level, NAb titer against wt/Omicron and T cell response significantly, and compared to healthy controls lower or similar response levels have been reported [ 38 , 40 ]. In patients with CKD, the third dose has been demonstrated to increase the antibody levels, the proportion of participants with NAbs and NAb titer levels, and T cell responses [ 41 , 42 , 43 , 44 ], and seroconversion has been observed in patients who did not respond after two vaccine doses [ 35 , 45 ]. However, in kidney transplant recipients, the rates of response have remained suboptimal [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…In patients with CKD, the third dose has been demonstrated to increase the antibody levels, the proportion of participants with NAbs and NAb titer levels, and T cell responses [ 41 , 42 , 43 , 44 ], and seroconversion has been observed in patients who did not respond after two vaccine doses [ 35 , 45 ]. However, in kidney transplant recipients, the rates of response have remained suboptimal [ 42 ]. Due to the significant waning of antibody levels in the months following the third dose [ 39 , 46 ] and the emergence of SARS-CoV-2 variants with a high potential of immune escape, the European Center for Disease Prevention and Control and European Medicine Agency recommended, in July 2022, the administration of the fourth dose to people above 60 years of age as well as to vulnerable persons of any age [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

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Hybrid Immunity Improves the Immune Response after the Fourth COVID-19 Vaccine Dose in Individuals with Medical Conditions Predisposing to Severe COVID-19

Ekström,

Leino,

Juutinen

et al. 2024

Vaccines

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Data on immune responses following COVID-19 booster vaccinations and subsequent infections in the immunocompromised are limited. We studied antibody responses after the fourth dose and subsequent infections to define patient groups benefiting most from boosters. Fourth vaccine (booster) doses were, in Finland, first recommended for severely immunocompromised individuals, whom we invited to participate in our study in 2022. We assessed spike protein-specific IgG and neutralizing antibodies (NAb) against the ancestral and Omicron BA.1 strains one month after the fourth dose from 488 adult participants and compared them to the levels of 35 healthy controls after three doses. We used Bayesian generalized linear modeling to assess factors explaining antibody levels and assessed vaccine-induced and hybrid immunity six months after the last vaccine dose. Chronic kidney disease (CKD) and immunosuppressive therapy (IT) were identified as factors explaining sub-optimal antibody responses. The proportion of participants with a normal antibody response and NAbs was significantly lower regarding CKD patients compared to the controls. By the 6-month sampling point, one-third of the participants became infected (documented by serology and/or molecular tests), which notably enhanced antibody levels in most immunocompromised participants. Impaired antibody responses, especially NAbs against the Omicron lineage, suggest limited protection in individuals with CKD and highlight the need for alternative pharmaceutical preventive strategies. Vaccination strategies should take into account the development of robust hybrid immunity responses also among the immunocompromised.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hybrid Immunity Improves the Immune Response after the Fourth COVID-19 Vaccine Dose in Individuals with Medical Conditions Predisposing to Severe COVID-19

Ekström,

Leino,

Juutinen

et al. 2024

Vaccines

View full text Add to dashboard Cite

show abstract

“…In patients with CKD, the third dose has been demonstrated to increase the antibody levels, proportion of participants with NAbs and NAb titer levels and T cell responses [40][41][42][43] and seroconversion has been observed in patients who did not respond after two vaccine doses [34,44]. However, in kidney transplant recipients the rates of response have remained suboptimal [41]. Due to significant waning of antibody levels in the months following the third dose [38,44,45] and the emergence of SARS-CoV-2 variants with a high potential of immune escape The European Center for Disease Prevention and Control and European Medicine Agency recommended in July 2022 the administration of the fourth dose to people above 60 years as well as vulnerable persons of any age [46].…”

Section: Discussionmentioning

confidence: 99%

Hybrid immunity improves the immune response after fourth Covid-19 vaccine dose in individuals with medical conditions predisposing to severe Covid-19

Ekström,

Leino,

Juutinen

et al. 2023

Preprint

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BackgroundData on Covid-19 booster vaccinations and subsequent infections on immune responses in the immunocompromised is limited. We studied antibody responses after the fourth dose and subsequent breakthrough infection to define patient groups benefiting most from boosters.MethodsIn Finland, fourth vaccine (booster) doses were first recommended for severely immunocompromised individuals, whom we invited to participate in 2022. We assessed spike protein specific IgG antibody levels and neutralizing antibodies (NAb) against the ancestral and Omicron BA.1 strains one month after the fourth dose from 488 adult participants and compared to the levels of 35 healthy controls after 3 doses. We used Bayesian generalized linear modelling to assess factors explaining antibody concentrations after the fourth dose. We assessed vaccine-induced and hybrid immunity six months after the last vaccine dose.ResultsChronic kidney disease (CKD) and immunosuppressive therapy (IT) were identified as factors explaining sub-optimal antibody responses. The proportion of participants with a normal antibody response and NAbs were significantly lower in CKD patients as compared to controls. By the 6-month sampling one third of the participants became infected, which enhanced antibody levels notably in most immunocompromised participants.ConclusionsImpaired antibody responses, especially NAbs against the Omicron lineage, predict limited protection in individuals with CKD, and highlight the need for alternative pharmaceutical preventive strategies. Vaccination strategies should take into account development of robust hybrid immunity responses also among the immunocompromised.

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“…Boosters of SARS‐CoV‐2 mRNA‐based vaccines are recommended in dialysis patients and the general population 11 . Reports have demonstrated high antibody levels following boosters in dialysis patients 12–19 . In one study, 91% of dialysis patients who received a third dose of BNT162b2 vaccine achieved antibody levels associated with protection, compared with only 35% prebooster 12 .…”

Section: Introductionmentioning

confidence: 99%

“…In one study, 91% of dialysis patients who received a third dose of BNT162b2 vaccine achieved antibody levels associated with protection, compared with only 35% prebooster 12 . However, there are still few studies characterizing the long‐term humoral response postbooster in these patients 16–19 . Additionally, few studies directly compare the long‐term response after two doses of a COVID‐19 vaccine to the response after three doses in the same cohort of patients which can provide valuable insights regarding patient variability.…”

Section: Introductionmentioning

confidence: 99%

Humoral immunity trends in a hemodialysis cohort following SARS‐CoV‐2 mRNA booster: A cohort study

Goggins,

Sharma,

et al. 2024

Health Science Reports

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Background and AimsPatients with end stage kidney disease on hemodialysis are vulnerable to SARS‐CoV‐2 infection. Current guidelines recommend boosters of SARS‐CoV‐2 mRNA‐based vaccines. The long‐term humoral response of hemodialysis patients infected with SARS‐CoV‐2 after receiving a booster of SARS‐CoV‐2 mRNA‐based vaccines has been incompletely characterized. Here, we determined the long‐term humoral response of hemodialysis patients to two and three doses of the Pfizer BioNTech (BNT162b2) mRNA SARS‐CoV‐2 vaccine and investigated the effect of postbooster SARS‐CoV‐2 infection on antibody levels over time.MethodsSamples were collected on a monthly basis and tested for anti‐SARS‐CoV‐2 antibodies against anti‐spike S1 domain. Thirty‐five hemodialysis patients were enrolled in the original study and 27 of these received a booster. Patients were followed up to 6 months after the first two doses and an additional 7 months after the third BNT162b2 dose. Results are presented as the internationally harmonized binding antibody units (BAU/mL).ResultsAntibody level significantly increased from prebooster to 2 weeks postbooster, with a median [25th, 75th percentile] rise from 52.72 [28.55, 184.7] to 6216 [3806, 11,730] BAU/mL in the total population. Of patients with a negative or borderline detectable antibody level 6 months after vaccination who received a third dose, 89% developed positive antibody levels 2 weeks postbooster. Postbooster antibody levels declined an average rate of 29% per month in infection‐naïve patients. Antibody levels spiked in patients infected with SARS‐CoV‐2 after receiving a booster but declined rapidly. No patients infected postbooster required hospitalization.ConclusionsA third dose of BNT162b2 restores antibody levels to high levels in dialysis patients but levels decline over time. A third dose did not necessarily prevent infection, but no patients suffered severe infection or required hospitalization. SARS‐CoV‐2 recovered patients appear to have a blunted rise in antibody levels after a third dose. Although patients infected with SARS‐CoV‐2 postbooster had an immediate spike in antibody levels, these declined over time.

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A Third Dose of SARS-CoV-2 mRNA Vaccine Improves Immune Response in Chronic Kidney Disease Patients

Cited by 5 publications

References 57 publications

Hybrid Immunity Improves the Immune Response after the Fourth COVID-19 Vaccine Dose in Individuals with Medical Conditions Predisposing to Severe COVID-19

Hybrid Immunity Improves the Immune Response after the Fourth COVID-19 Vaccine Dose in Individuals with Medical Conditions Predisposing to Severe COVID-19

Hybrid immunity improves the immune response after fourth Covid-19 vaccine dose in individuals with medical conditions predisposing to severe Covid-19

Humoral immunity trends in a hemodialysis cohort following SARS‐CoV‐2 mRNA booster: A cohort study

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