Humoral Responses to Single-Dose BNT162b2 mRNA Vaccination in Dialysis Patients Previously Infected With SARS-CoV-2

Abstract

Seroconversion rates following infection and vaccination are lower in dialysis patients compared to healthy controls. There is an urgent need for the characterization of humoral responses and success of a single-dose SARS-CoV-2 vaccination in previously infected dialysis patients. We performed a dual-center cohort study comparing three different groups: 25 unvaccinated hemodialysis patients after PCR-confirmed COVID-19 (Group 1), 43 hemodialysis patients after two-time BNT162b2 vaccination without prior SARS-CoV-2 infection (Group 2), and 13 single-dose vaccinated hemodialysis patients with prior SARS-CoV-2 infection (Group 3). Group 3 consists of seven patients from Group 1 and 6 additional patients with sera only available after single-dose vaccination. Anti-S1 IgG, neutralizing antibodies, and antibodies against various SARS-CoV-2 protein epitopes were measured 3 weeks after the first and 3 weeks after the second vaccination in patients without prior SARS-CoV-2 infection, 6 weeks after the onset of COVID-19 in unvaccinated patients, and 3 weeks after single-dose vaccination in patients with prior SARS-CoV-2 infection, respectively. Unvaccinated patients after COVID-19 showed a significantly higher neutralizing antibody capacity than two-time vaccinated patients without prior COVID-19 [median (IQR) percent inhibition 88.0 (71.5–95.5) vs. 50.7 (26.4–81.0); P = 0.018]. After one single vaccine dose, previously infected individuals generated 15- to 34-fold higher levels of anti-S1 IgG than age- and dialysis vintage-matched unvaccinated patients after infection or two-time vaccinated patients without prior SARS-CoV-2 infection with a median (IQR) index of 274 (151–791) compared to 18 (8–41) and 8 (1–21) (for both P < 0.001). With a median (IQR) percent inhibition of 97.6 (97.2–98.9), the neutralizing capacity of SARS-CoV-2 antibodies was significantly higher in single-dose vaccinated patients with prior SARS-CoV-2 infection compared to other groups (for both P < 0.01). Bead-based analysis showed high antibody reactivity against various SARS-CoV-2 spike protein epitopes after single-dose vaccination in previously infected patients. In conclusion, single-dose vaccination in previously infected dialysis patients induced a strong and broad antibody reactivity against various SARS-CoV-2 spike protein epitopes with high neutralizing capacity.

Humoral immunogenicity and tolerability of heterologous ChAd/BNT compared with homologous BNT/BNT and ChAd/ChAd SARS-CoV-2 vaccination in hemodialysis patients

“…There is evidence that, in the normal population, immunogenicity and efficacy advantages and tolerability disadvantages of heterologous versus homologous vaccination may be due to the additive effects of vectored-vaccines rather activating T-cell function and mRNA-vaccines stimulating IgG-antibody response [ 14 , 26 ] possibly explaining, in part, present study findings. The SARS-CoV-2 vaccine also consolidates antibody immunity in infected and surviving hemodialysis patients, which has also been recently described [ 27 ]. The finding of highest SARS-CoV-2-spike-IgG-levels in vaccinated hemodialysis patients with prior COVID-19 is also consistent in magnitude with SARS-CoV-2-spike-IgG-levels reported for the vaccinated normal population with prior COVID-19 [ 28 ].…”

Neutralizing antibody activity against the B.1.617.2 (delta) variant 8 months after two-dose vaccination with BNT162b2 in health care workers

“…We used a surrogate virus neutralization test (Medac, Wedel, Germany) to detect surrogate neutralizing antibodies in a sample, as described previously by us and others [ [10] , [11] , [12] , [13] , [14] ]. The test mimics the interaction between the virus and the host cell by direct protein-protein interaction using purified RBD protein from the viral spike protein and the host cell receptor angiotensin converting enzyme 2 (ACE2) [ 14 ].…”

Neutralizing Antibody Activity Against the B.1.617.2 (delta) Variant Before and After a Third BNT162b2 Vaccine Dose in Hemodialysis Patients

“…In this prospective, dual-center, observational cohort study, we enrolled 84 hemodialysis patients after two-dose BNT162b2 mRNA vaccination before a third BNT162b2 mRNA vaccine dose between August and September 2021. Serum was collected directly before third vaccination and after a median (IQR) of 21 (20)(21)(22)(23) days after third vaccination. The third vaccine dose was administered a median of 119 (109-165) days after the second vaccine dose.…”

“…A surrogate virus neutralization test (Medac, Wedel, Germany) was applied to detect snAB in a sample, as described previously by us and others (5,7,10,(17)(18)(19)(20)(21)(22)(23). Samples were pre-incubated with horseradish peroxidase (HRP) conjugated recombinant SARS-CoV-2 RBD fragment (HRP-RBD).…”