Hypertension is associated with antibody response and breakthrough infection in health care workers following vaccination with inactivated SARS-CoV-2

Soegiarto, Gatot; Wulandari, Laksmi; Purnomosari, Dewajani; Fahmita, Karin Dhia; Gautama, Hendra Ikhwan; Hadmoko, Satrio Tri; Prasetyo, Muhammad Edwin; Mahdi, Bagus Aulia; Arafah, Nur; Prasetyaningtyas, Dewi; Negoro, Pujo Prawiro; Prakoeswa, Cita Rosita Sigit; Endaryanto, Anang; Suprabawati, Desak Gede Agung; Tinduh, Damayanti; Rachmad, Eka Basuki; Triyono, Erwin Astha; Wahyuhadi, Joni; Keswardiono, Catur Budi; Wardani, Feby Elyana; Mayorita, Fitriyah; Kristiani, Nunuk; Baskoro, Ari; Fetarayani, Deasy; Nurani, Wita Kartika; Oceandy, Delvac

doi:10.1016/j.vaccine.2022.05.059

Cited by 43 publications

(57 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We did not find an association between peak antibody levels with BMI, but a study in Scotland suggested that obesity could lead to faster waning of immunity after vaccination, which may explain increased disease severity from breakthrough infections in people with obesity 32. Previous studies also found that hypertension33 and smoking34 35 were associated with lower antibody responses post-vaccination; there was marginal evidence for a similar effect in our population (p=0.09; 0.12).…”

Section: Discussioncontrasting

confidence: 78%

SARS-CoV-2 antibody responses post-vaccination in UK healthcare workers with pre-existing medical conditions: a cohort study

et al. 2022

View full text Add to dashboard Cite

ObjectivesTo examine antibody responses after the second vaccination in healthcare workers (HCWs) with underlying health conditions.DesignCohort study.SettingOxford University Hospitals in the United Kingdom.ParticipantsHealthcare workers who had SARS-CoV-2 serological data available and received two SARS-CoV- 2 vaccinations.Primary outcomePeak SARS-CoV-2 anti-spike IgG responses after the second vaccination and associations with underlying health conditions and the estimated risk of severe COVID-19 using an occupational health risk assessment tool.MethodsWe used univariable and multivariable linear regression models to investigate associations between antibody levels and demographics (age, sex, ethnicity), healthcare role, body mass index, underlying health conditions, vaccination status, prior infection and the Association of Local Authority Medical Advisors COVID-age risk score.Results1635 HCWs had anti-spike IgG measurements 14–84 days after second vaccination and data on any underlying health conditions. Only five HCWs (0.3%), all on immunosuppressive treatment, (including four organ transplant recipients), did not seroconvert after second vaccination. Antibody levels were independently lower with older age, diabetes, immunosuppression, respiratory disorders other than asthma and markedly so in organ transplant recipients. Levels were independently lower in ChAdOx1 versus BNT162b2 recipients and higher following previous infection. HCWs with ‘very high’ COVID-age risk scores had lower median antibody levels than those with ‘low’, ‘medium’ or ‘high’ risk scores; 4379 AU/mL, compared with 12 337 AU/mL, 9430 AU/mL and 10 524 AU/mL, respectively.ConclusionsTwo vaccine doses are effective in generating antibody responses among HCWs, including those with a high occupational risk. However, HCWs with underlying health conditions, especially diabetes, immunosuppression and organ transplant, had lower antibody levels, and vaccine response monitoring may be needed.

show abstract

Section: Discussioncontrasting

confidence: 78%

SARS-CoV-2 antibody responses post-vaccination in UK healthcare workers with pre-existing medical conditions: a cohort study

et al. 2022

View full text Add to dashboard Cite

show abstract

“…A previous study reported the difference in spike IgG antibody titers measured from the first to fourth week after two doses of BNT162b2 vaccination in a sample of 86 healthcare workers; patients with hypertension had lower median antibody titers than those without hypertension (650 versus 1911 U/mL, P = 0.001) [ 9 ]. Similar difference was reported in a sample of 101 healthcare workers who measured antibody titers at the fifth month after two doses of inactivated vaccination (P = 0.01) [ 10 ]. However, two studies involving 248 and 712 healthcare workers reported similar antibody titers in participants with and without hypertension (P = 0.52 and 0.33, respectively; measured on the seventh day and third month after two doses of vaccination, respectively) [ 12 , 13 ].…”

Section: Discussionsupporting

confidence: 85%

“…Several observational studies [ 9 – 11 ] reported that hypertension and diabetes were associated with lower spike IgG antibody titers following COVID-19 vaccination, while other studies did not [ 12 – 14 ]. Also, mixed findings were reported for other medical conditions such as chronic lung disease, cardiovascular disease, and cancer [ 10 , 15 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

Underlying medical conditions and anti-SARS-CoV-2 spike IgG antibody titers after two doses of BNT162b2 vaccination: A cross-sectional study

Nakagawa

Kojima

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

Patients with underlying medical conditions are at high risk of developing serious symptoms of the coronavirus disease 2019 than healthy individuals; therefore, it is necessary to evaluate the immune response to vaccination among them to formulate precision and personalized vaccination strategies. However, inconsistent evidence exists regarding whether patients with underlying medical conditions have lower anti-SARS-CoV-2 spike IgG antibody titers. We performed a cross-sectional study enrolling 2762 healthcare workers who received second doses of BNT162b2 vaccination from three medical and research institutes between June and July, 2021. Medical conditions were surveyed by a questionnaire, and spike IgG antibody titers were measured with chemiluminescent enzyme immunoassay using serum collected on the median of 62 days after the second vaccination. Multilevel linear regression model was used to estimate geometric mean and ratio of mean (95% confidence interval, CI) for the presence and absence of medical conditions and treatments. Among all participants (median age, 40 years [interquartile range, 30–50]; male proportion, 29.4%), the prevalence of hypertension, diabetes, chronic lung disease, cardiovascular disease, and cancer was 7.5%, 2.3%, 3.8%, 1.8%, and 1.3%, respectively. Patients with treated hypertension had lower antibody titers than those without hypertension; the multivariable-adjusted ratio of mean (95% CI) was 0.86 (0.76–0.98). Patients with untreated and treated diabetes had lower antibody titers than those without diabetes; the multivariable-adjusted ratio of mean (95% CI) was 0.63 (0.42–0.95) and 0.77 (0.63–0.95), respectively. No substantial difference was observed between the presence or absence of chronic lung disease, cardiovascular disease, or cancer. Patients with untreated hypertension and patients with untreated and treated diabetes had lower spike IgG antibody titers than participants without those medical conditions, suggesting that continuous monitoring of antibody titers and further booster shots could be necessary to maintain adaptive immunity in patients with hypertension or diabetes.

show abstract

“…This hypothesis agrees with previous data showing low seropositivity after vaccination in patients with chronic kidney disease ( 35 , 66 – 69 ). Moreover, higher rate of other comorbidities such as hypertension, coronary heart disease, myocardial infarction among T2DM group might confound the results ( 42 , 70 – 72 ).…”

Section: Discussionmentioning

confidence: 98%

Immunogenicity of COVID-19 vaccines in patients with diabetes mellitus: A systematic review

Boroumand

Forouhi

Karimi³

et al. 2022

Front. Immunol.

View full text Add to dashboard Cite

PurposeTo evaluate the immunogenicity of COVID-19 vaccines in patients with diabetes mellitus (DM) through a systematic approach.MethodA comprehensive search was conducted in PubMed, Scopus, and Web of Science with no time restrictions. The search was based on the three main concepts: Covid-19, Vaccine immunogenicity and Diabetes Mellitus.ResultsAfter excluding irrelevant studies, 16 studies remained for the quantitative assay. Among the sixteen studies, eleven had controls. Type of diabetes was specifically mentioned in six studies (T2DM; n=4, T1DM and T2DM; n=2). Twelve of the included studies were conducted on the immunogenicity of vaccines that included mRNA vaccines (i.e. BNT162b2 and mRNA-1273) in DM, five studies included vector-based vaccines (i.e. Ad5-nCoV and ChAdOx1-S), and five studies assessed the immunogenicity of vaccines in DM, including inactivated vaccines (i.e. BBV-152, CoronaVac, Sinopharm or SinoVac). Most of the current studies indicate lower antibody response in patients with DM compared to individuals without DM, after the second dose of vaccine and irrespective of vaccine type. Several studies have shown that higher age and higher BMI are associated with lower antibody response, while optimum glycemic control and higher GFR are associated with higher antibody response among patients with DM.ConclusionImmunogenicity of the vaccines has mostly been reported to be lower among patients with DM compared to healthy controls. There are also few studies assessing variables that significantly affect this association, including age, type of diabetes, BMI, glycemic control and eGFR. Investigating these associations could help us provide the most advantageous condition for patients with DM before, during and after vaccination for optimum antibody response. Many unresolved issues concerning potential factors affecting vaccine immunogenicity, including type of vaccine, numbers of administered doses, re-vaccination intervals and hyperglycemia in patients with DM need to be addressed through future research.

show abstract

Hypertension is associated with antibody response and breakthrough infection in health care workers following vaccination with inactivated SARS-CoV-2

Cited by 43 publications

References 43 publications

SARS-CoV-2 antibody responses post-vaccination in UK healthcare workers with pre-existing medical conditions: a cohort study

SARS-CoV-2 antibody responses post-vaccination in UK healthcare workers with pre-existing medical conditions: a cohort study

Underlying medical conditions and anti-SARS-CoV-2 spike IgG antibody titers after two doses of BNT162b2 vaccination: A cross-sectional study

Immunogenicity of COVID-19 vaccines in patients with diabetes mellitus: A systematic review

Contact Info

Product

Resources

About