Immunologic Effect of Bivalent mRNA Booster in Patients Undergoing Hemodialysis

Huth, Luca; Schäfer, Lutz; Almanzar, Giovanni; Lupoli, Gaia; Bischof, Marie L; Wratil, Paul R.; Stövesand, Torsten; Drechsler, Christiane; Keppler, Oliver T.; Prelog, Martina

doi:10.1056/nejmc2216309

Cited by 23 publications

(25 citation statements)

References 5 publications

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“…22 booster vaccination in hemodialysis patients. 23,24 In addition, our data show that particularly hemodialysis patients without prior infection benefited from bivalent mRNA booster vaccination. Despite lower neutralizing antibody levels against the wildtype or the BA.5 subtype before bivalent vaccination, patients without prior infection showed a significant increase after adapted vaccination, with their antibody titers reaching even equivalent levels as those in individuals with hybrid immunity due to prior breakthrough infection.…”

Section: Discussionmentioning

confidence: 59%

Live‐virus serum neutralization after bivalent SARS‐CoV‐2 mRNA vaccination in hemodialysis patients

Benning,

Bartenschlager,

Kim

et al. 2023

Journal of Medical Virology

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The development of bivalent booster vaccines addresses the ongoing evolution of the emerging B.1.1.529 (omicron) variant subtypes that are known to escape vaccine‐induced neutralizing antibody response. Little is known about the immunogenicity and reactogenicity of bivalent mRNA vaccines in hemodialysis patients with impaired vaccine response. In this prospective, observational cohort study, we analyzed SARS‐CoV‐2 anti‐S1 IgG, surrogate neutralizing antibodies (SNA), and live‐virus neutralization against the SARS‐CoV‐2 wildtype and the BA.5 variant in 42 hemodialysis patients with and without prior SARS‐CoV‐2 infection before and after an additional fifth bivalent vaccine dose. Anti‐S1 IgG and SNA were significantly higher in hemodialysis patients with prior infection than in patients without infection (p < 0.001 and p < 0.01, respectively). In patients without prior infection, both antibody levels increased, and live‐virus neutralizing antibodies against the wildtype and the BA.5 variant were correspondingly significantly higher after bivalent booster vaccination (p < 0.001 for both). Conversely, in patients with prior infection, anti‐S1 IgG and SNA did not alter significantly, and bivalent booster vaccination did not induce additional humoral immune response against the SARS‐CoV‐2 wildtype and the BA.5 variant. Thus, bivalent mRNA vaccines might increase humoral responses in hemodialysis patients without prior infection. Larger clinical trials are needed to help guide vaccination strategies in these immunocompromised individuals.

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Section: Discussionmentioning

confidence: 59%

Live‐virus serum neutralization after bivalent SARS‐CoV‐2 mRNA vaccination in hemodialysis patients

Benning,

Bartenschlager,

Kim

et al. 2023

Journal of Medical Virology

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“…Predictably, similar decrease in seroresponse has been observed in dialysis patients across vaccine types [40]. Several studies from different cohorts have described higher antibody levels following administration of third and fourth booster (mRNA vaccine) doses [41–44]. Patients with poor initial responses derived the most relative benefit [45].…”

Section: Covid-19 Vaccination; Humoral Responses In Chronic Kidney Di...mentioning

confidence: 70%

“…with improved spike protein and neutralizing antibodies observed after a third vaccine dose [18,47,48]. Most recently, a single dose of bivalent mRNA vaccine has been recommended for adults at a high risk of severe COVID-19 following primary vaccination series [42,49 ▪▪ ]. Given the emergence of variance of concerns, and increased resistance patterns of prevalent monovalent mRNA vaccines, it is currently recommended to discontinue use of monovalent mRNA vaccines for primary series.…”

Section: Covid-19 Vaccination; Humoral Responses In Chronic Kidney Di...mentioning

confidence: 99%

Vaccination in kidney disease: what did we learn from COVID-19 pandemic

Khan

2023

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewPatients with kidney disease were prioritized during COVID-19 vaccination efforts. Initial data on vaccine seroconversion and efficacy were confounded by heterogeneous vaccination regimens as well as response assessments. Recent data have addressed responses to evolving vaccine regimens, and addressed concerns in this high-risk population.Recent findingsmRNA vaccines BNT162b2 (Pfizer/BioNTech), mRNA1273 (Moderna) were the predominant vaccines used in two and three-dose regimens. Although population-based studies show reduced rates of seroconversion in kidney disease cohorts, there continues to be evolving efficacy largely due to emerging variants, and utilization of ongoing vaccine development. Recommendations on vaccination regimens now exclude use of monovalent mRNA vaccines, with bivalent vaccines are now the preferred effective vaccination. Individualization and adjustment of immunosuppressive drugs is recommended for maximal serological response in transplant recipients and patient with autoimmune kidney diseases.SummaryWaning responses to initial vaccination regimen, as well as emerging variants of concern have resulted in multiple dose regimens being investigated in patient with kidney disease. Use of bivalent mRNA vaccine is now recommended for initial as well as subsequent vaccine doses.

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“…Our results are consistent with a case series of dialysis patients, where bivalent vaccination increased anti-spike IgG 2.5 fold which correlated with BA.4/5 neutralization. 11 Other studies have found not found a higher peak neutralizing antibody response with bivalent vaccines in comparison to monovalent vaccines, and suggested a role for immunologic imprinting wherein prior antigenic exposure primes B cell memory and limits the development of memory B cells and neutralizing antibodies against newer subvariants. 8,12 Kidney transplant recipients generally had both lower increases and absolute lower neutralizing antibodies levels post-vaccination which is unsurprising given that transplant recipients are known to have attenuated humoral response to COVID-19 vaccination.…”

Section: Discussionmentioning

confidence: 97%

Omicron variant BA.1, BA.5, BQ.1.1, and XBB.1.5 Neutralizing Antibodies Following BNT162b2 BA.4/5 versus mRNA-1273 BA.1 Bivalent Vaccination

Hladunewich

Yau

Kurtesi

et al. 2023

Preprint

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Neutralization of Omicron subvariants by different bivalent vaccines have not been well evaluated. This study characterized neutralization against Omicron subvariants in 98 individuals receiving dialysis or with a kidney transplant receiving the BNT162b2 (BA.4/BA.5) or mRNA-1273 (BA.1) bivalent COVID-19 vaccine. Neutralization against Omicron BA.1, BA.5, BQ.1.1, and XBB.1.5 increased by 8-fold one month following bivalent vaccination. In comparison to wild-type (D614G), neutralizing antibodies against Omicron-specific variants were 7.3-fold lower against BA.1, 8.3-fold lower against BA.5, 45.8-fold lower against BQ.1.1, and 48.2-fold lower against XBB.1.5. Viral neutralization was not significantly different by bivalent vaccine type for wild-type (D614G) (P=0.48), BA.1 (P=0.21), BA.5 (P=0.07), BQ.1.1 (P=0.10), nor XBB.1.5 (P=0.10). Hybrid immunity conferred higher neutralizing antibodies against all Omicron subvariants. Given that both BNT162b2 (BA.4/BA.5) and mRNA-1273 (BA.1) induced similar neutralization against all Omicron subvariants, this suggests that bivalent vaccines confer protection even when they are antigenically divergent from the circulating variant.

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Immunologic Effect of Bivalent mRNA Booster in Patients Undergoing Hemodialysis

Cited by 23 publications

References 5 publications

Live‐virus serum neutralization after bivalent SARS‐CoV‐2 mRNA vaccination in hemodialysis patients

Live‐virus serum neutralization after bivalent SARS‐CoV‐2 mRNA vaccination in hemodialysis patients

Vaccination in kidney disease: what did we learn from COVID-19 pandemic

Omicron variant BA.1, BA.5, BQ.1.1, and XBB.1.5 Neutralizing Antibodies Following BNT162b2 BA.4/5 versus mRNA-1273 BA.1 Bivalent Vaccination

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