Poor neutralization and rapid decay of antibodies to SARS-CoV-2 variants in vaccinated dialysis patients

Abstract

Patients on dialysis are at risk of severe course of SARS-CoV-2 infection. Understanding the neutralizing activity and coverage of SARS-CoV-2 variants of vaccine-elicited antibodies is required to guide prophylactic and therapeutic COVID-19 interventions in this frail population. By analyzing plasma samples from 130 hemodialysis and 13 peritoneal dialysis patients after two doses of BNT162b2 or mRNA-1273 vaccines, we found that 35% of the patients had low-level or undetectable IgG antibodies to SARS-CoV-2 Spike (S). Neutralizing antibodies against the vaccine-matched SARS-CoV-2 and Delta variant were low or undetectable in 49% and 77% of patients, respectively, and were further reduced against other emerging variants. The fraction of non-responding patients was higher in SARS-CoV-2-naïve hemodialysis patients immunized with BNT162b2 (66%) than those immunized with mRNA-1273 (23%). The reduced neutralizing activity correlated with low antibody avidity. Patients followed up to 7 months after vaccination showed a rapid decay of the antibody response with an average 21- and 10-fold reduction of neutralizing antibodies to vaccine-matched SARS-CoV-2 and Delta variant, which increased the fraction of non-responders to 84% and 90%, respectively. These data indicate that dialysis patients should be prioritized for additional vaccination boosts. Nevertheless, their antibody response to SARS-CoV-2 must be continuously monitored to adopt the best prophylactic and therapeutic strategy.

High Incidence of SARS-CoV-2 Variant of Concern Breakthrough Infections Despite Residual Humoral and Cellular Immunity Induced by BNT162b2 Vaccination in Healthcare Workers: A Long-Term Follow-Up Study in Belgium

“…Similar observations were seen in cohorts studied by Katz et al [82] and Naito et al [83] who both observed an increase in BTI cases 3 and 5 months post-vaccination, respectively, during increased circulation of SARS-CoV-2 VoCs. In our opinion, this paves the way for an additional booster vaccine to restimulate waning immunity against SARS-CoV-2, especially in immunocompromised patients [84] or the frail elderly population. All 13 subjects reported mild symptoms at time of diagnosis, implying that vaccination protects against severe disease [85,86].…”

Broadly neutralizing antibodies overcome SARS-CoV-2 Omicron antigenic shift

“…2c) who were boosted with a third mRNA vaccine dose. In the same cohort of dialysis patients, antibodies neutralizing the vaccine-matched Wuhan-Hu-1 strain were found to be low (less than 1/100) or undetectable in 44% of patients after the second mRNA vaccine dose 27 .…”

Longitudinal analysis of anti-SARS-CoV-2 S-RBD IgG antibodies before and after the third dose of the BNT162b2 vaccine

“…Overall, most literature evidence on healthy individuals describes a significant reduction of antibody levels four-six months after the second COVID-19 vaccine dose. Fragile patients, such as patients with haematological malignancies and haemodialysis, show an overall reduced response to anti-SARS-CoV-2 vaccination than healthy individuals 26 , 27 . Additionally, some Authors reported that fragile patients have a significantly more substantial decline of anti-SARS-CoV-2 antibody titers within 6 months compared to healthy individuals 28 , 29 .…”