SARS-CoV-2 neutralizing antibody response after three doses of mRNA1273 vaccine and COVID-19 in hemodialysis patients

Abstract

BackgroundIn hemodialysis patients, a third vaccination is frequently administered to augment protection against coronavirus disease 2019 (COVID-19). However, the newly emerged B.1.1.159 (Omicron) variant may evade vaccinal protection more easily than previous strains. It is of clinical interest to better understand the neutralizing activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants after booster vaccine or COVID-19 infection in these mostly immunocompromised patients.MethodsHemodialysis patients from four dialysis centers were recruited between June 2021 and February 2022. Each patient provided a median of six serum samples. SARS-CoV-2 neutralizing antibodies (nAbs) against wild type (WT) or Omicron were measured using the GenScript SARS-CoV-2 Surrogate Virus Neutralization Test Kit.ResultsForty-two patients had three doses of mRNA1273. Compared to levels prior to the third dose, nAb-WT increased 18-fold (peak at day 23) and nAb-Omicron increased 23-fold (peak at day 24) after the third dose. Peak nAb-WT exceeded peak nAb-Omicron 27-fold. Twenty-one patients had COVID-19 between December 24, 2021, and February 2, 2022. Following COVID-19, nAb-WT and nAb-Omicron increased 12- and 40-fold, respectively. While levels of vaccinal and post-COVID nAb-WT were comparable, post-COVID nAb-Omicron levels were 3.2 higher than the respective peak vaccinal nAb-Omicron. Four immunocompromised patients having reasons other than end-stage kidney disease have very low to no nAb after the third dose or COVID-19.ConclusionsOur results suggest that most hemodialysis patients have a strong humoral response to the third dose of vaccination and an even stronger post-COVID-19 humoral response. Nevertheless, nAb levels clearly decay over time. These findings may inform ongoing discussions regarding a fourth vaccination in hemodialysis patients.

18-month longitudinal SARS COV-2 neutralizing antibody dynamics in haemodialysis patients receiving heterologous 3-dose vaccination (AZD-1222- AZD-1222- BNT162b2) in a lower middle income setting

“…Seropositivity and MAB level in both groups increased rapidly 2 weeks after the third dose (TP4) and showed further increase over the following one year with 100% seroconversion and comparably high MAB levels in both groups. Although there are fewer data available regarding the immune response to 3 dose-mixed vaccination in HD patients, several countries have studied the immune response to 3 doses of mRNA vaccines (BNT162b2 and/ or mRNA-1237) where seroconversion rates ranged between 95–98.5% [ 16 , 29 – 31 , 56 , 57 , 61 ] with increased antibody titres (SARS CoV-2 anti-spike IgG) that ranged between 9910 AU/ml and 26037AU/ml within 1–3 months of receiving the third booster dose. HD patients were shown to maintain seropositivity at 98.3% four months after the third dose, though MAB levels reduced [ 16 ].…”

“…HD patients were shown to maintain seropositivity at 98.3% four months after the third dose, though MAB levels reduced [ 16 ]. Importantly, low to moderate levels of Omicron neutralization were seen in patients only after either 3rd dose vaccination or post COVID-19 infection [ 50 , 57 ]. Further, while patients who had COVID-19 (after 2 previous doses) developed nAB levels similar to those who had 3rd dose vaccination (2200 -2500 IU/ml), those who had infection, had a 3.2 fold higher level of Omicron nAB compared to post vaccination individuals [ 57 ].…”

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

“…Notably, Wang et al compared the neutralizing antibody response in dialysis patients to both WT and omicron variants and found that the vaccine response against Omicron was significantly less compared with that against WT. 31 Additionally, the half‐life of the omicron antibody response was shorter than that of the WT. These findings likely account for our rapid increase in antibody level in patients who were infected postbooster and the subsequent rapid decline.…”

Real-World Effectiveness of SARS-CoV-2 Vaccine Booster in Hemodialysis Patients with COVID-19 Receiving Molnupiravir

“…Although COVID-19 vaccine boosters are highly effective in enhancing immunity against SARS-CoV-2 variants in HD patients, their optimal doses and durability are still uncertain in this population [ 52 ]. A previous study in Israel demonstrated that the third dose of the BNT162b2 vaccine induced a more durable humoral response than the second dose in healthcare workers, and the reliable neutralizing capacity for the Omicron variant could persist for at least four months [ 53 ].…”