Kronbichler Andreas, Anders Hans-Joachim, Fernandez-Juárez Gema Maria, Floege Jürgen, Goumenos Dimitrios, Segelmark Mårten, Tesar Vladimir, Turkmen Kultigin, van Kooten Cees, Bruchfeld Annette
Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria.
Department of Medicine, University of Cambridge, Cambridge, UK.
Nephrol Dial Transplant. 2021 Mar 9. doi: 10.1093/ndt/gfab064.
Coronavirus Disease 19 (COVID-19) vaccine platforms are becoming available and are the most promising strategy to curb the spread of SARS-CoV-2 infections. However, numerous uncertainties exist regarding the pros and cons of vaccination, especially in patients with (immune-mediated) kidney diseases on immunosuppressive drugs. Here, members of the Immunonephrology Working Group (IWG) of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) discuss thirteen frequently-asked questions regarding safety and efficacy of the most promising vaccine candidates. Post-marketing surveillance should be performed to estimate the rate of vaccine response (humoral and cellular) of different vaccine platforms, and surveillance of disease activity following administration of COVID-19 vaccines. Some of the candidates induce signaling pathways which also promote autoimmune kidney diseases, e.g. type I interferons in systemic lupus erythematosus. Efficacy estimates would thus far favor the use of selected COVID-19 vaccines, such as BNT162b2, mRNA-1273 or Gam-COVID-Vac. Humoral immune response after vaccination should be monitored using appropriate assays. Even in the absence of neutralizing antibodies patients might be protected by a sufficient cellular immune response capable to reduce severity of COVID-19. A reduced vaccine response after the use of CD20-depleting agents is anticipated, and it is particularly important to discuss strategies to improve vaccine response with these patients. Distancing and shielding measures remain important as not all vaccines fully protect from coronavirus infection. In-depth information about the most pressing vaccine questions is essential to reduce vaccine hesitancy of patients.
新型冠状病毒肺炎（COVID-19）疫苗平台已开始可用，是遏制严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染传播最有前景的策略。然而，关于接种疫苗的利弊存在许多不确定性，尤其是对于正在使用免疫抑制药物治疗（免疫介导）肾脏疾病的患者。在此，欧洲肾脏协会-欧洲透析与移植协会（ERA-EDTA）免疫肾脏病学工作组（IWG）的成员讨论了关于最有前景的候选疫苗的安全性和有效性的13个常见问题。应进行上市后监测，以评估不同疫苗平台的疫苗反应（体液和细胞）率，以及接种COVID-19疫苗后疾病活动的监测。一些候选疫苗可诱导也会促进自身免疫性肾脏疾病的信号通路，例如系统性红斑狼疮中的I型干扰素。迄今为止，有效性评估支持使用选定的COVID-19疫苗，如BNT162b2、mRNA-1273或Gam-COVID-Vac。接种疫苗后的体液免疫反应应使用适当的检测方法进行监测。即使没有中和抗体，患者也可能通过足以降低COVID-严重性的细胞免疫反应得到保护。预计使用CD20清除剂后疫苗反应会降低，与这些患者讨论改善疫苗反应的策略尤为重要。保持社交距离和防护措施仍然很重要，因为并非所有疫苗都能完全预防冠状病毒感染。提供有关最紧迫疫苗问题的深入信息对于减少患者的疫苗犹豫至关重要。
