Biogem, Biology and Molecular Genetics Institute, Ariano Irpino, Italy.
Department of Translational Medical Science, University of Campania "Luigi Vanvitelli,", Naples, Italy.
Kidney Blood Press Res. 2022;47(7):467-474. doi: 10.1159/000524034. Epub 2022 Mar 22.
Since the pandemic of COVID-19 started from December 2019, remarkable numbers of infections and deaths associated with COVID-19 have been recorded worldwide. End-stage kidney disease patients on dialysis are particularly at high risk of infections due to impairments in the innate and adaptive immune systems. Vaccination on dialysis patients (DP) still remains challenging because of the variable response and a low seroconversion rate compared with healthy participants (HP). Therefore, it is urgently necessary to establish a different vaccination strategy for DP, in terms of the dose and administration time.
Here, we report an observational prospective cohort study in which the immunogenic efficacies of SARS-CoV-2 vaccine BNT162b2 on DP and HP were evaluated by absolute quantification of IgG levels in the blood.
DP showed a delayed seroconversion after two vaccine doses, with a low absolute IgG levels compared to HP. While HP reached complete seroconversion within 10 days from the administration of a second dose, only 76% of DP were seropositive. After the booster dose, DP had a strongly improved seroconversion rate as well as antibody levels, reaching 97% seropositivity and 50 times enhancement on antibody levels.
DISCUSSION/CONCLUSION: These results prompt to suggest an additional vaccine dose in DP, reducing the interval of time from the second dose. Since limited data are available on immune response in DP overtime after three vaccine doses currently, our study is among the first reports demonstrating the improved seropositivity and IgG levels in DP after the booster vaccine dose.
自 2019 年 12 月 COVID-19 大流行开始以来，全球范围内记录了大量与 COVID-19 相关的感染和死亡病例。由于先天和适应性免疫系统受损，接受透析的终末期肾病患者特别容易感染。由于与健康参与者相比，透析患者（DP）的反应变化和低血清转化率，疫苗接种仍然具有挑战性。因此，迫切需要为 DP 制定不同的疫苗接种策略，包括剂量和接种时间。
在这里，我们报告了一项观察性前瞻性队列研究，通过血液中 IgG 水平的绝对定量评估了 SARS-CoV-2 疫苗 BNT162b2 对 DP 和 HP 的免疫原性效果。
DP 在接受两剂疫苗后出现血清转化延迟，与 HP 相比，绝对 IgG 水平较低。虽然 HP 在第二剂后 10 天内达到完全血清转化，但只有 76%的 DP 呈血清阳性。在加强剂量后，DP 的血清转化率以及抗体水平均得到显著提高，达到 97%的血清阳性率和抗体水平提高 50 倍。
讨论/结论：这些结果提示 DP 需要额外接种一剂疫苗，减少第二剂疫苗的间隔时间。由于目前关于 DP 接种三剂疫苗后免疫反应的可用数据有限，我们的研究是首批报告在加强疫苗剂量后 DP 血清阳性率和 IgG 水平提高的研究之一。
