Broseta José Jesús, Rodríguez-Espinosa Diana, Cuadrado Elena, Rodríguez Néstor, Bedini José Luis, Maduell Francisco
Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, 08036 Barcelona, Spain.
Diaverum Renal Services Haemodialysis Group, Institut Hemodiàlisi Barcelona, 08036 Barcelona, Spain.
Vaccines (Basel). 2022 Mar 27;10(4):522. doi: 10.3390/vaccines10040522.
The COVID-19 pandemic continues to be a worldwide health issue. Among hemodialysis (HD) patients, two-dose immunization schemes with mRNA vaccines have contributed to preventing severe COVID-19 cases; however, some have not produced a sufficient humoral response, and most have developed a rapid decline in antibody levels over the months following vaccination. This observational, prospective, multi-center study evaluated the humoral response in terms of presence and levels of IgG antibodies to the receptor-binding domain of the S1 spike antigen of SARS-CoV-2 (anti-S1-RBD IgG) to the third dose of SARS-CoV-2 mRNA vaccines, either the mRNA-1273 (Moderna) or BNT162b2 (Pfizer), in 153 patients from three dialysis units affiliated to Hospital Clínic of Barcelona (Spain). Most hemodialysis patients responded intensely to this third vaccine dose, achieving the seroconversion in three out of four non- or weak responders to two doses. Moreover, 96.1% maintained the upper limit or generated higher titers than after the second. BNT162b2 vaccine, active cancer, and immunosuppressive treatment were related to a worse humoral response. Every hemodialysis patient should be administered a third vaccine dose six months after receiving the second one. Despite the lack of data, immunosuppressed patients and those with active cancer may benefit from more frequent vaccine boosters.
新冠疫情仍是一个全球性的健康问题。在血液透析（HD）患者中，两剂次的mRNA疫苗免疫方案有助于预防重症新冠病例；然而，一些患者并未产生足够的体液免疫反应，且大多数患者在接种疫苗后的数月内抗体水平迅速下降。这项观察性、前瞻性、多中心研究评估了西班牙巴塞罗那临床医院附属的三个透析单元的153例患者接种第三剂新冠病毒mRNA疫苗（mRNA-1273[莫德纳]或BNT162b2[辉瑞]）后，针对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）S1刺突抗原受体结合域的IgG抗体（抗S1-RBD IgG）的存在情况和水平方面的体液免疫反应。大多数血液透析患者对第三剂疫苗反应强烈，四分之三的两剂次无反应或弱反应者实现了血清转化。此外，96.1%的患者维持了上限水平或产生了高于第二剂后的滴度。BNT162b2疫苗、活动性癌症和免疫抑制治疗与较差的体液免疫反应有关。每位血液透析患者应在接种第二剂疫苗六个月后接种第三剂疫苗。尽管缺乏数据，但免疫抑制患者和活动性癌症患者可能会从更频繁的疫苗加强接种中获益。
