Department of General Medicine, Osaka Medical and Pharmaceutical University Hospital, Takatsuki City, Osaka, Japan.
Department of Emergency and General Internal Medicine, Rakuwakai Marutamachi Hospital, Kyoto, Nakagyo Ward, Japan.
PLoS One. 2022 May 16;17(5):e0268529. doi: 10.1371/journal.pone.0268529. eCollection 2022.
Inadequate vaccine response is a common concern among healthcare workers at the frontlines of the COVID-19 pandemic. We aimed to investigate if healthcare workers with history of weak immune response to HBV vaccination are more likely to have weak responses against the BioNTech/Pfizer's BNT162b2 mRNA SARS-CoV-2 vaccine.
We prospectively tested 954 healthcare workers for the Anti-SARS-CoV-2 spike (S) protein antibody titers prior to the first and second BNT162b2 vaccination doses and after four weeks after the second dose using Roche's Elecsys® assay. We calculated the percentage of patients who seroconverted after the first and second doses. We estimated the relative risk of non-seroconversion after the first BNT162b2 vaccine (defined as anti-SARS-CoV-2-S titer <15 U/mL) among HBV vaccine non-responders (HBs-Ab titer <10 mIU/mL) and weak responders (≥10 and <100 mIU/mL) compared to normal responders (≥100 mIU/mL).
Among 954 healthcare workers recruited between March 9 and March 24, 2021 at Osaka Medical and Pharmaceutical University, weak and normal HBV vaccine responders had comparable S-protein titers after the first BNT162b2 dose (51.4 [95% confidence interval 25.2-137.0] versus 59.7 [29.8-138.0] U/mL, respectively). HBV vaccine non-responders were more likely than normal responders to not seroconvert after a single dose (age and sex-adjusted relative risk 1.85 95% confidence interval [1.10-3.13]) although nearly all participants seroconverted after the second dose. After limiting the analysis to 382 patients with baseline comorbidity data, the comorbidity-adjusted relative risk of non-seroconversion among HBV vaccine non-responders to normal responders was 1.32 (95% confidence interval [0.59-2.98]).
Long term follow-up studies are needed to understand if protective immunity against SARS-CoV-2 wanes faster among those with history of HBV vaccine non-response and when booster doses are warranted for these healthcare workers.
在 COVID-19 大流行的前线，医护人员对疫苗反应不足是一个普遍关注的问题。我们旨在研究既往乙型肝炎病毒（HBV）疫苗免疫反应较弱的医护人员，其对辉瑞/BioNTech 的 BNT162b2 mRNA SARS-CoV-2 疫苗的反应是否更差。
我们前瞻性地在第一剂和第二剂 BNT162b2 疫苗接种前，以及第二剂疫苗接种后 4 周，使用罗氏 Elecsys®检测 954 名医护人员的抗 SARS-CoV-2 刺突（S）蛋白抗体滴度。我们计算了第一剂和第二剂疫苗接种后血清转化率的百分比。我们估计了第一剂 BNT162b2 疫苗接种后非血清转化率的相对风险（定义为抗 SARS-CoV-2-S 滴度 <15 U/mL），在 HBV 疫苗无应答者（HBs-Ab 滴度 <10 mIU/mL）和弱应答者（≥10 和 <100 mIU/mL）与正常应答者（≥100 mIU/mL）之间。
在 2021 年 3 月 9 日至 3 月 24 日期间，在大阪医科药科大学招募的 954 名医护人员中，弱应答者和正常应答者在接种第一剂 BNT162b2 后 S 蛋白滴度相当（分别为 51.4 [95%置信区间 25.2-137.0]与 59.7 [29.8-138.0] U/mL）。与正常应答者相比，HBV 疫苗无应答者在单次接种后更有可能无法产生血清转化（年龄和性别调整后的相对风险 1.85 [95%置信区间 1.10-3.13]），尽管几乎所有参与者在接种第二剂后都产生了血清转化。在对 382 名有基线合并症数据的患者进行分析后，HBV 疫苗无应答者与正常应答者之间非血清转化的合并症调整后相对风险为 1.32 [95%置信区间 0.59-2.98]。
需要进行长期随访研究，以了解既往 HBV 疫苗无应答者对 SARS-CoV-2 的保护性免疫是否更快减弱，以及这些医护人员何时需要加强免疫。
