Chan Jeffery C H, Chan Eugene Yu-Hin, Cheng Samuel M S, Leung Daniel, Ho Fanny Tsz-Wai, Tong Pak-Chiu, Lai Wai-Ming, Lee Matthew H L, Chim Stella, Tsang Leo C H, Kwan Tsz-Chun, Cheuk Yin Celeste, Wang Manni, Wong Howard H W, Lee Amos M T, Li Wing Yan, Chan Sau Man, Tam Issan Y S, Lam Jennifer H Y, Zhang Kaiyue, Tu Wenwei, Peiris Malik, Rosa Duque Jaime S, Lau Yu Lung, Ma Alison Lap-Tak
Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong.
Paediatric Nephrology Centre, Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong.
Clin Kidney J. 2025 Feb 21;18(3):sfaf052. doi: 10.1093/ckj/sfaf052. eCollection 2025 Mar.
Children with chronic kidney disease (CKD) are at risk of severe complications after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and are recommended to receive vaccine boosters. Although coronavirus disease 2019 (COVID-19) boosters are effective in providing immune responses among healthy children, data on the use of a fourth dose among children with CKD are limited.
We prospectively investigated the immunogenicity and safety of a fourth dose of BNT162b2 in children with CKD. Dosages were 0.1 mL and 0.3 mL for children aged 5-11 years and 11-18 years, respectively. Humoral and cellular immunogenicity was assessed at pre-dose 4, and at 1 and 6 months post-dose 4.
Twenty-one children, with a median age of 14.0 years, were included for evaluation. A fourth dose of BNT162b2 elicited significant increases in humoral spike receptor-binding domain immunoglobulin G levels and T-cell responses. Antibody responses were significantly lower among kidney transplant recipients or children receiving calcineurin inhibitors than other CKD children at 1 month post-dose 4. Breakthrough COVID-19 occurred in three children after the fourth dose, and one was hospitalized. One child developed mild gross hematuria 1 day after the fourth dose, which spontaneously resolved. The overall safety profile was acceptable.
A fourth dose of BNT162b2 was immunogenic and safe in children with CKD.
慢性肾脏病（CKD）患儿在感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）后有发生严重并发症的风险，因此建议接种加强疫苗。虽然2019冠状病毒病（COVID-19）加强针在健康儿童中能有效引发免疫反应，但关于CKD患儿使用第四剂疫苗的数据有限。
我们前瞻性地研究了第四剂BNT162b2在CKD患儿中的免疫原性和安全性。5至11岁和11至18岁儿童的剂量分别为0.1毫升和0.3毫升。在接种第四剂前、接种第四剂后1个月和6个月评估体液免疫和细胞免疫原性。
纳入21名儿童进行评估，中位年龄为14.0岁。第四剂BNT162b2可显著提高体液中刺突受体结合域免疫球蛋白G水平和T细胞反应。在接种第四剂后1个月，肾移植受者或接受钙调神经磷酸酶抑制剂的儿童的抗体反应明显低于其他CKD儿童。三名儿童在接种第四剂后发生了突破性COVID-19感染，其中一名住院。一名儿童在接种第四剂后1天出现轻度肉眼血尿，随后自行缓解。总体安全性良好。
第四剂BNT162b2在CKD患儿中具有免疫原性且安全。
