Evaluation of the SARS-CoV-2 Antibody Response to the BNT162b2 Vaccine in Patients Undergoing Hemodialysis

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dc.contributor.author

Yau, Kevin

Abe, Kento T.

Naimark, David

Oliver, Matthew J.

Perl, Jeffrey

Leis, Jerome A.

Bolotin, Shelly

Tran, Vanessa

Mullin, Sarah I.

Shadowitz, Ellen

Gonzalez, Anny

Sukovic, Tatjana

Garnham-Takaoka, Julie

Quinn de Launay, Keelia

Takaoka, Alyson

Straus, Sharon E.

McGeer, Allison J.

Chan, Christopher T.

Colwill, Karen

Gingras, Anne-Claude

Hladunewich, Michelle A.

dc.date.accessioned

2024-01-02T19:41:24Z

dc.date.available

2024-01-02T19:41:24Z

dc.date.issued

2021-09-02

dc.description.abstract - en

Importance: Patients undergoing hemodialysis have a high mortality rate associated with COVID-19, and this patient population often has a poor response to vaccinations. Randomized clinical trials for COVID-19 vaccines included few patients with kidney disease; therefore, vaccine immunogenicity is uncertain in this population. Objective: To evaluate the SARS-CoV-2 antibody response in patients undergoing chronic hemodialysis following 1 vs 2 doses of BNT162b2 COVID-19 vaccination compared with health care workers serving as controls and convalescent serum. Design, Setting, and Participants: A prospective, single-center cohort study was conducted between February 2 and April 17, 2021, in Toronto, Ontario, Canada. Participants included 142 patients receiving in-center hemodialysis and 35 health care worker controls. Exposures: BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine. Main Outcomes and Measures: SARS-CoV-2 IgG antibodies to the spike protein (anti-spike), receptor binding domain (anti-RBD), and nucleocapsid protein (anti-NP). Results: Among the 142 participants undergoing maintenance hemodialysis, 94 (66%) were men; median age was 72 (interquartile range, 62-79) years. SARS-CoV-2 IgG antibodies were measured in 66 patients receiving 1 vaccine dose following a public health policy change, 76 patients receiving 2 vaccine doses, and 35 health care workers receiving 2 vaccine doses. Detectable anti-NP suggestive of natural SARS-CoV-2 infection was detected in 15 of 142 (11%) patients at baseline, and only 3 patients had prior COVID-19 confirmed by reverse transcriptase polymerase chain reaction testing. Two additional patients contracted COVID-19 after receiving 2 doses of vaccine. In 66 patients receiving a single BNT162b2 dose, seroconversion occurred in 53 (80%) for anti-spike and 36 (55%) for anti-RBD by 28 days postdose, but a robust response, defined by reaching the median levels of antibodies in convalescent serum from COVID-19 survivors, was noted in only 15 patients (23%) for anti-spike and 4 (6%) for anti-RBD. In patients receiving 2 doses of BNT162b2 vaccine, seroconversion occurred in 69 of 72 (96%) for anti-spike and 63 of 72 (88%) for anti-RBD by 2 weeks following the second dose and median convalescent serum levels were reached in 52 of 72 patients (72%) for anti-spike and 43 of 72 (60%) for anti-RBD. In contrast, all 35 health care workers exceeded the median level of anti-spike and anti-RBD found in convalescent serum 2 to 4 weeks after the second dose. Conclusions and Relevance: This study suggests poor immunogenicity 28 days following a single dose of BNT162b2 vaccine in the hemodialysis population, supporting adherence to recommended vaccination schedules and avoiding delay of the second dose in these at-risk individuals.

dc.identifier.doi

https://doi.org/10.1001/jamanetworkopen.2021.23622

dc.identifier.issn

2574-3805

dc.identifier.pubmedID

34473256

dc.identifier.uri

https://open-science.canada.ca/handle/123456789/1378

dc.language.iso

en

dc.publisher

JAMA Network

dc.rights - en

Creative Commons Attribution 4.0 International (CC BY 4.0)

dc.rights - fr

Creative Commons Attribution 4.0 International (CC BY 4.0)

dc.rights.uri - en

https://creativecommons.org/licenses/by/4.0/

dc.rights.uri - fr

https://creativecommons.org/licenses/by/4.0/deed.fr

dc.subject - en

Health

dc.subject - fr

Santé

dc.subject.en - en

Health

dc.subject.fr - fr

Santé

dc.title - en

Evaluation of the SARS-CoV-2 Antibody Response to the BNT162b2 Vaccine in Patients Undergoing Hemodialysis

dc.type - en

Article

dc.type - fr

Article

local.article.journalissue

9

local.article.journaltitle

JAMA Network Open

local.article.journalvolume

4

local.pagination

1-10

local.peerreview - en

Yes

local.peerreview - fr

Oui

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