Infectious Disease

According to study results, a booster dose could make transplant recipients less susceptible to COVID-19

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Werbel does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.

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Previous research has shown that solid organ transplant recipients do not respond as well to COVID-19 vaccines as others. Johns Hopkins researchers found that a booster dose could make them less prone to infection.

In a new study published in the Annals of Internal Medicine, Wilhelm A. Werbel, MD, an Infectious Disease Fellow at the Johns Hopkins School of Medicine, and colleagues reported that a third dose of the COVID-19 vaccine increased antibody levels in one-third of patients with negative levels and all patients with low positive antibody levels after two doses.

Vial of COVID19 vaccine

Receiving a third dose of the COVID-19 vaccine appears to increase anti-spike antibody responses in solid organ transplant recipients.
Source: Adobe Stock.

“We have been running a national vaccine registry over the past 6 months to quickly assess the safety and antibody responses of COVID-19 vaccines in thousands of immunocompromised patients, such as organ transplant patients,” Werbel told Healio.

“We found that almost half of all transplant patients did not produce antibodies against the main viral protein in the approved vaccines – anti-spike antibodies – in contrast to very high levels in almost all healthy people in the clinical trials,” said Werbel . “This, coupled with reports of breakthrough infections after vaccination and the fact that COVID-19 can be very severe in transplant patients, has sparked global interest in strategies to improve the immune response to these otherwise highly potent vaccines in the hope of providing better protection for at-risk patients. “

Wilhelm A. Werbel

According to Werbel, the booster strategy has not been thoroughly investigated in any population.

“Once vaccine supplies in the United States improved, hundreds of transplant patients who had suboptimal antibody responses after the two-dose messenger RNA vaccine series have independently searched for third doses of COVID-19 vaccines,” Werbel said. “Many have reported this to us and volunteered to donate blood for antibody tests before and after a third vaccination and to let us know if they had any reactions or other side effects in the week after the vaccination.”

Werbel et al. Studied 30 organ transplant recipients who received a third dose of vaccine between March 20 and May 10, 2021. None of the patients reported any disease compatible with COVID-19 or had a positive PCR test prior to vaccination.

During primary vaccination, 57% of the 30 patients received two doses of the Pfizer / BioNTech vaccine and the remainder received two doses of the Moderna vaccine. All patients were tested for anti-spike antibodies for a median of 9 days before receiving a third dose. The results of these tests showed that 24 patients had negative antibody levels and six patients had low positive antibody levels, Werbel and colleagues said.

Patients received their third dose a median 67 days after the second – 15 patients received the Johnson & Johnson injection, nine received the Moderna vaccine, and six received the Pfizer / BioNTech vaccine. The researchers repeated the antibody tests a median 14 days after the third dose and found that of the six patients with low positive antibody levels before the third dose, all after the third dose had high positive antibody levels before the third dose, only six of the 24 had high positive antibody levels after the third dose. Of these, two had low positive antibody levels and 16 (67%) remained negative.

Werbel and colleagues also interviewed 23 patients 7 days after the third dose and asked about specific vaccine reactions. Fifteen reported having mild or moderate local reactions and one reported severe arm pain. The most common systemic reaction was mild or moderate fatigue, followed by severe headache and severe myalgia. According to the researchers, no patients reported fever, anaphylactoid reactions, or neurological complications.

“The third dose of COVID-19 vaccines appears to increase anti-spike antibody responses in approximately 50% of transplant recipients in this preliminary series, especially those who had weakly positive results after a standard two-dose mRNA vaccination” said Werbel. “However, patients with negative antibodies after standard vaccination were less likely to have an increased antibody response and were generally lower when triggered. The booster dose may be a viable option for certain transplant patients to improve antibody responses and thus possibly better protection against COVID-19. “

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