Infectious Disease

CDC, leaders of the kidney group, urge the protection of COVID-19 vaccines for workers and sufferers

January 14, 2021

4 min read

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Kidney care organizations and dialysis providers joined the CDC last week to reassure staff at the dialysis clinic and transplant center that COVID-19 vaccinations are safe for themselves and their patients.

“We have followed 21 cases of anaphylaxis in the US under 1.89 million doses.” Kathleen Dooling, MD, MPH, A CDC health worker and a panelist at the “Safety and Efficacy of COVID-19 Vaccines in the Dialysis Population” webinar organized by the American Society of Nephrology said. “That’s 11.1 cases of anaphylaxis per million doses.”

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Both the FDA-approved Moderna and Pfizer-BioNTech vaccines have shown greater than 90% effectiveness in studies across all age groups, as well as interracial and ethnic groups, Dooling said.

While the vaccination safety profile of both products is acceptable, dialysis providers should advise patients prior to vaccination about expected local and systemic symptoms after vaccination.

“80% to 89% of participants in clinical trials reported one or more local reactions that included pain or swelling at the injection site. 55% to 83% of participants in clinical trials reported one or more systemic reactions that included fever, fatigue, muscle pain, headache, and chills, ”said Dooling. “Most are mild to moderate in severity, appear within the first 3 days of vaccination, and subside within 1 to 2 days of starting.”

Vaccinations should be offered regardless of a history of previous symptomatic or asymptomatic SARS-CoV-2 infection, Dooling said. People with HIV infection, other immunocompromised conditions, or taking immunosuppressive medications like transplant patients could be at increased risk for severe COVID-19, she said. “There are currently no data available to demonstrate the safety and effectiveness of the vaccines in these groups,” she said.

Health workers and residents of long-term care facilities have been prioritized by federal agencies to receive either vaccine to treat COVID-19. In kidney care, dialysis center workers like other health care workers are given high priority to receive the vaccine, as are dialysis patients over 75 years of age.

The virus caused 381,000 deaths in the US last year.

Panelists Talat I amgirl, MD, The effectiveness of the two vaccines in dialysis patients remains unclear as high-risk individuals were not included in the Moderna and Pfizer-BioNTech studies.

“The Pfizer study included only 250 chronic kidney disease patients among the 40,000 patients who received the vaccine,” said Ikizler, director of the Department of Nephrology and Hypertension and Professor of Medicine and Catherine McLaughlin Hakim, Chair of Vascular Biology at Vanderbilt University School of Medicine in Nashville, Tennessee said. “The Moderna study did not include any patients with CRF.

“Fortunately, there are currently 236 registered vaccine trials for COVID-19 worldwide,” said Ikizler. “That’s a number we should be optimistic about.”

This includes 12 vaccines that are being investigated in phase 3 studies. Novavax Inc. plans to enroll 30,000 people in approximately 115 locations in the United States and Mexico for one of these Phase 3 studies and include patients with end-stage kidney disease and CKD, he said.

While dialysis patients have a high priority for vaccination, other patients in this category – Phase A1c – include those with COPD and other conditions like obesity, Ikizler said. “That means we have to compete with every other patient” to vaccinate dialysis patients, he said. Patients who smoke also belong to the same vaccination group. “This is an important issue that we need to consider,” he said.

While both vaccines were effective in all patients, “there is a confidence gap … there is a history of health care abuse” in people of color that may make patients reluctant to take the vaccine, Dooley said.

Dialysis workers have also shown a certain reluctance to take the vaccine. “We saw a 50/50 split between those in my department between those who take the vaccine and those who don’t.” Elizabeth Fortune, A dialysis patient and spokesman for the National Kidney Foundation said during the webinar.

Recently, the CDC worked with the Ad Council on a video encouraging health care workers to get vaccinated.

brigItte Schiller

With dialysis patients selected by the CDC as a high priority for vaccination, especially elderly patients, panelists brigItte Schiller, MD, Satellite Healthcare’s chief medical officer said the centers need to proactively administer vaccinations. “There are over 100 million patients who fit into the Phase A1c category. We have to identify patients in our clinics who are older than 75 years. The US kidney data system states there are 162,000 patients in that age group, ”she said.

Clinics should start vaccine surveys among patients and deal with the logistics for distribution to identify immediate needs and how to obtain the vaccine. “Continue to advocate a higher risk allocation compared to less risky terms,” ​​said Schiller.

Patients on in-center hemodialysis should receive the vaccine during their treatment. Patients on dialysis at home should be vaccinated during their monthly visits. The vaccine should be administered at least 30 minutes before leaving the dialysis clinic.

“It is important to monitor and document any systemic reactions or side effects 30 minutes after vaccination and to do a vital sign check after vaccination,” she said.

Reference:

American Society of Nephrology. Safety and effectiveness of COVID-19 vaccines in the dialysis population. Presented: January 7, 2021. www.asn-online.org/covid-19/

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