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Platen L, Liao BH, Tellenbach M, Cheng CC, Holzmann-Littig C, Christa C, Dächert C, Kappler V, Bester R, Werz ML, Schönhals E, Platen E, Eggerer P, Tréguer L, Küchle C, Schmaderer C, Heemann U, Keppler OT, Renders L, Braunisch MC, Protzer U. Longitudinal SARS-CoV-2 neutralization of Omicron BA.1, BA.5 and BQ.1.1 after four vaccinations and the impact of breakthrough infections in haemodialysis patients. Clin Kidney J 2023; 16:2447-2460. [PMID: 38046025 PMCID: PMC10689143 DOI: 10.1093/ckj/sfad147] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Indexed: 12/05/2023] Open
Abstract
Background Individuals on haemodialysis (HD) are more vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than the general population due to end-stage kidney disease-induced immunosuppression. Methods A total of 26 HD patients experiencing SARS-CoV-2 infection after a third vaccination were matched 1:1 with 26 of 92 SARS-CoV-2-naïve patients by age, sex, dialysis vintage and immunosuppressive drugs receiving a fourth vaccination with a messenger RNA-based vaccine. A competitive surrogate neutralization assay was used to monitor vaccination success. To determine infection neutralization titres, Vero-E6 cells were infected with SARS-CoV-2 variants of concern (VoCs), Omicron sublineage BA.1, BA.5 and BQ.1.1. The 50% inhibitory concentration (IC50, serum dilution factor 1:x) was determined before, 4 weeks after and 6 months after the fourth vaccination. Results A total of 52 HD patients received four coronavirus disease 2019 (COVID-19) vaccinations and were followed up for a median of 6.3 months. Patient characteristics did not differ between the matched cohorts. Patients without a SARS-CoV-2 infection had a significant reduction of real virus neutralization capacity for all Omicron sublineages after 6 months (P < .001 each). Those patients with a virus infection did not experience a reduction in real virus neutralization capacity after 6 months. Compared with the other Omicron VoC, the BQ.1.1 sublineage had the lowest virus neutralization capacity. Conclusions SARS-CoV-2-naïve HD patients had significantly decreased virus neutralization capacity 6 months after the fourth vaccination, whereas patients with a SARS-CoV-2 infection had no change in neutralization capacity. This was independent of age, sex, dialysis vintage and immunosuppression. Therefore, in infection-naïve HD patients a fifth COVID-19 vaccination might be reasonable 6 months after the fourth vaccination.
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Affiliation(s)
- Louise Platen
- Department of Nephrology, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Bo-Hung Liao
- Institute of Virology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Myriam Tellenbach
- Department of Nephrology, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Cho-Chin Cheng
- Institute of Virology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Christopher Holzmann-Littig
- Institute of Virology, Technical University of Munich, School of Medicine, Munich, Germany
- TUM Medical Education Center, Technical University of Munich, School of Medicine, Munich, Germany
| | - Catharina Christa
- Institute of Virology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Christopher Dächert
- Max von Pettenkofer Institute & Gene Center, Virology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Verena Kappler
- Department of Nephrology, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Romina Bester
- Institute of Virology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Maia Lucia Werz
- Department of Nephrology, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Emely Schönhals
- Department of Nephrology, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Eva Platen
- Kidney Center Eifel Dialyse, Mechernich, Germany
| | - Peter Eggerer
- KfH Kidney Center Harlaching, Munich-Harlaching, Germany
| | - Laëtitia Tréguer
- German Center for Infection Research (DZIF), Partner Site, Munich, Germany
| | - Claudius Küchle
- Department of Nephrology, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site, Munich, Germany
| | - Oliver T Keppler
- Max von Pettenkofer Institute & Gene Center, Virology, Ludwig Maximilian University of Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site, Munich, Germany
| | - Lutz Renders
- Department of Nephrology, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
- KfH Kidney Center, Traunstein, Germany
| | - Matthias Christoph Braunisch
- Department of Nephrology, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Ulrike Protzer
- Institute of Virology, Technical University of Munich, School of Medicine, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site, Munich, Germany
- Institute of Virology, Helmholtz Munich, Munich, Germany
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Cheng CC, Platen L, Christa C, Tellenbach M, Kappler V, Bester R, Liao BH, Holzmann-Littig C, Werz M, Schönhals E, Platen E, Eggerer P, Tréguer L, Küchle C, Schmaderer C, Heemann U, Renders L, Protzer U, Braunisch MC. Improved SARS-CoV-2 Neutralization of Delta and Omicron BA.1 Variants of Concern after Fourth Vaccination in Hemodialysis Patients. Vaccines (Basel) 2022; 10:vaccines10081328. [PMID: 36016216 PMCID: PMC9415993 DOI: 10.3390/vaccines10081328] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 12/21/2022] Open
Abstract
Hemodialysis patients are exposed to a markedly increased risk when infected with SARS-CoV-2. To date, it is unclear if hemodialysis patients benefit from four vaccinations. A total of 142 hemodialysis patients received four COVID-19 vaccinations until March 2022. RDB binding antibody titers were determined in a competitive surrogate neutralization assay. Vero-E6 cells were infected with SARS-CoV-2 variants of concern (VoC), Delta (B.1.617.2), or Omicron (B.1.1.529, sub-lineage BA.1) to determine serum infection neutralization capacity. Four weeks after the fourth vaccination, serum infection neutralization capacity significantly increased from a 50% inhibitory concentration (IC50, serum dilution factor 1:x) of 247.0 (46.3−1560.8) to 2560.0 (1174.0−2560.0) for the Delta VoC, and from 37.5 (20.0−198.8) to 668.5 (182.2−2560.0) for the Omicron VoC (each p < 0.001) compared to four months after the third vaccination. A significant increase in the neutralization capacity was even observed for patients with high antibody titers after three vaccinations (p < 0.001). Ten patients with SARS-CoV-2 breakthrough infection after the first blood sampling had by trend lower prior neutralization capacity for Omicron (p = 0.051). Our findings suggest that hemodialysis patients benefit from a fourth vaccination in particular in the light of the highly infectious SARS-CoV-2 Omicron-variants. A routinely applied four-time vaccination seems to broaden immunity against variants and would be recommended in hemodialysis patients.
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Affiliation(s)
- Cho-Chin Cheng
- Institute of Virology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Louise Platen
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Catharina Christa
- Institute of Virology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Myriam Tellenbach
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Verena Kappler
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Romina Bester
- Institute of Virology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Bo-Hung Liao
- Institute of Virology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Christopher Holzmann-Littig
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
- TUM Medical Education Center, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Maia Werz
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Emely Schönhals
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Eva Platen
- Kidney Center Eifel Dialyse, 53894 Mechernich, Germany
| | - Peter Eggerer
- KfH Kidney Center Harlaching, Munich-Harlaching, 81545 Munich, Germany
| | | | - Claudius Küchle
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Lutz Renders
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
- German Center for Infection Research (DZIF), Partner Site, 81675 Munich, Germany
| | - Ulrike Protzer
- Institute of Virology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
- German Center for Infection Research (DZIF), Partner Site, 81675 Munich, Germany
- Institute of Virology, Helmholtz Munich, 85764 Munich, Germany
- Correspondence: (U.P.); (M.C.B.); Tel.: +0049-(0)-89-4140-6863 (U.P.); +0049-(0)-89-4140-2231 (M.C.B.); Fax: +0049-(0)-89-4140-6823 (U.P.); +0049-(0)-89-4140-7734 (M.C.B.)
| | - Matthias Christoph Braunisch
- Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
- Correspondence: (U.P.); (M.C.B.); Tel.: +0049-(0)-89-4140-6863 (U.P.); +0049-(0)-89-4140-2231 (M.C.B.); Fax: +0049-(0)-89-4140-6823 (U.P.); +0049-(0)-89-4140-7734 (M.C.B.)
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