COVID-19 outbreak in vaccinated patients from a haemodialysis unit: antibody titres as a marker of protection from infection.

Autor:	Boudhabhay I; Service de Néphrologie et Transplantation rénale, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France., Serris A; Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France., Servais A; Service de Néphrologie et Transplantation rénale, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France., Planas D; Institut Pasteur, Université de Paris, CNRS UMR 3569, Virus and Immunity Unit, Paris, France.; Vaccine Research Institute, Creteil, France., Hummel A; Service de Néphrologie et Transplantation rénale, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France., Guery B; Service de Néphrologie et Transplantation rénale, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France., Parize P; Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France., Aguilar C; Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France., Dao M; Service de Néphrologie et Transplantation rénale, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France., Rouzaud C; Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France., Ferriere E; Service de Néphrologie et Transplantation rénale, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France., Knebelmann B; Service de Néphrologie et Transplantation rénale, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France., Sakhi H; Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Department of Nephrology, Centre de Référence Maladie Rare 'Syndrome Néphrotique Idiopathique', Fédération Hospitalo-Universitaire 'Innovative therapy for immune disorders', Créteil, France.; University Paris Est Créteil, Institut National de la Santé et de la Recherche Médical, INSERM U955, Institut Mondor de Recherche Biomédicale, Equipe 21, Créteil, France., Leruez M; Virology Laboratory, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France., Joly D; Service de Néphrologie et Transplantation rénale, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France., Schwartz O; Institut Pasteur, Université de Paris, CNRS UMR 3569, Virus and Immunity Unit, Paris, France.; Vaccine Research Institute, Creteil, France., Lanternier F; Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France., Bruel T; Institut Pasteur, Université de Paris, CNRS UMR 3569, Virus and Immunity Unit, Paris, France.; Vaccine Research Institute, Creteil, France.
Jazyk:	angličtina
Zdroj:	Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association [Nephrol Dial Transplant] 2022 Jun 23; Vol. 37 (7), pp. 1357-1365.
DOI:	10.1093/ndt/gfac016
Abstrakt:	Background: Patients on maintenance haemodialysis (HD) have an increased risk of severe coronavirus disease 2019 (COVID-19) and a reduced response to vaccines. Data are needed to identify immune correlates of protection in this population. Methods: Following a COVID-19 outbreak among vaccinated patients in a HD unit, clinical data and serological response to BNT162b2 vaccine were retrospectively recorded. Results: Among 53 patients present in the dialysis room, 14 were infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) alpha variant (COVID_Pos) and 39 were not. Compared with uninfected patients, COVID_Pos patients more frequently had additional causes of immunosuppression (50% versus 21%; P = .046) and were more often scheduled on the Monday-Wednesday-Friday (MWF) shift (86% versus 39%; P = .002). Moreover, COVID_Pos had lower anti-spike (S) immunoglobulin G (IgG) titres than uninfected patients {median 24 BAU/mL [interquartile range (IQR) 3-1163] versus 435 [99-2555]; P = .001} and lower neutralization titres [median 108 (IQR 17-224) versus 2483 (481-43 908); P = .007]. Anti-S and neutralization antibody titres are correlated (r = 0.92, P < .001). In multivariable analysis, an MWF schedule {odds ratio [OR] 10.74 [95% confidence interval (CI) 1.9-93.5], P = .014} and anti-S IgG titres 1 month before the outbreak [<205 BAU/mL: OR 0.046 (95% CI 0.002-0.29), P = .006] were independently associated with COVID-19 infection. None of the patients with anti-S IgG >284 BAU/mL got infected. Ten of 14 COVID_Pos patients were treated with casirivimab and imdevimab. No patient developed severe disease. Conclusions: Anti-S IgG titre measured prior to exposure correlates to protection from SARS-CoV-2 infection in HD patients. BNT162b2 vaccination alone or in combination with monoclonal antibodies prevented severe COVID-19. (© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.)
Databáze:	MEDLINE
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