ABSTRACT
Background: The immunogenicity and safety of mRNA-based vaccination in people living with HIV have yet to be clarified. We aimed to describe the impact of SARS-CoV-2 mRNA vaccination on safety, HIV-RNA control, and humoral immune responses after two doses of vaccine. Methods: From January 2021 to April 2021, vaccination with mRNA1273 (Moderna) and BNT162b2 (BioNTech/Pfizer) was offered to every individual with HIV registered at our institution who fulfilled vaccination criteria and consented to routine vaccination. HIV-1 RNA levels and anti-SARS-CoV-2 S total Ig (Elecsys®, Roche Diagnostics, Rotkreuz, Switzerland) were measured at the time of the first and second doses, 30 days later, and at 6 months after the first dose. Results: The study sample included 131 individuals (median age: 54 years [interquartile range (IQR): 47-60.5]);male: 70.2%;median baseline CD4-T cell: 602 cells/μ l [IQR: 445.0-825.5]). HIV viral load data were collected for 129 patients at the time of the first dose (M0) and 30 days later (M1);for 124 patients, 30 days after the second dose (M2);and for 42 patients, 6 months after the first dose (M6). Twenty (15.5%) of 129 patients had detectable HIV-1 RNA (>20 copies/ml;IQR: 24.0-43.5) at M0, 13/129 (10.1%) at M1 (among which 5 were newly detected), 15/124 (12.1%) at M2 (among which 4 were newly detected), and 6/42 (14.3%) at M6. HIV-RNA levels returned below the detection threshold of 20 copies/mL at the subsequent measure. All analyzed patients showed a positive anti-SARS-CoV-2 S Ig after vaccination with geometric mean titers (GMT) of 131.8 U/ml (95% CI: 130.4-133.2) 30 days after the first dose and 2003.4 U/ml (95% CI: 2002.3-2004.4) 30 days after the second dose. Six months after the first dose, 75/131 patients were analyzed, and they were all still positive for anti-SARS-CoV-2 S Ig, with GMT of 1132.2 U/ml (95% CI: 1131.0-1133.4). We found no statistical significance in anti-SARS-CoV-2 S Ig titers between patients with detectable and undetectable HIV-1 RNA. No serious adverse effects were reported. Conclusion: In a patient population on effective antiretroviral drugs, only minor or transient effects of mRNA vaccines on HIV-1 RNA levels were observed. All patients developed anti-SARS-CoV-2 S total antibodies after two-dose vaccination and antibodies were detectable in all analyzed patients 6 months after the first dose.
ABSTRACT
OBJECTIVE: To determine pertussis and influenza vaccination coverage during pregnancy among women delivering in all the maternities of Geneva (Switzerland), during the COVID-19 pandemic. METHODS: All women delivering in all the maternity centres of the canton of Geneva from 1st November 2020 to 30th November 2020 (beginning of the flu vaccination season) and from 8th March 2021 to 7th April 2021 (end of the flu vaccination season) had their records checked upon admission to the labour ward regarding pertussis and influenza vaccination during pregnancy. Reasons for non-vaccination were recorded. Univariate and multivariate analyses were done to identify predictors of vaccine uptake. RESULTS: 951 women delivered in Geneva during the two study periods, of which 950 were included in the study. 86.2% were vaccinated against pertussis, with no significant difference between the study periods (87.5% vs 85% at the beginning and end of the flu vaccination season respectively). 49.8% were vaccinated against influenza, with no significant difference between the study periods (48.8% vs 50.7% beginning and end of the flu vaccination season respectively). The influenza vaccine was 5 times more likely not to be proposed (8.9% vs. 1.7%) and 3 times more likely to be refused (26.6% vs. 8%) than the pertussis vaccine. Main reason for refusal was a lack of maternal desire for both vaccines, but not vaccine fear. Maternal parity ≥ 1 was significantly associated with pertussis vaccine uptake at univariate analysis. Women were significantly more likely to accept the influenza vaccine if they had a university degree or if they did not deliver in a midwife-only run delivery unit in both univariate and multivariate analysis. CONCLUSIONS: In Geneva, most gynaecologists offer pertussis immunization during antenatal care and uptake is high, but more efforts must be done to increase influenza vaccination coverage. Education level impacts maternal flu vaccination uptake, but other social disparities did not.