ABSTRACT
Lung transplant recipients (LTRs) are at the greatest risk for mortality of COVID-19 among recipients of solid organ transplantation. However, LTRs have been shown to have impaired humoral response (0-40%) to the two doses of mRNA SARS-CoV-2 vaccine. In this study, we aimed to assess the humoral response to a third and fourth dose of SARS-CoV-2 mRNA vaccines in LTRs. This was a prospective observational study of 45 LTRs without a history of SARS-CoV-2 infection, who received two or more doses of the BNT162b2 or mRNA-1273 vaccines between April and October 2022. Among these, 11, 26 and 8 LTRs received 2, 3 and 4 doses of the vaccine, respectively. The levels of antibodies to SARS-CoV-2 spike protein were tested by quantitative immunochromatographic assay. LTRs with antibody titers of 250 AU/mL or higher were defined as responders, which corresponds to two-fold the LD50 concentration level in vitro. The median age of the LTRs was 50 years (interquartile range [IQR], 34-59), and 77% of the LTRs were female. The median time from transplantation to anti-SARS-CoV-2 IgG test was 82 months (IQR, 35-124), and the median time from the last dose to anti-SARS-CoV-2 IgG test was 101 days (IGR, 60-158). The maintenance immunosuppression included calcineurin inhibitors (100%), mycophenolate mofetil (95%), and corticosteroids (100%). The humoral responses were detected in 0%, 31%, and 50% of LTRs and the median titers of anti-SARS-CoV-2 IgG were 0.01 AU/ml (IQR, 0.01-0.01), 0.01 AU/ml (IQR, 0.01-335.25), and 1429.48 AU/mL (IQR, 32.06-8195.91) after the second, third and fourth vaccination, respectively. The response rate and the levels of antibodies significantly increased with the numbers of vaccinations (p = 0.027). No patient had acute rejection or serious adverse events within the study period. Augmented humoral response was achieved in the LTRs after the third and fourth vaccine dose. Repeated vaccination may be beneficial to enhance humoral immunity even in the LTRs. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
OBJECTIVES: The coronavirus disease (COVID-19) pandemic has imposed restrictions on people's social behavior. However, there is limited evidence regarding the relationship between changes in social participation and depressive symptom onset among older adults during the pandemic. We examined the association between changes in social participation and the onset of depressive symptoms among community-dwelling older adults during the COVID-19 pandemic. DESIGN: This was a longitudinal study. SETTING: Communities in Minokamo City, a semi-urban area in Japan. PARTICIPANTS: We recruited community-dwelling older adults aged ≥ 65 years using random sampling. Participants completed a questionnaire survey at baseline (March 2020) and follow-up (October 2020). MEASUREMENTS: Depressive symptoms were assessed using the Two-Question Screen. Based on their social participation status in March and October 2020, participants were classified into four groups: "continued participation," "decreased participation," "increased participation," and "consistent non-participation." RESULTS: A total of 597 older adults without depressive symptoms at baseline were analyzed (mean age = 79.8 years; 50.4% females). Depressive symptoms occurred in 20.1% of the participants during the observation period. Multivariable Poisson regression analysis showed that decreased social participation was significantly associated with the onset of the depressive symptoms, compared to continued participation, after adjusting for all covariates (incidence rate ratio = 1.59, 95% confidence interval = 1.01-2.50, p = 0.045). CONCLUSION: Older adults with decreased social participation during the COVID-19 pandemic demonstrated a high risk of developing depressive symptoms. We recommend that resuming community activities and promoting the participation of older adults, with sufficient consideration for infection prevention, are needed to maintain mental health among older adults.