ABSTRACT
Purpose: We report the immunogenicity and safety of a third BNT162b2 vaccine in pediatric solid organ transplant recipients (pSOTRs). Method(s): Samples from pSOTRs (12-18 years) enrolled in our multicenter, observational study (COVID-19 Antibody Testing of Recipients of Solid Organ Transplants and Patients with Chronic Diseases) who received a third vaccine (V3) were analyzed for antibodies to SARS-CoV-2 spike protein receptor-binding domain, with a positive cutoff of >=0.8 and maximum titer of >2500 U/mL. Pre-V3 samples were 1-3 months after vaccine 2, and post-V3 were 1 month after vaccine 3. Result(s): Thirty-seven pSOTRs (46% heart, 24% liver, 27% kidney, 3% multi) received V3. Median (interquartile range [IQR]) age was 15 (14-16) years;42% were male and 78% white. pSOTRs were median (IQR) 9 (6-13) years from transplant. Four (11%) patients had prior SARS-CoV-2 infection. Antibody titers were positive in 26/37 (70%) patients pre-V3 and 32/37 (86%) post-V3 (Figure). Median (IQR) antibody titers were higher post-V3 (2500 [1581-2500] U/mL) than pre-V3 (211 [0.8-2500] U/mL) in paired analysis (p<0.001). 6/11 (55%) pSOTRs with negative pre-V3 titers seroconverted, with a post-V3 median (IQR) titer of 418 (132-1581) U/ mL. Transplant within 3 years was associated with negative post-V3 titer (p=0.037). Main side effects after V3 were pain (71%) and fatigue (50%). No patients reported allergic reaction, myocarditis, or rejection. One patient tested positive for SARSCoV- 2 between vaccines 2 and 3, with negative pre- and post-V3 titers. At time of first vaccine, this patient was transplanted a year ago, treated for rejection recently, and taking 3 immunosuppression agents including an antimetabolite. Conclusion(s): In this limited cohort, 86% of pSOTRs had a positive antibody response after three SARS-CoV-2 vaccines with no adverse events. Importantly, 55% of pSOTRs with prior negative response seroconverted post-V3, and 100% of pSOTRs with positive response increased their antibody titer or remained at maximum titer. Our preliminary results suggest the benefit of a third vaccine for adolescent pSOTRs based on antibody response;larger studies are needed to assess vaccine effectiveness.
ABSTRACT
Background: The coronavirus disease 2019 (COVID-19) pandemic has greatly affected pediatric patients and their caregivers. Immunosuppressed patients, such as pediatric liver transplant (LT) recipients, face unique challenges. The objective of this study was to describe the psychosocial impact of the COVID-19 pandemic on caregivers of young children and adolescents who received LT and assess their views on vaccinations. Methods: A cross-sectional analysis was conducted using an anonymous survey composed of a validated 4 question anxiety questionnaire, closed yes/no questions, and Likert scale questions. The survey was distributed electronically from March-May 2021 through social media and in-person at Jackson Hospital Miami to caregivers of pediatric LT recipients. Results: A total of 28 surveys were returned. The majority (76%) of caregivers endorsed feeling anxious about the COVID-19 pandemic with most reporting high (average score of 4/5) stress associated with their child being immunosuppressed. 55% of respondents additionally believed that their child felt anxious, and approximately one-third of caregivers reported increased domestic tension. Less than 20% of caregivers believed that the COVID-19 pandemic changed their child's blood work schedule or healthcare. Most (78%) respondents used telehealth during the pandemic and endorsed high (average score of 4/5) satisfaction, but only half selected that they wanted to continue to use telehealth in the future. Exposure to sick contacts was minimal, with 11% having a household member fall ill and 25% having to quarantine because of exposure. While a majority of caregivers expressed high trust in their child's medical team to use precautions (93%), knowledge of COVID-19 symptoms (100%), willingness to bring their child for testing if symptomatic (100%), and high adherence with masking and quarantining precautions (100%), 54% of caregivers reported that they do not intend to get the COVID-19 vaccine for their child after approval. Conclusion: Our pilot results demonstrate that caregivers of pediatric LT recipients feel concerned about COVID-19, the majority were compliant with precautions and have not had their child's healthcare impacted. However, high vaccine hesitancy was also reported, highlighting the need for education on vaccine utility and safety in the immunosuppressed patient population.