ABSTRACT
Background: Previous studies have shown an inferior response to mRNA SARS-CoV-2 vaccination in solid organ transplant (SOT) recipients up to four months after vaccination. We examined the development in anti-receptor binding domain (RBD) IgG after two doses of BNT162b2 in SOT recipients six months after vaccination compared to immunocompetent controls. Methods: in 200 SOT recipients and 200 age-and sex-matched controls, we measured immunogenicity of two doses of BNT162b2 vaccine up to 6 months after vaccination. An in-house enzyme-linked immunosorbent assay (ELISA) based system was used to measure concentrations of anti-receptor binding domain (RBD) IgG. Neutralizing capacity of antibodies was estimated using an in-house ELISA based pseudo-neutralization assay. Presence of anti-SARS-CoV-2 nucleocapsid (N) antibodies was assessed using an electrochemiluminescence based kit from Roche diagnostics. Presence of N-antibodies was used as evidence of previous natural infection. In a subset of participants an interferon-gamma releasing assay was used to assess T-cell responses. Results: SOT recipients and controls demonstrated an increase in anti-RBD IgG after both first and second dose of BNT162b2. Six months after the first dose, GMC of anti-RBD IgG declined in both groups but remained higher in controls (55.85 AU/mL, 95% CI 36.95-83.33 vs. 1448.94 AU/mL, 95% CI 1139.43-1799.48). Furthermore, more controls had a cellular response six months after vaccination (13.1% of SOT recipients vs. 59.4% of controls, p<0.001). We found increasing age (RR 1.23 pr year, 95% CI 1.11-1.35, p<0.001), being within one year of transplantation (RR 1.55, 95% CI 1.30-1.85, p<0.001), use of mycophenolate (RR 1.53, 95% CI 1.18-1.99 p=0.001), kidney transplanation (RR 1.70, 95% CI 1.25-2.30, p=0.001), lung-transplantation (RR 1.63, 95% CI 1.16-2.29, p=0.005) and cancer comorbidity (RR 1.52, 95% CI 1.26-1.82, p <0.001) to be significantly associated with humoral non-response. Conclusion: Humoral and cellular responses to two doses of BNT162b2 are inferior in SOT recipients compared to controls. Furthermore, anti-RBD concentration decline 6 months after first vaccine dose. Further investigations of clinical significance of anti-RBD IgG concentration and vaccine non-response is warranted to optimize the timing and use of booster vaccines. Multiple risk factors for non-response were identified and may help identify SOT recipients at high risk of vaccine non-response.
ABSTRACT
Background and importanceEmpathy is an essential part of good patient communication. However, pharmacists often provide information without taking patients’ preferences into account. Narrative medicine is an innovative approach, where empathic skills are nurtured through close reading of literary texts and creative writing.Aim and objectivesThe purpose was to investigate the feasibility of a narrative medicine course for pharmacists and to explore the experiences of the participating pharmacists.Material and methodsA 2-day course of narrative medicine was offered to Danish community and hospital pharmacists in Summer 2020. The course capacity was set at 16 pharmacists. The course consisted of close reading of short literary texts about illness and related creative writing, facilitated by both experienced literary and health care professional lecturers. Pharmacists’ empathy was assessed before and after participating in the course with the Jefferson Scale of Empathy (JSE). Feasibility was assessed focusing on acceptability, demand, implementation, practicality and limited efficacy using focus group interviews, participant observation and a satisfaction questionnaire.ResultsIn total, 8 pharmacists participated in the course. All pharmacists answered the questionnaire, and 5 focus group interviews were held with participants and lecturers. The practicality of the course can be optimised, as only half of the course capacity was filled. This could, however, be due to the situation with the COVID-19 pandemic, as the workload at the pharmacies was unpredictable in that period. The pharmacists accepted participation in the course, even though some of the sessions required a personal investment far from their normal routines and education. The pharmacists were, in general, very satisfied with the course and found it useful in their daily patient communication as it helped them to envision the life of each patient. As expected, no significant change was found in the JSE, but the pharmacists found the scale acceptable to complete.Conclusion and relevanceThe course in narrative medicine was feasible on all assessed parameters, even though the course capacity was not fully utilised. A course in narrative medicine has potential for improving pharmacists’ general communication with patients. Yet, the results should be tested in larger studies, including patient-reported outcomes, to provide distinct evidence on eventual effect.References and/or acknowledgementsConflict of interestNo conflict of interest