ABSTRACT
Background. Pediatric kidney transplant recipients (PKTR) are at risk of poor outcomes from COVID-19. Data on serologic responses to COVID-19 vaccines in PKTR remain sparse. We characterized the magnitude, breadth, and longevity of SARS-CoV-2 spike protein binding antibody responses in PKTR. Methods. This single institution, prospective observational study enrolled PKTR presenting to a transplant clinic for routine care who had received or were eligible to receive a COVID-19 vaccine. Demographic data, history of prior COVID-19, and vaccination details were collected. Plasma samples obtained from standard-of-care residual specimens were analyzed for SARS-CoV-2 spike variant IgG using the MesoScale Discovery V-PLEX platform, which quantitatively measures antibodies to SARS-CoV-2 full-length spike wild-type (Wuhan-hu-1), Alpha (B.1.1.7), Beta (B.1.351), Delta (B.1.617.2), Gamma (P.1), and Omicron (B.1.1.529;BA.1) variants. Vaccine time points with > 5 samples available were analyzed. Geometric mean titers (GMTs) were calculated and log-transformed titers were compared using one-way ANOVA with Tukey's post-hoc comparisons test. Results. 61 PKTR enrolled (Table1);47 (77%) received at least 1 dose of COVID-19 vaccine in transplant clinic. 47 (77%) PKTR had at least one sample available for analysis, but serial specimens were lacking for many. By 6 months post-dose 2 of COVID-19 mRNA vaccination, spike (Wuhan-hu-1) IgG titers had waned to prevaccination levels (GMT 24 vs 47 binding antibody units (BAU)/mL, P=0.988). Administration of a 3rd dose of mRNA vaccine significantly boosted IgG antibodies (GMT 492 BAU/mL, P=0.007), and titers were maintained at 3 months (GMT 656 BAU/mL, P=0.001) but gradually waned by 6 months (GMT 223 BAU/mL, P=0.070). Administration of a 4th dose elicited a non-significant increase in titers (GMT 905 BAU/mL, P=0.870). Binding IgG antibodies to SARS-CoV-2 variant spike proteins post-vaccination were not significantly different from Wuhan spike. Conclusion. In this cohort of PKTR, a 3rd dose of COVID-19 mRNA vaccine significantly boosted broadly cross-reactive binding IgG antibodies to SARS-CoV-2 spike variants, including Omicron. Decreasing titers at 6 months post-dose 3 raise concern for waning protective immunity and support 4th dose vaccination.
ABSTRACT
Background The pediatric population is at high risk of morbidity and mortality from influenza, yet pediatric influenza vaccination rates remain <50% in the United States. The National Vaccine Advisory Committee recommends administration of indicated vaccines during every health care encounter, including acute care visits. Many children miss these outpatient opportunities for immunizations as they utilize the pediatric emergency department (PED) for acute care visits. PEDs that implement and monitor a systematic approach to provide the influenza vaccine can decrease vaccine-preventable mortality and morbidity from influenza. There are limited studies evaluating influenza vaccination administration to patients discharged from the PED. Aim Statement Utilize a user-centered design clinical decision support (CDS) intervention to identify and facilitate the administration of influenza vaccine in at least 20% of eligible patients during a 9-week trial in the PED fast track (FT) area. Methodology This is a single-center study of a metropolitan free-standing Level-1 trauma center with approximately 80,000 visits annually. Utilizing an Emergency Severity Index (ESI), patients with low illness severity on arrival are directed to FT for evaluation. FT has approximately 16,000 patient encounters/year with highest volumes in winter. To determine feasibility of providing influenza vaccination in the PED, the trial was performed in FT. We conducted a 9-week trial offering the influenza vaccine to eligible patients in FT regardless of their chief complaint. We utilized a CDS intervention that identified influenza vaccination eligible FT patients based on the following criteria: >6 months old, no prior documented influenza vaccine for the current season in our health system or the state immunization registry, and no history of anaphylaxis to a prior influenza vaccine. A Best Practice Advisory (BPA) was triggered for eligible patients and the provider ordered the vaccine. Manufacturer, lot number, and expiration were entered at the bedside and automatically integrated into the medical record and the state immunization database. The rate of influenza vaccination of eligible patients treated in FT was measured by the number of vaccines administered and identification of eligible patients was tracked via the CDS activation of the BPA. Discussion Results Twenty percent (3,385/16,666) of the yearly FT volume was seen during the intervention period from 12/1/2019- 2/1/2020;87% (2,966/3,385) were eligible for the influenza vaccine and 22% (649/2,966) of eligible patients agreed to vaccination. Institutional challenges included developing a bedside platform to enter vaccine data and placement of vaccine supply close to FT while maintaining FT operational metrics. Conclusion The PED offers a unique opportunity to increase influenza vaccination rates in children who represent an undervaccinated population. PED vaccination is feasible, and may be even more relevant during a COVID-19 pandemic. Utilizing a CDS intervention can help identify eligible patients to vaccinate against influenza and promote vaccine administration.