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Humoral response and breakthrough infections with SARS-CoV-2 B.1.617.2 variant in vaccinated maintenance hemodialysis patients.
Wand, Ori; Nacasch, Naomi; Fadeela, Ayman; Shashar, Moshe; Grupper, Ayelet; Benchetrit, Sydney; Erez, Daniel; Shitrit, Pnina; Cohen-Hagai, Keren.
  • Wand O; Department of Pulmonology, Meir Medical Center, Kfar Saba, Israel.
  • Nacasch N; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Fadeela A; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Shashar M; Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.
  • Grupper A; Corona and Respiratory Viruses Laboratory, Meir Medical Center, Kfar Saba, Israel.
  • Benchetrit S; Department of Nephrology and Hypertension, Laniado Hospital, Netanya, Israel.
  • Erez D; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
  • Shitrit P; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Cohen-Hagai K; Department of Nephrology and Hypertension, Tel Aviv Sourasky Medical Center Tel Aviv, Tel Aviv, Israel.
J Nephrol ; 35(5): 1479-1487, 2022 06.
Article in English | MEDLINE | ID: covidwho-1899388
ABSTRACT

INTRODUCTION:

Breakthrough COVID-19 may occur in vaccinated people, and may result from declining vaccine effectiveness or highly transmittable SARS-CoV-2 variants, such as the B.167.2 (delta) variant. We investigated risk factors and outcomes for infection with the delta variant among vaccinated hemodialysis patients.

METHODS:

Patients on maintenance hemodialysis who received two doses of the BNT162b2 (Pfizer-BioNTech) vaccine were analysed according to having developed COVID-19 (study group) or not (control group), in a retrospective, observational, comparative study. We compared risk-factors for developing breakthrough COVID-19 and assessed clinical outcomes, including 30-day mortality rates.

RESULTS:

Twenty-four cases of breakthrough SARS-CoV-2 infection were compared to 91 controls without infection. Breakthrough infection was associated with chronic immunosuppressive treatment, hematological malignancies, and low antibody levels against SARS-CoV-2 spike protein. All COVID-19 cases occurred at least 5 months after vaccination, and most were caused by the B.1.617.2 variant (at least 23/24 cases). COVID-19 was categorized as severe or critical disease in 11/24 patients (46%), and 54% required hospitalization and COVID-19-directed treatment. The source of infection was nosocomial in 6/24 cases (25%), and healthcare-related in 3/24 (12.5%). Mortality rate was 21%. Overall mortality was significantly higher in patients who developed COVID-19 than in controls (odds ratio for all-cause mortality 7.6, 95% CI 1.4-41, p = 0.002).

CONCLUSIONS:

Breakthrough COVID-19 with the B.1.617.2 variant can occur in vaccinated hemodialysis patients and is associated with immunosuppression and weaker humoral response to vaccination. Infections may be nosocomial and result in significant morbidity and mortality.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Viral Vaccines / Cross Infection / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Vaccines / Variants Limits: Humans Language: English Journal: J Nephrol Journal subject: Nephrology Year: 2022 Document Type: Article Affiliation country: S40620-022-01245-9

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Viral Vaccines / Cross Infection / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Vaccines / Variants Limits: Humans Language: English Journal: J Nephrol Journal subject: Nephrology Year: 2022 Document Type: Article Affiliation country: S40620-022-01245-9