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COMPARISON OF INFECTION-INDUCED AND VACCINE-INDUCED IMMUNITY AGAINST CORONAVIRUS 2019 IN PATIENTS WITH CIRRHOSIS
Gastroenterology ; 162(7):S-1137, 2022.
Article in English | EMBASE | ID: covidwho-1967412
ABSTRACT
Background and

Aims:

Immunity to Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be either infection-induced or vaccine-induced. The duration of protective immunity following SARS-CoV-2 infection and how this compares with that from vaccination is presently unclear. Cirrhosis is associated with vaccine hyporesponsiveness to several vaccines include COVID-19 mRNA vaccines. The objective of our study was to compare infection-induced and vaccine-induced immunity against COVID-19 among patients with cirrhosis.

Methods:

This was a retrospective cohort study among patients with cirrhosis. Vaccine-induced immunity group was defined as participants with cirrhosis who were fully vaccinated with an mRNA vaccine and received the first dose of the mRNA vaccine between 12/18/2020 and 4/1/2021. Infection-induced immunity was defined as participants who had their first positive SARS-CoV-2 PCR in the same study period. The outcome was a positive SARS-CoV-2 PCR more than 60 days after previous infection or vaccination. Patients were followed until the outcome, death or the end of the study period (11/16/21). COVID-19 cases were classified based on individual chart review using the National Institute of Health (NIH) COVID-19 severity scale as asymptomatic, mild, moderate, severe or critical illness. The two groups were matched 13 using propensity score (PS) matching, with PS scores calculated based on variables associated with COVID-19 severity, including for the date of infection or first dose of vaccnation, and location, to account for variants. Cox proportional hazards models were fit from the immunity generating event to outcome (SARS-CoV-2PCR). Logistic regression models were also fit for the outcome (positive SARS-CoV-2 PCR) after the immunity generating event.

Results:

There were 443 participants in the infection-induced group, that were PS matched with 1,329 participants in the vaccine-induced group. The two groups were well matched after PS matching. On multivariable Cox hazard model, vaccine-induced immunity was associated with a 75% reduction in COVID-19 compared to infection-induced immunity (adjusted Hazard Ratio 0.25, 95% CI 0.15-0.43, p<0.0001). On multinomial logistic regression analysis, vaccine-induced immunity was associated with a 80% reduction in asymptomatic (adjusted Odds Ratio [aOR] 0.20, 95% CI 0.09-0.47, p-0.0002), 64% reduction in mild (aOR 0.36, 95% CI 0.13-0.97, p=0.048), and 79% reduction in severe or critical COVID-19 (aOR 0.21,95% CI 0.06-0.74, p=0.02) compared to infection-induced immunity. There were no observed differences between the two groups for moderate COVID-19 (aOR 0.31, 95% CI 0.06-1.56, p=0.16).

Conclusions:

In participants with cirrhosis, vaccine-induced immunity is associated with a significantly greater protection against COVID-19 compared to infection-induced immunity.[Figure Presented]
Keywords

Full text: Available Collection: Databases of international organizations Database: EMBASE Topics: Vaccines Language: English Journal: Gastroenterology Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Topics: Vaccines Language: English Journal: Gastroenterology Year: 2022 Document Type: Article