Serial SARS-CoV-2 antibody titers in vaccinated dialysis patients: prevalence of unrecognized infection and duration of seroresponse
Abstract Rationale & Objective SARS-CoV-2 infections are likely underdiagnosed, but the degree of underdiagnosis among maintenance dialysis patients is unknown. Durability of the immune response after third vaccine doses in this population also remains uncertain. This study tracked antibody levels to 1) assess the rate of undiagnosed infections and 2) characterize seroresponse durability after third doses.Study Design Retrospective observational studySetting & Participants SARS-CoV-2 vaccinated patients receiving maintenance dialysis through a national dialysis provider. Immunoglobulin G spike antibodies (anti-spike IgG) titers were assessed monthly following vaccination.Exposure(s) Two and three doses of SARS-CoV-2 vaccineOutcome(s) Undiagnosed and diagnosed SARS-CoV-2 infections; anti-spike IgG titers over timeAnalytical Approach “Undiagnosed” SARS-CoV-2 infections were identified as an increase in anti-spike IgG titer of ≥ 100 BAU/mL, not associated with receipt of vaccine or “diagnosed” SARS-CoV-2 infection (by PCR or antigen test). In descriptive analyses, anti-spike IgG titers were followed over time.Results Among 2660 patients without prior COVID-19 who received an initial two-dose vaccine series, 371 (76%) SARS-CoV-2 infections were diagnosed and 115 (24%) were undiagnosed. Among 1717 patients without prior COVID-19 who received a third vaccine dose, 155 (80%) SARS-CoV-2 infections were diagnosed and 39 (20%) were undiagnosed. In both cohorts, anti-spike IgG levels declined over time. Of the initial two-dose cohort, 66% had a titer ≥ 500 BAU/mL in the first month, with 23% maintaining a titer ≥ 500 BAU/mL at six months. Of the third dose cohort, 95% had a titer ≥ 500 BAU/mL in the first month after the third dose, with 76% maintaining a titer ≥ 500 BAU/mL at six months.Limitations Assays used had upper limits.Conclusions Among maintenance dialysis patients, 20-24% of SARS-CoV-2 infections were undiagnosed. Given this population’s vulnerability to COVID-19, ongoing infection control measures are needed. A three-dose primary mRNA vaccine series optimizes seroresponse rate and durability..
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Preprint| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
bioRxiv.org - (2024) vom: 23. Apr. Zur Gesamtaufnahme - year:2024 |
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| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hsu, Caroline M. [VerfasserIn] |
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| doi: |
10.1101/2023.03.16.23287322 |
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| PPN (Katalog-ID): |
XBI038997398 |
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| 245 | 1 | 0 | |a Serial SARS-CoV-2 antibody titers in vaccinated dialysis patients: prevalence of unrecognized infection and duration of seroresponse |
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| 520 | |a Abstract Rationale & Objective SARS-CoV-2 infections are likely underdiagnosed, but the degree of underdiagnosis among maintenance dialysis patients is unknown. Durability of the immune response after third vaccine doses in this population also remains uncertain. This study tracked antibody levels to 1) assess the rate of undiagnosed infections and 2) characterize seroresponse durability after third doses.Study Design Retrospective observational studySetting & Participants SARS-CoV-2 vaccinated patients receiving maintenance dialysis through a national dialysis provider. Immunoglobulin G spike antibodies (anti-spike IgG) titers were assessed monthly following vaccination.Exposure(s) Two and three doses of SARS-CoV-2 vaccineOutcome(s) Undiagnosed and diagnosed SARS-CoV-2 infections; anti-spike IgG titers over timeAnalytical Approach “Undiagnosed” SARS-CoV-2 infections were identified as an increase in anti-spike IgG titer of ≥ 100 BAU/mL, not associated with receipt of vaccine or “diagnosed” SARS-CoV-2 infection (by PCR or antigen test). In descriptive analyses, anti-spike IgG titers were followed over time.Results Among 2660 patients without prior COVID-19 who received an initial two-dose vaccine series, 371 (76%) SARS-CoV-2 infections were diagnosed and 115 (24%) were undiagnosed. Among 1717 patients without prior COVID-19 who received a third vaccine dose, 155 (80%) SARS-CoV-2 infections were diagnosed and 39 (20%) were undiagnosed. In both cohorts, anti-spike IgG levels declined over time. Of the initial two-dose cohort, 66% had a titer ≥ 500 BAU/mL in the first month, with 23% maintaining a titer ≥ 500 BAU/mL at six months. Of the third dose cohort, 95% had a titer ≥ 500 BAU/mL in the first month after the third dose, with 76% maintaining a titer ≥ 500 BAU/mL at six months.Limitations Assays used had upper limits.Conclusions Among maintenance dialysis patients, 20-24% of SARS-CoV-2 infections were undiagnosed. Given this population’s vulnerability to COVID-19, ongoing infection control measures are needed. A three-dose primary mRNA vaccine series optimizes seroresponse rate and durability. | ||
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| 700 | 1 | |a Weiner, Daniel E. |e verfasserin |4 aut | |
| 700 | 1 | |a Manley, Harold J. |e verfasserin |4 aut | |
| 700 | 1 | |a Miskulin, Dana |e verfasserin |4 aut | |
| 700 | 1 | |a Ladik, Vladimir |e verfasserin |4 aut | |
| 700 | 1 | |a Frament, Jill |e verfasserin |4 aut | |
| 700 | 1 | |a Argyropoulos, Christos |e verfasserin |4 aut | |
| 700 | 1 | |a Abreo, Kenneth |e verfasserin |4 aut | |
| 700 | 1 | |a Chin, Andrew |e verfasserin |4 aut | |
| 700 | 1 | |a Gladish, Reginald |e verfasserin |4 aut | |
| 700 | 1 | |a Salman, Loay |e verfasserin |4 aut | |
| 700 | 1 | |a Johnson, Doug |e verfasserin |4 aut | |
| 700 | 1 | |a Lacson, Eduardo K. |e verfasserin |4 aut | |
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