Efficacy of covid-19 vaccines in immunocompromised patients: systematic review and meta-analysis

BMJ, Journal Year: 2022, Volume and Issue: unknown, P. e068632 - e068632

Published: March 2, 2022

Abstract Objective To compare the efficacy of covid-19 vaccines between immunocompromised and immunocompetent people. Design Systematic review meta-analysis. Data sources PubMed, Embase, Central Register Controlled Trials, COVID-19 Open Research Dataset Challenge (CORD-19), WHO databases for studies published 1 December 2020 5 November 2021. ClinicalTrials.gov International Clinical Trials Registry Platform were searched in 2021 to identify registered but as yet unpublished or ongoing studies. Study selection Prospective observational comparing vaccination participants. Methods A frequentist random effects meta-analysis was used separately pool relative absolute risks seroconversion after first second doses a vaccine. without SARS-CoV-2 antibody titre levels performed first, second, third vaccine rate dose. Risk bias certainty evidence assessed. Results 82 included Of these studies, 77 (94%) mRNA vaccines, 16 (20%) viral vector 4 (5%) inactivated whole virus vaccines. 63 assessed be at low risk 19 moderate bias. After one dose, about half likely patients with haematological cancers (risk ratio 0.40, 95% confidence interval 0.32 0.50, I 2 =80%; 0.29, 0.20 =89%), immune mediated inflammatory disorders (0.53, 0.39 0.71, =89%; 0.11 0.58, =97%), solid (0.55, 0.46 0.65, =78%; 0.44, 0.36 0.53, =84%) compared controls, whereas organ transplant recipients times less seroconvert (0.06, 0.04 0.09, =0%; 0.06, 0.08, =0%). remained least (0.39, 0.46, =92%; 0.35, 0.26 0.46), only achieving seroconversion. Seroconversion increasingly (0.63, 0.57 0.69, =88%; 0.62, 0.54 0.70, =90%), (0.75, 0.69 0.82, 0.77, 0.66 0.85, =93%), (0.90, 0.88 0.93, =51%; 0.89, 0.86 0.91, =49%). similar people HIV controls (1.00, 0.98 1.01, 0.97, 0.83 1.00, =89%). 11 showed that dose associated among non-responders cancers, disorders, although response variable inadequately studied those receiving non-mRNA Conclusion rates significantly lower patients, especially recipients. consistently improved across all patient groups, albeit magnitude Targeted interventions including (booster) should performed. registration PROSPERO CRD42021272088.

Language: Английский

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Immunogenicity and Risk Factors Associated With Poor Humoral Immune Response of SARS-CoV-2 Vaccines in Recipients of Solid Organ Transplant

JAMA Network Open, Journal Year: 2022, Volume and Issue: 5(4), P. e226822 - e226822

Published: April 12, 2022

Importance

Recipients of solid organ transplant (SOT) experience decreased immunogenicity after COVID-19 vaccination.

Objective

To summarize current evidence on vaccine responses and identify risk factors for diminished humoral immune response in recipients SOT.

Data Sources

A literature search was conducted from existence database through December 15, 2021, using MEDLINE, Embase, Web Science, Cochrane Library, ClinicalTrials.gov.

Study Selection

Studies reporting the vaccines SOT were reviewed. Extraction Synthesis Two reviewers independently extracted data each eligible study. Descriptive statistics a random-effects model used. This report prepared following Preferred Reporting Items Systematic Reviews Meta-analyses (PRISMA) guideline. Data analyzed 2021 to February 2022.

Main Outcomes Measures

The total numbers positive percentage across platform recorded. Pooled odds ratios (pORs) with 95% CIs used calculate pooled effect estimates poor antibody response.

Results

83 studies included systematic review, 29 meta-analysis, representing 11 713 weighted mean (range) antispike antibodies receipt mRNA 10.4% (0%-37.9%) 1 dose, 44.9% (0%-79.1%) 2 doses, 63.1% (49.1%-69.1%) 3 doses. In studies, 50% no or minimal doses mounted an fourth dose. Among associated older age (mean [SE] difference between responders nonresponders, 3.94 [1.1] years), deceased donor status (pOR, 0.66 [95% CI, 0.53-0.83];I² = 0%), antimetabolite use 0.21 0.14-0.29];I² 70%), recent rituximab exposure 0.07-0.61];I² antithymocyte globulin 0.32 0.15-0.71];I² 0%).

Conclusions Relevance

this review rates remained low despite multiple vaccines. These findings suggest that more efforts are needed modulate reduced study monoclonal prophylaxis among who at high

Language: Английский

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Safety and antibody response to inactivated COVID‐19 vaccine in patients with chronic hepatitis B virus infection

Liver International, Journal Year: 2022, Volume and Issue: 42(6), P. 1287 - 1296

Published: Feb. 2, 2022

Abstract Background and Aims The safety antibody responses of coronavirus disease 2019 (COVID‐19) vaccination in patients with chronic hepatitis B (CHB) virus infection is still unclear, exploration COVID‐19 CHB significant clinical practice. Methods 362 adult 87 healthy controls at an interval least 21 days after a full‐course (21–105 days) were enrolled. Adverse events (AEs) collected by questionnaire. profiles 1, 2 3 months elucidated determination anti‐spike IgG, anti‐receptor‐binding domain (RBD) RBD‐angiotensin‐converting enzyme blocking antibody. SARS‐CoV‐2 specific cells also analysed. Results All AEs mild self‐limiting, the incidence was similar between controls. Seropositivity rates three antibodies months, but had lower titers 1 month. Compared to controls, HBeAg‐positive higher (all P < .05) slower decline titers. Frequency RBD‐specific positively correlated anti‐RBD IgG (OR = 1.067, .004), while liver cirrhosis, antiviral treatment, levels HBV DNA, alanine aminotransferase (ALT) aspartate (AST) total bilirubin (TB) not IgG. Conclusions Inactivated vaccines well tolerated, induced effective response against patients.

Language: Английский

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Immunogenicity of COVID-19 vaccines in solid organ transplant recipients: a systematic review and meta-analysis

Clinical Microbiology and Infection, Journal Year: 2022, Volume and Issue: 29(4), P. 441 - 456

Published: Dec. 9, 2022

BackgroundSolid organ transplant (SOT) recipients are at increased risks of morbidity and mortality associated with COVID-19.ObjectivesThis study aimed to evaluate the immunogenicity COVID-19 vaccines in SOT recipients.Data sourcesElectronic databases were searched for eligible reports published from 1 December 2019 31 May 2022.Study eligibility criteriaWe included evaluating humoral immune response (HIR) or cellular rate after administration vaccines.ParticipantsSOT who received vaccines.Assessment risk biasWe used Newcastle-Ottawa scale assess bias case-control cohort studies. For randomised-controlled trials, Jadad Scale was used.MethodsWe a random-effects model calculate pooled rates 95% CI. We ratio (RR) CI comparison responses between healthy controls.ResultsA total 91 involving 11 886 (lung: 655; heart: 539; liver: 1946; kidney: 8746) 2125 controls revealed HIR 1st, 2nd, 3rd vaccine doses 9.5% (95% CI, 7–11.9%), 43.6% 39.3–47.8%) 55.1% 44.7–65.6%), respectively. specific organs, still low 1st dose 4.4%; 9.4%; 13.2%; 29.5%) 2nd 28.4%; 37.6%; 50.3%; 64.5%).ConclusionsA booster vaccination enhances SOT; however, significant share has not built detectable receiving dose. This finding calls alternative approaches, including use monoclonal antibodies. In addition, lung need urgent improve response.

Language: Английский

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COVID-19-associated liver injury: Clinical characteristics, pathophysiological mechanisms and treatment management

Biomedicine & Pharmacotherapy, Journal Year: 2022, Volume and Issue: 154, P. 113568 - 113568

Published: Aug. 17, 2022

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has become a global epidemic and poses major threat to public health. In addition COVID-19 manifesting as disease, patients with also have complications in extrapulmonary organs, including liver damage. Abnormal function is relatively common patients; its clinical manifestations can range from an asymptomatic elevation of enzymes decompensated hepatic function, injury more prevalent critical patients. Liver comprehensive effect mediated multiple factors, damage directly SARS-CoV-2, drug-induced damage, hypoxia reperfusion dysfunction, immune stress inflammatory factor storms. Patients chronic (especially alcohol-related nonalcoholic fatty cirrhosis hepatocellular carcinoma) are at increased risk death after infection aggravates disease. This article reviews the latest SARS-CoV-2 reports, focusing on underlying mechanism, expounds risk, treatment vaccine safety transplantation.

Language: Английский

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A third dose of the BNT162b2 mRNA vaccine significantly improves immune responses among liver transplant recipients

Journal of Hepatology, Journal Year: 2022, Volume and Issue: 77(3), P. 702 - 709

Published: April 19, 2022

Language: Английский

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Patients with Liver Cirrhosis Show High Immunogenicity upon COVID-19 Vaccination but Develop Premature Deterioration of Antibody Titers

Vaccines, Journal Year: 2022, Volume and Issue: 10(3), P. 377 - 377

Published: Feb. 28, 2022

SARS-CoV-2 infection is known to lead severe morbidity and mortality in patients with liver cirrhosis. For this reason, vaccination of these against COVID-19 widely recommended. However, data regarding immunogenicity cirrhosis limited even less about the kinetics antibody response, as well optimal timing booster immunization. We analyzed 110 after receiving two doses mRNA-based vaccine BNT162b2 following standard protocol compared results a control group consisting 80 healthcare workers. One hundred six (96%) developed antibodies SARS-CoV-2, 79 (99%) (p = 0.400). Still, median IgG titer was significantly lower (939 vs. 1905 BAU/mL, p 0.0001). also strength response relation time between second dose detection. Antibody titers remained relatively stable while showing rapid significant decrease In conclusion, our reveals favorable initial outcome cirrhotic but show deterioration time, thereby giving strong hint towards importance early immunization for patients.

Language: Английский

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Advancements in Vaccine Strategies for Chronic Liver Disease Patients: Navigating Post-COVID Challenges and Opportunities

Vaccines, Journal Year: 2024, Volume and Issue: 12(2), P. 197 - 197

Published: Feb. 15, 2024

This review addresses the vital role of vaccinations in managing patients with chronic liver disease (CLD), especially context post-COVID-19 landscape. The pandemic has highlighted unique vulnerabilities CLD patients, including those awaiting transplantation and post-transplant individuals, who face heightened risks infection due to compromised immune responses. Recent advancements vaccine technology, such as mRNA platforms, novel adjuvants, advanced delivery systems, have significantly accelerated development, enhancing both speed efficacy. Moreover, emergence personalized vaccines, tailored everyone’s immunological profile, presents new opportunities, particularly for conditions. synthesizes current state evidence regarding recommendations focusing on their response proposing effective strategies protect this vulnerable group from vaccine-preventable diseases. It also explores challenges implementing these considers impact emerging systems improving outcomes patients. paper aims provide nuanced guidance vaccination rapidly evolving healthcare landscape, addressing technological innovations comprehensive patient care strategies.

Language: Английский

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Coordinated cellular and humoral immune responses after two‐dose SARS‐CoV2 mRNA vaccination in liver transplant recipients

Liver International, Journal Year: 2021, Volume and Issue: 42(1), P. 180 - 186

Published: Oct. 31, 2021

Limited data are available on risks and benefits of anti-SARS-CoV2 vaccination in solid organ transplant recipients, weaker responses have been described. At the Italian National Institute for Infectious Diseases, 61 liver recipients underwent testing to describe dynamics humoral cell-mediated immune response after two doses mRNA vaccines compared with 51 healthy controls. Humoral was measured by quantifying both anti-spike neutralizing antibodies; PBMC proliferation assay IFN-γ IL-2 production. Liver showed lower rates controls cellular arms; shorter time since transplantation multi-drug immunosuppressive regimen containing mycophenolate mofetil were predictive reduced vaccination. Specific antibody cytokine production, though reduced, highly correlated recipients.

Language: Английский

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Involvement of the Liver in COVID-19: A Systematic Review

American Journal of Tropical Medicine and Hygiene, Journal Year: 2022, Volume and Issue: 106(4), P. 1026 - 1041

Published: Feb. 24, 2022

ABSTRACT. COVID-19, a respiratory viral infection, has affected 388 million individuals worldwide as of the February 4, 2022. In this review, we have outlined important liver manifestations COVID-19 and discussed possible underlying pathophysiological mechanisms their diagnosis management. Factors that may contribute to hepatic involvement in include direct cytopathic effects, exaggerated immune responses/systemic inflammatory response syndrome, hypoxia-induced changes, vascular changes due coagulopathy, endothelitis, cardiac congestion from right heart failure, drug-induced injury. The majority COVID-19-associated symptoms are mild self-limiting. Thus management is generally supportive. Liver function tests abdominal imaging primary investigations done relation patients. However, findings nonspecific. Severe acute syndrome coronavirus 2 RNA been found biopsies. there limited place for biopsy clinical context, it does not influence Although, supportive patients without previous disease, special emphasis needed those with nonalcoholic fatty cirrhosis, hepatocellular carcinoma, hepatitis B C infections, alcoholic transplant recipients.

Language: Английский

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