Abstract: PO0146
No Antibody Response to Viral Vector SARS-CoV-2 Vaccine but Subsequent Conversion After COVID-19 Infection in an ESKD Patient
Session Information
- COVID-19: Vaccines, Diagnosis, and Treatment
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Chhibar, Ruchika, University of California Davis School of Medicine, Sacramento, California, United States
- Madan, Niti, University of California Davis School of Medicine, Sacramento, California, United States
- Chin, Andrew I., University of California Davis School of Medicine, Sacramento, California, United States
Group or Team Name
- UC Davis,Division of Nephrology
Introduction
ESKD patients generally have low response rate to vaccines. Early data suggests that viral vector SARS-CoV-19 vaccine is less effective than its mRNA counterparts. This case illustrates AB non-response to a viral vector based SARS-CoV-19 vaccine (Janssen) with subsequent AB response to mild clinical COVID-19 in an ESKD patient.
Case Description
84 year old male on HD for 12 years. He had a prior response to the Hepatitis B vaccine with a recent titer >10 IU/L. SARS-CoV-19 AB (IgG AB to the spike protein) was being checked monthly as part of an observational cohort. SARS-CoV-19 AB was (-) 1 month prior to receiving a viral vector-based vaccine. The AB was rechecked 1 month after the vaccine and remained (-). He was soon after admitted for GI bleed and tested positive for COVID-19 by PCR nasal swab on routine hospital screening. On discharge, he was asymptomatic but was hypoxemic requiring oxygen. 17 days after hospital discharge, SARS-CoV-19 by nasal PCR remained positive and AB titer was detectable at 1.3 U/L. Both were checked again 1 week later, viral PCR remained (-) with further increase in AB to 2.3 U/L. A titer of >2.0 U/L has been reported as protective. He was no longer hypoxemic by that time.
Discussion
SARS-CoV-19 AB was measured longitudinally in this elderly HD patient. AB titer to the spike protein was negative 4 weeks after receiving a viral vector-based SARS-CoV-19 vaccine. He was relatively immunocompetent based on prior AB response to Hepatitis B vaccination. He became SARS-CoV-19 AB (+) 2.5 weeks after mild COVID-19 infection. Most studies on SARS-CoV-19 vaccination in ESKD have focused on mRNA vaccines, which show a reasonably high AB conversion rate after the second injection. We do not know if lack of detectable spike protein AB after vaccination necessarily precludes resistance to infection, nor do we know if this patient’s eventual seroconversion was due only to his COVID-19 infection or simply a slow response to the vaccine. There is evidence in the general public that efficacy of the viral vector-based SARS-CoV-19 vaccine may be lower than that of mRNA vaccines. With ESKD patients more susceptible to infection and less able to mount AB’s to vaccines, this case supports the use of mRNA SARS-CoV-19 vaccines preferentially in the ESKD population if AB seroconversion is the targeted intermediary outcome.