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Abstract: PO0143

Rapid Decline in Antibody Levels After Initial High Response in ESKD Patients Vaccinated with mRNA COVID-19 Vaccines

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Mulhern, Jeffrey, Baystate Medical Center, Springfield, Massachusetts, United States
  • Ficociello, Linda, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Willetts, Joanna, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Dahne-Steuber, Ines, Spectra Laboratories, Milpitas, California, United States
  • Mullon, Claudy, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Delisi, Josephine, Spectra Laboratories, Milpitas, California, United States
  • Johnson, Curtis D., Spectra Laboratories, Milpitas, California, United States
  • Mysayphonh, Chance, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Kossmann, Robert J., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Anger, Michael S., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Hymes, Jeffrey L., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
Background

Vaccine unresponsiveness and rapid AB level decline after successful vaccination have been barriers to antiviral strategies in ESKD populations. We report an interim analysis of a quality improvement project characterizing the temporal AB response to COVID-19 vaccination across 7 dialysis clinics in MA.

Methods

Chronic dialysis pts received 2 doses of mRNA vaccine at prescribed intervals. AB response was measured in remnant blood with semiquantitative chemiluminescent assay detecting IgG AB directed against receptor binding domain of S1 subunit of SARS-CoV-2 spike antigen (Siemens); AB index >1 was considered reactive. AB index >7 produce plaque reduction neutralization test (PRNT50) titers >1:80 dilution recommended by FDA standard for measuring neutralizing titer.

Results

211 pts received the 2-dose mRNA vaccine (mRNA-1273, 1 given BNT162b2). On average (ave) AB peaked at day 19 post 2nd vaccine; peak index was >7 for 97% of pts. Pts with AB peak >7 had higher serum albumin vs pts with AB peak ≤ 7 (3.8 vs 3.4 g/dl). Among pts with AB measured after peak AB index (n=188), ave AB index decreased by 125 (46% reduction) over an ave 46 days. Ave decreases from peak were 51% in pts with no prior COVID-19 history (n=162) and 20% in pts with COVID-19 history (n=26); illustrated in subset with >5 AB measurements > 45 days post 2nd vaccine dose (n=114, Figure). No symptomatic COVID-19 cases were reported.

Conclusion

mRNA-1273 is a highly reactive vaccine producing reactive AB in all, and >7 index in 97% of vaccinated ESKD pts. However, if AB index confers immunity, blunted and rapid decline of circulating AB may place ESKD pts at risk of future COVID-19 infection. Monitoring post-vaccination AB levels may be important for ESKD pts (especially hypoalbuminemic pts) and may guide future vaccination requirements.

Funding

  • Commercial Support –