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Abstract: SA-OR08

Vaccine Effectiveness of One, Two, or Three Doses of SARS-CoV-2 mRNA Vaccines in Maintenance Dialysis Patients

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Manley, Harold J., Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Li, Nien Chen, Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Harford, Antonia, Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Frament, Jill M., Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Mcnamara, Margaret, Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Aweh, Gideon N., Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Majchrzak, Karen M., Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Miskulin, Dana, Tufts Medical Center, Boston, Massachusetts, United States
  • Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
  • Hsu, Caroline M., Tufts Medical Center, Boston, Massachusetts, United States
  • Johnson, Doug, Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Lacson, Eduardo K., Dialysis Clinic Inc, Nashville, Tennessee, United States
Background

Preventing COVID-19 infection or its consequences through SARS-CoV-2 vaccination in maintenance dialysis patients, a high risk population, is imperative. We determined relative vaccine effectiveness (VE) of 1, 2, or 3 doses of an mRNA vaccine in preventing SARS-CoV-2 infection, hospitalization, and death.

Methods

All adult maintenance dialysis patients at Dialysis Clinic, Inc. offered an mRNA vaccine between 12/15/20 and 2/28/22 were included, with follow up time through 3/31/22. Using a multivariable logistic regression model, we calculated adjusted odds ratios (OR) for COVID-19 infection and associated hospitalization and death within 30 days during pre-Delta (12/15/20-6/19/21), Delta (6/20-12/18/21) and Omicron (12/19/21-2/28/22) periods. VE was calculated as (1-adjusted OR) x 100%. Patients were censored at infection, death, or transplantation.

Results

The 17,309 maintenance dialysis patients included had mean age of 63±15 years, 58% male, 35% Black, 47% White, 87% HD and mean vintage 42±55 months. Across all three COVID-19 variant periods, VE increased with each successive mRNA dose received, improving protection against infection, hospitalization and death (Table). VE was highest among patients vaccinated with homologous mRNA-1273 regimens.

Conclusion

Two or more SARS-CoV-2 mRNA vaccine doses exhibited VE protecting against COVID-19 related associated hospitalization and death in maintenance dialysis patients irrespective of variant era. At least 3 doses maximizes protection and may be necessary due to uremia-related mild to moderate immunodeficiency.

SARS-CoV-2 mRNA vaccine effectiveness
Period# mRNA doses# PatientsVaccine Effectiveness, %
(95% Confidence Interval)
InfectionHospitalizationDeath
Pre-DeltaUnvaccinated3,651Ref
One dose544NRNR78 (39, 92)
Two doses9,44159 (52, 65)70 (61, 77)99 (97, 100)
Delta DominantUnvaccinated2,572Ref
One dose384NRNRNR
Two doses4,81624 (12, 33)44 (29, 56)
64 (47, 76)
Three doses5,78361 (55, 67)76 (69, 82)97 (92, 99)
Omicron DominantUnvaccinated2,415Ref
One dose390NRNRNR
Two doses3,771NR40 (18, 55)64 (34, 81)
Three doses6,89633 (22, 42)66 (54, 75)93 (83, 97)

Ref = reference group; NR = not reported as effect and/or confidence interval crosses zero