Longitudinal SARS-CoV-2 neutralization of Omicron BA.1, BA.5 and BQ.1.1 after four vaccinations and the impact of breakthrough infections in haemodialysis patients

Louise Platen; Bo-Hung Liao; Myriam Tellenbach; Cho-Chin Cheng; Christopher Holzmann-Littig; Catharina Christa; Christopher Dächert; Verena Kappler; Romina Bester; Maia Lucia Werz; Emely Schönhals; Eva Platen; Peter Eggerer; Laëtitia Tréguer; Claudius Küchle; Christoph Schmaderer; Uwe Heemann; Oliver T Keppler; Lutz Renders; Matthias Christoph Braunisch; Ulrike Protzer

doi:10.1093/ckj/sfad147

Longitudinal SARS-CoV-2 neutralization of Omicron BA.1, BA.5 and BQ.1.1 after four vaccinations and the impact of breakthrough infections in haemodialysis patients

Clin Kidney J. 2023 Jun 24;16(12):2447-2460. doi: 10.1093/ckj/sfad147. eCollection 2023 Dec.

Authors

Louise Platen¹, Bo-Hung Liao², Myriam Tellenbach¹, Cho-Chin Cheng², Christopher Holzmann-Littig^{2

3}, Catharina Christa², Christopher Dächert⁴, Verena Kappler¹, Romina Bester², Maia Lucia Werz¹, Emely Schönhals¹, Eva Platen⁵, Peter Eggerer⁶, Laëtitia Tréguer⁷, Claudius Küchle¹, Christoph Schmaderer¹, Uwe Heemann^{1

7}, Oliver T Keppler^{4

7}, Lutz Renders^{1

8}, Matthias Christoph Braunisch¹, Ulrike Protzer^{2

7

9}

Affiliations

¹ Department of Nephrology, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.
² Institute of Virology, Technical University of Munich, School of Medicine, Munich, Germany.
³ TUM Medical Education Center, Technical University of Munich, School of Medicine, Munich, Germany.
⁴ Max von Pettenkofer Institute & Gene Center, Virology, Ludwig Maximilian University of Munich, Munich, Germany.
⁵ Kidney Center Eifel Dialyse, Mechernich, Germany.
⁶ KfH Kidney Center Harlaching, Munich-Harlaching, Germany.
⁷ German Center for Infection Research (DZIF), Partner Site, Munich, Germany.
⁸ KfH Kidney Center, Traunstein, Germany.
⁹ Institute of Virology, Helmholtz Munich, Munich, Germany.

Abstract

Background: Individuals on haemodialysis (HD) are more vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than the general population due to end-stage kidney disease-induced immunosuppression.

Methods: A total of 26 HD patients experiencing SARS-CoV-2 infection after a third vaccination were matched 1:1 with 26 of 92 SARS-CoV-2-naïve patients by age, sex, dialysis vintage and immunosuppressive drugs receiving a fourth vaccination with a messenger RNA-based vaccine. A competitive surrogate neutralization assay was used to monitor vaccination success. To determine infection neutralization titres, Vero-E6 cells were infected with SARS-CoV-2 variants of concern (VoCs), Omicron sublineage BA.1, BA.5 and BQ.1.1. The 50% inhibitory concentration (IC50, serum dilution factor 1:x) was determined before, 4 weeks after and 6 months after the fourth vaccination.

Results: A total of 52 HD patients received four coronavirus disease 2019 (COVID-19) vaccinations and were followed up for a median of 6.3 months. Patient characteristics did not differ between the matched cohorts. Patients without a SARS-CoV-2 infection had a significant reduction of real virus neutralization capacity for all Omicron sublineages after 6 months (P < .001 each). Those patients with a virus infection did not experience a reduction in real virus neutralization capacity after 6 months. Compared with the other Omicron VoC, the BQ.1.1 sublineage had the lowest virus neutralization capacity.

Conclusions: SARS-CoV-2-naïve HD patients had significantly decreased virus neutralization capacity 6 months after the fourth vaccination, whereas patients with a SARS-CoV-2 infection had no change in neutralization capacity. This was independent of age, sex, dialysis vintage and immunosuppression. Therefore, in infection-naïve HD patients a fifth COVID-19 vaccination might be reasonable 6 months after the fourth vaccination.

Keywords: BA.1; BA.5; BQ.1.1; COVID-19 vaccination; haemodialysis.