Abstract: SA-OR08
Vaccine Effectiveness of One, Two, or Three Doses of SARS-CoV-2 mRNA Vaccines in Maintenance Dialysis Patients
Session Information
- COVID-19 and Kidney Diseases: Mechanisms and Management
November 05, 2022 | Location: W230, Orange County Convention Center‚ West Building
Abstract Time: 05:33 PM - 05:42 PM
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 | # Patients | Vaccine Effectiveness, % (95% Confidence Interval) | ||
| Infection | Hospitalization | Death | |||
| Pre-Delta | Unvaccinated | 3,651 | Ref | ||
| One dose | 544 | NR | NR | 78 (39, 92) | |
| Two doses | 9,441 | 59 (52, 65) | 70 (61, 77) | 99 (97, 100) | |
| Delta Dominant | Unvaccinated | 2,572 | Ref | ||
| One dose | 384 | NR | NR | NR | |
| Two doses | 4,816 | 24 (12, 33) | 44 (29, 56) | 64 (47, 76) | |
| Three doses | 5,783 | 61 (55, 67) | 76 (69, 82) | 97 (92, 99) | |
| Omicron Dominant | Unvaccinated | 2,415 | Ref | ||
| One dose | 390 | NR | NR | NR | |
| Two doses | 3,771 | NR | 40 (18, 55) | 64 (34, 81) | |
| Three doses | 6,896 | 33 (22, 42) | 66 (54, 75) | 93 (83, 97) | |
Ref = reference group; NR = not reported as effect and/or confidence interval crosses zero