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Humoral and Cellular Immunogenicity of 3 Doses of BNT162b2 in Children With Kidney Diseases
Daniel Leung1, Eugene Yu-Hin Chan2, Xiaofeng Mu1
1Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China.
Insights
An accelerated 3-dose COVID-19 vaccine series is safe and effective for children and adolescents with kidney disease, generating significant antibody and T cell responses. This vaccination strategy offers crucial protection for this vulnerable population.
Area of Science:
- Pediatric Nephrology
- Vaccinology
- Immunology
Background:
- Children and adolescents with severe kidney diseases face increased risks from COVID-19.
- Limited data exists on the effectiveness of COVID-19 vaccines in pediatric kidney disease patients.
Purpose of the Study:
- To assess the immunogenicity and safety of an accelerated 3-dose BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine primary series in pediatric patients with chronic kidney disease (CKD).
Main Methods:
- A study involving 59 pediatric patients with CKD (mean age 12.9 years), including those with immunosuppression, dialysis, or kidney transplant.
- Administered an accelerated 3-dose BNT162b2 primary series, with age-appropriate dosing for children aged 5-11 and 11-18 years.
Main Results:
- Significant antibody responses, including spike receptor-binding domain (S-RBD) IgG and surrogate virus neutralization (sVNT), were observed post-vaccination.
- T cell responses were notable, though neutralization was weaker against Omicron BA.1 compared to the wild type.
- Immunosuppressed patients showed reduced neutralization, particularly those on multiple immunosuppressants or mycophenolate mofetil.
- Mild to moderate adverse reactions were reported, indicating a favorable safety profile.
Conclusions:
- An accelerated 3-dose BNT162b2 primary series is immunogenic and safe for children and adolescents with kidney diseases.
- The vaccine elicits robust immune responses, contributing to protection against severe COVID-19.
- Preserved T cell responses against Omicron BA.1 suggest continued protection in this population.
Introduction:
Patients with severe kidney diseases are at risk of complications from COVID-19; however, little is known about the effectiveness of COVID-19 vaccines in children and adolescents with kidney diseases.
Methods:
We investigated the immunogenicity and safety of an accelerated 3-dose primary series of COVID-19 vaccination among 59 pediatric patients with chronic kidney disease (CKD) (mean age 12.9 years; 30 male) with or without immunosuppression, dialysis, or kidney transplant. Dosage was 0.1 ml BNT162b2 to those aged 5 to 11 years, and 0.3 ml BNT162b2 to those aged 11 to 18 years.
Results:
Three doses of either vaccine type elicited significant antibody responses that included spike receptor-binding domain (S-RBD) IgG (90.5%-93.8% seropositive) and surrogate virus neutralization (geometric mean sVNT% level, 78.6%-79.3%). There were notable T cell responses. Weaker neutralization responses were observed among those on immunosuppression, especially those receiving higher number of immunosuppressants or on mycophenolate mofetil. Neutralization was reduced against Omicron BA.1 compared to wild type (WT, i.e., ancestral) (post-dose 3 sVNT% level; 82.7% vs. 27.4%; P < 0.0001). However, the T cell response against Omicron BA.1 was preserved, which likely confers protection against severe COVID-19. Infected patients exhibited hybrid immunity after vaccination, as evidenced by the higher Omicron BA.1 neutralization response among these infected patients who received 2 doses compared with those who were uninfected. Generally mild or moderate adverse reactions following vaccines were reported.
Conclusion:
An accelerated 3-dose primary series with BNT162b2 is immunogenic and safe in young children and adolescents with kidney diseases.
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