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Cheng, C.C.* ; Platen, L.* ; Christa, C.* ; Tellenbach, M.* ; Kappler, V.* ; Bester, R.* ; Liao, B.H.* ; Holzmann-Littig, C.* ; Werz, M.* ; Schönhals, E.* ; Platen, E.* ; Eggerer, P.* ; Tréguer, L.* ; Küchle, C.* ; Schmaderer, C.* ; Heemann, U.* ; Renders, L.* ; Protzer, U. ; Braunisch, M.C.*

Improved SARS-CoV-2 neutralization of delta and omicron BA.1 variants of concern after fourth vaccination in hemodialysis patients.

Vaccines 10:1328 (2022)

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Hemodialysis patients are exposed to a markedly increased risk when infected with SARS-CoV-2. To date, it is unclear if hemodialysis patients benefit from four vaccinations. A total of 142 hemodialysis patients received four COVID-19 vaccinations until March 2022. RDB binding antibody titers were determined in a competitive surrogate neutralization assay. Vero-E6 cells were infected with SARS-CoV-2 variants of concern (VoC), Delta (B.1.617.2), or Omicron (B.1.1.529, sub-lineage BA.1) to determine serum infection neutralization capacity. Four weeks after the fourth vaccination, serum infection neutralization capacity significantly increased from a 50% inhibitory concentration (IC50, serum dilution factor 1:x) of 247.0 (46.3-1560.8) to 2560.0 (1174.0-2560.0) for the Delta VoC, and from 37.5 (20.0-198.8) to 668.5 (182.2-2560.0) for the Omicron VoC (each p < 0.001) compared to four months after the third vaccination. A significant increase in the neutralization capacity was even observed for patients with high antibody titers after three vaccinations (p < 0.001). Ten patients with SARS-CoV-2 breakthrough infection after the first blood sampling had by trend lower prior neutralization capacity for Omicron (p = 0.051). Our findings suggest that hemodialysis patients benefit from a fourth vaccination in particular in the light of the highly infectious SARS-CoV-2 Omicron-variants. A routinely applied four-time vaccination seems to broaden immunity against variants and would be recommended in hemodialysis patients.

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