COVID-19 vaccine protection ‘lower and slower’ in patients with cirrhosis
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Protection provided by the mRNA COVID vaccinations is slower to build to efficacy and lower overall in patients with cirrhosis as compared to unvaccinated controls, according to a presentation at The Liver Meeting Digital Experience.
“After two doses of vaccine, there was a 78% reduction in COVID-19 and a 100% reduction of hospitalization or death. However, no differences were noted in the first 28 days indicating that protection with vaccination is lower and slower compared to data in normal healthy controls from clinical trials,” Binu V. John, MD, MPH, affiliate associate professor at the University of Miami Miller School of Medicine and chief of hepatology at the Bruce W. Carter VA Medical Center, said during his presentation.
John and colleagues performed a retrospective cohort study looking at patients with cirrhosis who received at least one dose of either the Pfizer or Moderna COVID-19 mRNA vaccines through the Veterans Administration Health System. They matched veterans who received at least one dose (n = 20,037) one-to-one with unvaccinated veterans. The time period studied was from Dec. 18, 2020, to March 17, 2021.
The vaccines were evenly split (51% Moderna; 49% Pfizer) and 99.7% of patients who received the first dose also received their second dose. Results of the two vaccines were similar enough to warrant combination of results.
“We find that after vaccine administration, there was similar numbers of COVID-19 in vaccines and controls until 28 days, so there’s 77 infections in the vaccine group compared to 88 patients in the control, but these differences start to diverge after 28 days,” John said.
Researchers showed one dose of an mRNA vaccine with a 64.8% reduction in COVID-19 infections after 28 days and 100% protection against hospitalization or death due to COVID-19 infection. The association of reduced COVID-19 infections was lower among patients with decompensated cirrhosis (50.3%) compared to compensated cirrhosis (66.8%).
A second dose produced a 78.6% reduction in COVID-19 infections and 100% reduction in COVID-19 related hospitalization or death after 7 days, John reported.
In the discussion, John noted that this study was early in the pandemic and they are still gathering data.
“We now have more extended data on longer follow up and we are seeing that unlike the initial result where we found no deaths ... we are now seeing deaths and hospitalization,” John said. “We are still finding a very strong association with reduced death.”
Additionally, the delta variant seems to be impacting vaccine efficacy in the cirrhotic population, he said. As the VA is now fully eligible for a third dose, John said they anticipate ongoing analyses.