SARS-CoV-2 infection not as protective against reinfection for patients on dialysis
Click Here to Manage Email Alerts
For patients receiving hemodialysis in the United States, prior infection with SARS-CoV-2 led to lower risks for subsequent reinfection and for the development of clinically manifest COVID-19.
However, findings also suggested that the protective effect was not as robust in these patients when compared with that in the general population.
“Overall, it is reassuring that naturally acquired seropositivity was associated with a decreased risk of subsequent SARS-CoV-2 infection among patients with [end-stage kidney disease]. Protective associations were greater with respect to clinically manifest COVID-19 vs. SARS-CoV-2 infection overall, supporting the hypothesis that natural immunity may reduce disease severity even when it does not prevent reinfection entirely,” Dena E. Cohen, PhD, of DaVita Clinical Research in Minneapolis, and colleagues wrote. “Importantly, prior infection was markedly less protective in this high-risk population compared with what has been elsewhere observed in younger, healthier subjects, where prior infection was associated approximately 70% to 90% lower relative risk of subsequent SARS-CoV-2 infection, depending on the study considered.”
Including a cohort of 2,337 patients receiving in-center dialysis treatments, researchers determined the presence or absence of IgG against SARS-CoV-2 at baseline, as well as a history of documented COVID-19 before study entry (9.5% were anti-SARS-CoV-2 IgG positive at baseline, whereas 3.6% had a history of COVID-19).
After 6,679 patient-months of follow-up, 263 participants were found to have been infected with SARS-CoV-2, with 141 of these cases clinically manifesting as COVID-19.
When assessing only patients who had evidence of SARS-CoV-2 infection at baseline (IgG+), researchers detected a total of 14 SARS-CoV-2 infections during follow-up (2.3 per 100 patient-months), three of which were clinically manifest COVID-19.
For patients who had not been previously infected with SARS-CoV-2, researchers observed 249 infections during the study period (4.1 per 100 patient-months).
Taken together, researchers determined that the presence of anti-SARS-CoV-2 IgG at baseline lowered the risk for any SARS-CoV-2 infection by 45% (incidence rate ratio [IRR] = 0.55) and for clinically manifest COVID-19 by 79% (IRR = 0.21).
“In summary, these data demonstrate that protection afforded by natural immunity to SARS-CoV-2 among patients treated with [in-center hemodialysis] is present but incomplete, and is of lower magnitude than in younger, relatively healthy populations,” Cohen and colleagues concluded. “These findings support two current recommendations: first, that older individuals and those with chronic disease should be prioritized for COVID-19 vaccination; and second, that decisions on vaccine candidacy should be made independent of prior disease history or serologic status.”
Collapse
Read more about
Click Here to Manage Email Alerts