Abstract
Background
The effectiveness of vaccines against the severe acute respiratory syndrome
coronavirus-2 (SARS-CoV-2) B.1.1.529 Omicron variant in immunosuppressed solid
organ and islet transplant (SOT) recipients is unclear.
Methods
National registries in England were linked to identify SARS-CoV-2 positive tests, noninjury
hospitalisation within 14 days, and deaths within 28 days between 7 December
2020 and 31 March 2022 in adult SOT recipients. Incidence rate ratios (IRRs) for
infection, and hospitalisation or death, were adjusted for recipient demographics and
calendar month for the Omicron-dominant period (20 December 2021 to 31 March
2022). Mortality risk following SARS-CoV-2 infection was adjusted for recipient
demographics and dominant variant using a Cox proportional-hazards model for the
entire time period.
Results
During the Omicron-dominant period, infection IRRs (95% confidence intervals) were
higher in those receiving two, three and four vaccine doses compared to unvaccinated patients (1·25 (1·08-1·45), 1·46 (1·28-1·67), and 1·79 (1·54-2·06), respectively).
However, hospitalisation or death IRRs during this period were lower in those receiving
three or four vaccine doses compared to unvaccinated patients (0·62 (0·45-0·86) and
0·39 (0·26-0·58), respectively). Risk-adjusted analyses for deaths after SARS-CoV-2
infection between 7 December 2020 to 31 March 2022 found hazard ratios (95%
confidence intervals) of 0·67 (0·46-0·98), 0·46 (0·30-0·69), 0·18 (0·09-0·35) for those
with two, three, and four vaccine doses, respectively, when compared to the
unvaccinated group.
Conclusions
In immunosuppressed SOT recipients, vaccination is associated with incremental,
dose-dependent protection against hospitalisation or death after SARS-CoV-2
infection, including against the Omicron variant.
The effectiveness of vaccines against the severe acute respiratory syndrome
coronavirus-2 (SARS-CoV-2) B.1.1.529 Omicron variant in immunosuppressed solid
organ and islet transplant (SOT) recipients is unclear.
Methods
National registries in England were linked to identify SARS-CoV-2 positive tests, noninjury
hospitalisation within 14 days, and deaths within 28 days between 7 December
2020 and 31 March 2022 in adult SOT recipients. Incidence rate ratios (IRRs) for
infection, and hospitalisation or death, were adjusted for recipient demographics and
calendar month for the Omicron-dominant period (20 December 2021 to 31 March
2022). Mortality risk following SARS-CoV-2 infection was adjusted for recipient
demographics and dominant variant using a Cox proportional-hazards model for the
entire time period.
Results
During the Omicron-dominant period, infection IRRs (95% confidence intervals) were
higher in those receiving two, three and four vaccine doses compared to unvaccinated patients (1·25 (1·08-1·45), 1·46 (1·28-1·67), and 1·79 (1·54-2·06), respectively).
However, hospitalisation or death IRRs during this period were lower in those receiving
three or four vaccine doses compared to unvaccinated patients (0·62 (0·45-0·86) and
0·39 (0·26-0·58), respectively). Risk-adjusted analyses for deaths after SARS-CoV-2
infection between 7 December 2020 to 31 March 2022 found hazard ratios (95%
confidence intervals) of 0·67 (0·46-0·98), 0·46 (0·30-0·69), 0·18 (0·09-0·35) for those
with two, three, and four vaccine doses, respectively, when compared to the
unvaccinated group.
Conclusions
In immunosuppressed SOT recipients, vaccination is associated with incremental,
dose-dependent protection against hospitalisation or death after SARS-CoV-2
infection, including against the Omicron variant.
| Original language | English |
|---|---|
| Journal | Transplantation |
| Early online date | 25 Jan 2023 |
| DOIs | |
| Publication status | E-pub ahead of print - 25 Jan 2023 |