Timely and tragic case report examines COVID-19 vaccine for the immunocompromised

After SARS-CoV-2 began to rapidly spread across the globe in 2020, there was a rush to develop safe and effective vaccines that could slow the spread and limit the severity of the virus. Although the mRNA vaccines reduce symptoms of COVID-19 by more than 90%, the efficacy of these mRNA vaccines in immunocompromised people has not been thoroughly tested. A recent case report published in Transplantation Direct from Masaaki Yamada, MD, clinical assistant professor in Nephrology, and a team of UI researchers describe a kidney transplant recipient suffering from severe COVID-19, despite the two-dose series of SARS-CoV-2 mRNA vaccine. The lacking anti-spike antibody in this case is concordant with the recent clinical evidence of reduced humoral response to the SARS-CoV-2 mRNA vaccine in solid organ transplant recipients.

In the report, Yamada and colleagues explore the symptoms, diagnosis, and treatment of a man in his late 70s who received a long-term kidney transplant and developed his initial symptoms of COVID-19 about eleven days after his second dose of SARS-CoV-2 mRNA vaccine.

His initial symptoms were a cough and intermittent low-grade fevers, which gradually worsened. He was evaluated twice in the Emergency Department. When he presented to the hospital for the second time, he tested positive for SARS-CoV-2 infection. His respiratory symptoms were so severe that his condition proved fatal despite treatment efforts. The man died on the seventh day after admission.

“The novel SARS-CoV-2 mRNA vaccines remain highly effective,” Yamada said. “An additional booster dose of vaccine is recently approved for immunocompromised hosts, namely, solid organ transplant recipients. However, it will not be 100% effective, like our case.” [Related: The FDA authorizes additional vaccine dose for immunocompromised individuals.]

This case highlights the importance, Yamada said, of understanding the risks of COVID-19 in immunosuppressed patients, even ones who have been fully vaccinated. Recent clinical evidence has shown that the mRNA vaccine could be less effective in people with solid organ transplant.

As a result of this case and other cases with vaccine breakthrough infection of SARS-CoV-2, the researchers conclude that physicians should be highly suspicious of COVID-19 despite vaccination records. Patients with high risks of developing severe COVID-19 should continue to protect against disease, and policymakers should be aware that herd immunity is the only effective way to halt the spread of COVID-19.

“In order to protect these vulnerable people as an entire society, it is important to reduce overall burden of COVID-19 in the community by primary prevention with vaccines,” Yamada said. “I strongly encourage that those eligible for the SARS-CoV-2 vaccine will make a well-informed and reasonable choice about both benefits and risks of these novel vaccines.”

In addition to Yamada, authors on this publication include Eiyu Matsumoto, MD, clinical associate professor in Infectious Disease; Christie P. Thomas, MBBS, professor in Nephrology; Jennifer R. Carlson, PA; J. Stacey Klutts, MD, PhD, clinical associate professor of Pathology, Bharat Kumar, MD, MME, clinical assistant professor in Immunology; Judy A. Streit, MD, clinical professor in Infectious Disease; and Melissa L. Swee, MD, MME, clinical assistant professor in Nephrology.


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