Matthew J Oliver1,2, Doneal Thomas2, Shabnam Balamchi3, Jane Ip2, Kyla Naylor4,5, Stephanie N Dixon4,5,6, Eric McArthur4,5,6, Jeff Kwong5,7,8,9, Jeffrey Perl10, Mohammad Atiquzzaman11, Joel Singer12, Angie Yeung2, Michelle Hladunewich13,2, Kevin Yau13, Amit X Garg4,5,14, Jerome A Leis15, Adeera Levin11,16,17, Mel Krajden18,19, Peter G Blake2,14. 1. Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada matthew.oliver@sunnybrook.ca. 2. Ontario Renal Network, Ontario Health, Toronto, Canada. 3. Health System Performance and Support, Ontario Health, Toronto, Canada. 4. Department of Epidemiology and Biostatistics, Western University, London, Canada. 5. ICES, Toronto, Canada. 6. Lawson Health Research Institute, London, Canada. 7. Dalla Lana School of Public Health, Centre for Vaccine Preventable Diseases, and Department of Family and Community Medicine, University of Toronto, Toronto, Canada. 8. Public Health Ontario, Toronto, Canada. 9. University Health Network, Toronto, Canada. 10. Division of Nephrology, St. Michael's Hospital and the Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada. 11. British Columbia Provincial Renal Agency, Vancouver, Canada. 12. Centre for Health Evaluation and Outcome Sciences, School of Population and Public Health, University of British Columbia, Vancouver, Canada. 13. Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. 14. Department of Medicine, Western University, London, Canada. 15. Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. 16. Department of Medicine, University of British Columbia, Vancouver, Canada. 17. St. Paul's Hospital, Vancouver, Canada. 18. British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, Canada. 19. Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
Abstract
BACKGROUND: Vaccination studies in the hemodialysis population have demonstrated decreased antibody response compared with healthy controls, but vaccine effectiveness for preventing SARS-CoV-2 infection and severe disease is undetermined. METHODS: We conducted a retrospective cohort study in the province of Ontario, Canada, between December 21, 2020, and June 30, 2021. Receipt of vaccine, SARS-CoV-2 infection, and related severe outcomes (hospitalization or death) were determined from provincial health administrative data. Receipt of one and two doses of vaccine were modeled in a time-varying cause-specific Cox proportional hazards model, adjusting for baseline characteristics, background community infection rates, and censoring for non-COVID death, recovered kidney function, transfer out of province, solid organ transplant, and withdrawal from dialysis. RESULTS: Among 13,759 individuals receiving maintenance dialysis, 2403 (17%) were unvaccinated and 11,356 (83%) had received at least one dose by June 30, 2021. Vaccine types were BNT162b2 (n=8455, 74%) and mRNA-1273 (n=2901, 26%); median time between the first and second dose was 36 days (IQR 28-51). The adjusted hazard ratio (HR) for SARS-CoV-2 infection and severe outcomes for one dose compared with unvaccinated was 0.59 (95% CI, 0.46 to 0.76) and 0.54 (95% CI, 0.37 to 0.77), respectively, and for two doses compared with unvaccinated was 0.31 (95% CI, 0.22 to 0.42) and 0.17 (95% CI, 0.1 to 0.3), respectively. There were no significant differences in vaccine effectiveness among age groups, dialysis modality, or vaccine type. CONCLUSIONS: COVID-19 vaccination is effective in the dialysis population to prevent SARS-CoV-2 infection and severe outcomes, despite concerns about suboptimal antibody responses.
BACKGROUND: Vaccination studies in the hemodialysis population have demonstrated decreased antibody response compared with healthy controls, but vaccine effectiveness for preventing SARS-CoV-2 infection and severe disease is undetermined. METHODS: We conducted a retrospective cohort study in the province of Ontario, Canada, between December 21, 2020, and June 30, 2021. Receipt of vaccine, SARS-CoV-2 infection, and related severe outcomes (hospitalization or death) were determined from provincial health administrative data. Receipt of one and two doses of vaccine were modeled in a time-varying cause-specific Cox proportional hazards model, adjusting for baseline characteristics, background community infection rates, and censoring for non-COVID death, recovered kidney function, transfer out of province, solid organ transplant, and withdrawal from dialysis. RESULTS: Among 13,759 individuals receiving maintenance dialysis, 2403 (17%) were unvaccinated and 11,356 (83%) had received at least one dose by June 30, 2021. Vaccine types were BNT162b2 (n=8455, 74%) and mRNA-1273 (n=2901, 26%); median time between the first and second dose was 36 days (IQR 28-51). The adjusted hazard ratio (HR) for SARS-CoV-2 infection and severe outcomes for one dose compared with unvaccinated was 0.59 (95% CI, 0.46 to 0.76) and 0.54 (95% CI, 0.37 to 0.77), respectively, and for two doses compared with unvaccinated was 0.31 (95% CI, 0.22 to 0.42) and 0.17 (95% CI, 0.1 to 0.3), respectively. There were no significant differences in vaccine effectiveness among age groups, dialysis modality, or vaccine type. CONCLUSIONS: COVID-19 vaccination is effective in the dialysis population to prevent SARS-CoV-2 infection and severe outcomes, despite concerns about suboptimal antibody responses.
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