Vaccinations are insufficient for various patient groups
The UMCG is conducting research into the effect of COVID-19 vaccines in kidney patients, lung transplant patients and patients with cancer. On Tuesday, August 17, the first two studies presented their results. Vaccinations are insufficient for various patient groups.
Family in lockdown
During a knowledge session for interested media, Annelies Hilgersom explained the impact corona has on her life. As a kidney transplant patient, received a kidney transplant in 2007. She takes drugs to make sure her immune system doesn’t reject the new kidney. For patients like her, the coronavirus is extra dangerous: she can become seriously ill from the virus and the chance of death is considerably higher for her than for others.
Annelies and her family have been in lockdown since the start of the pandemic. For example, her son does not go to school. The fear that the virus will enter the house through their son is too great. Although she indicates that she is used to something, it is clear that the situation is taking a heavy toll on her and her family. And there are many like this patient: an estimated more than 500,000 people in the Netherlands with a weakened immune system are at extra risk during the pandemic and are therefore considerably limited in what they can and cannot do.
Read the story of kidney transplant patient Annelies Hilgersom here.
Importance of a well-functioning vaccine
A well-functioning and safe vaccine is especially important for these vulnerable people. However, the currently available vaccines have mainly been studied in relatively healthy adults. Specific risk groups are not included or only very limited in these studies. As a result, there is insufficient knowledge about the immune response of the vaccine in patients who are known to have a less well-functioning immune system due to a congenital disorder, from medication after a transplant or from chemotherapy or immunotherapy for cancer.
ZonMw has started eight studies into the effect of COVID-19 vaccines in vulnerable groups. Three of these are coordinated in the UMCG. This concerns studies into the effect of COVID-19 vaccines in kidney patients, lung transplant patients and patients with cancer. The first two presented their first results on Tuesday 17 August.
Effectiveness in lung transplant patients
Corona vaccines are safe for lung transplant patients, but the corona vaccination is not or hardly effective for a large part of the patients who have undergone a lung transplant, because virtually no antibodies are produced. This is apparent from the first results of the study led by lung transplant doctor Erik Verschuuren and virologist Coretta van Leer of the UMCG.
Many of these patients still fear being infected with the coronavirus on a daily basis, and many of them live in continuous quarantine. They may benefit from a third or even fourth shot, but until then are mainly dependent on the vaccination coverage in their immediate environment and in society.
Patients who have had a lung transplant are given drugs to keep their bodies from rejecting the new lungs. These drugs suppress the immune system, but as a result, these patients are also more susceptible to viral infections, such as the coronavirus. The coronavirus is even more dangerous for them, because the virus infects the transplanted organ, the lungs. In addition, an infection lasts longer, because the immune response is suppressed.
A corona infection is a lot more dangerous for lung transplant patients than for healthy people. They have a greater chance of ending up in the ICU and of dying from corona.
Vaccine effect in kidney patients
In the Netherlands there are approximately 12,000 kidney transplant patients who use immunosuppressive drugs, approximately 60,000 patients with renal failure and 6,000 patients on dialysis. A research group led by internist-nephrologist Jan-Stephan Sanders of the UMCG is investigating the immune system’s response to a COVID-19 vaccination in these three patient groups.
The good news: the first results show that vaccination with a corona vaccine is safe for all kidney patients. Also good news: the first results show that the immune response in patients with kidney failure and dialysis patients is good: after two vaccinations they have produced sufficient antibodies. Whether this remains the case needs to be further investigated. However, this does not apply to kidney transplant patients: 43% of this group has no antibodies.
Amount of antibodies
The researchers also look at the amount of antibodies that people make and to what extent they can inhibit the virus. The kidney transplant patients also do not score well on this: in 67% no or insufficient antibodies are made. This usually concerns patients who have recently received a transplant, patients with lower kidney function, patients who are taking multiple immunosuppressive drugs and patients who are taking immunosuppressive drugs containing the substance MMF.
Booster
A solution for these patients could be a booster: one or more extra vaccinations so that they still produce sufficient antibodies. The researchers will investigate effective applications of this. Perhaps it can help – if it is safe – to (temporarily) stop certain immunosuppressive drugs and then vaccinate.
More information
More information will follow shortly about the research into the effect of the corona vaccine in people with cancer, the third study the UMCG is leading. On the ZonMw’s website you can find all information about the eight studies. Read here too their news item following the knowledge session.
Lack of freedom underexposed
Because all studies are set up in the same way, the researchers and ZonMw hope to eventually be able to draw comparisons between the different patient groups. Which in any case applies to all: they mainly benefit from a high vaccination rate of the people in their immediate environment and in society as a whole. Lung transplant doctor Erik Verschuuren: ‘In the end, there remains a large group of patients that we cannot protect against corona. In the discussion about the freedom that everyone in the Netherlands has to have themselves vaccinated or not, this remains underexposed. These patients are often close to despair, the freedom they give up just goes on and on.’
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