Severe COVID-19 by SARS-CoV-2 Lineage B.1.1.7 in Vaccinated Solid-Organ Transplant Recipients: New Preventive Strategies Needed to Protect Immunocompromised Patients

被引:8
|
作者
Loconsole, Daniela [1 ]
Stea, Emma Diletta [1 ,2 ]
Sallustio, Anna [3 ]
Fonto, Giulia [2 ]
Pronzo, Virginia [2 ]
Simone, Simona [2 ]
Centrone, Francesca [1 ]
Accogli, Marisa [1 ]
Gesualdo, Loreto [2 ]
Chironna, Maria [1 ]
机构
[1] Univ Bari, Dept Biomed Sci & Human Oncol, Hyg Sect, I-70124 Bari, Italy
[2] Univ Bari, Dept Emergency & Organ Transplantat, Nephrol Dialysis & Transplantat Unit, I-70124 Bari, Italy
[3] Azienda Osped Univ, Hyg Unit, Consorziale Policlin Bari, I-70124 Bari, Italy
关键词
solid-organ transplant recipients; SARS-CoV-2; infection; B.1.1.7; lineage; COVID-19; vaccine; whole-genome sequencing;
D O I
10.3390/vaccines9080806
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background: Solid-organ transplant (SOT) recipients are at a high risk of severe COVID-19, and are priority for vaccination. Here, we describe three cases of severe COVID-19 caused by SARS-CoV-2 B.1.1.7 lineage in vaccinated SOT recipients. Methods: Three SOT patients were hospitalized in the Policlinico Hospital of Bari (southern Italy) and underwent nasopharyngeal swabs for molecular detection of SARS-CoV-2 genes and spike protein mutations by real-time PCR. One sample was subjected to whole-genome sequencing. Results: One patient was a heart transplant recipient and two were kidney transplant recipients. All were hospitalized with severe COVID-19 between March and May 2021. Two patients were fully vaccinated and one had received only one dose of the BNT162b2 mRNA vaccine. All the patients showed a high viral load at diagnosis, and molecular typing revealed the presence of B.1.1.7 lineage SARS-CoV-2. In all three cases, prolonged viral shedding was reported. Conclusions: The three cases pose concern about the role of the B.1.1.7 lineage in severe COVID-19 and about the efficacy of COVID-19 vaccination in immunocompromised patients. Protecting immunocompromised patients from COVID-19 is a challenge. SOT recipients show a suboptimal response to standard vaccination, and thus, an additive booster or a combined vaccination strategy with mRNA, protein/subunit, and vector-based vaccines may be necessary. This population should continue to practice strict COVID-19 precautions post-vaccination, until new strategies for protection are available.
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页数:8
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