In large study of dialysis patients, low immune response to the COVID-19 vaccine made by Johnson & Johnson indicates that a booster shot might be needed.
October 15, 2021 - By Tracie White
In a head-to-head comparison of the three widely used coronavirus vaccines in the United States, the Johnson & Johnson vaccine yielded a strikingly lower antibody response in a Stanford School of Medicine-led study published Oct. 13 in the Journal of the American Society of Nephrology.
The study, which analyzed early vaccine immune response in 2,099 dialysis patients, found that 33% of those vaccinated with Johnson & Johnson did not develop coronavirus antibodies, compared with 4% of those who received the Pfizer-BioNTech vaccine and 2% who received the Moderna vaccine. The study is one of the first to compare immune response associated with antibody levels using the same blood test for all three vaccines.
“We weren’t expecting this large a difference between vaccines,” said Shuchi Anand, MD, assistant professor of nephrology and a lead author of the study. “Since part of the rationale for boosters is waning antibody response, our study strongly argues for the need for booster shots for Johnson & Johnson, particularly in the immunocompromised population.”
Pablo Garcia, MD, a postdoctoral scholar in nephrology and co-lead author of the study, agreed that people vaccinated with the J&J vaccine are probably less protected from the coronavirus and will “most likely need a booster shot.”
The researchers, who set out to analyze antibody response in the early post-vaccination period, collaborated with a nonprofit dialysis provider that treats kidney patients undergoing dialysis in California, Tennessee, Texas and New Jersey. The tests were conducted between 28 and 60 days after each patient had been fully vaccinated.
About 65% of the participants within the group received Moderna; about 20% received Pfizer-BioNTech; and about 17% received Johnson & Johnson.
Dialysis patients have some degree of immune suppression, which means the strength of the vaccine response may have been slightly diminished, the study said, but the disparity between the Johnson & Johnson antibody response and the two other mRNA vaccines is notable.
In addition to one-third of the J&J-vaccinated patients showing no antibody response, another third showed diminished response, the study said.
The Pfizer-BioNTech and Moderna vaccines, which both require two shots for full vaccination, rely on mRNA that uses the body’s own cells to produce a key viral protein. The J&J vaccine, which is given once, uses a common cold virus to carry bits of the SARS-CoV-2 DNA into cells to make the same viral protein.
Concern about waning protection from all three vaccines has caught the attention of federal officials, who in September approved a booster shot for the Pfizer-BioNTech vaccine for certain groups six months post-vaccination. The Federal Drug Administration is considering similar approvals for boosters for both the J&J and Moderna vaccines..
“I think they are probably going to authorize an mRNA vaccine for people who got the J&J vaccine,” Garcia said, pointing to a results from a study, not yet peer reviewed, that shows the use of an mRNA vaccine as a booster shot for J&J significantly improves immune response.
In the United States, the J&J vaccine is the least-administered of the COVID-19 vaccines. According to the Centers for Disease Control and Prevention, 14.9 million Americans have been inoculated with the J&J vaccine, compared with 69.3 million who have received the Moderna vaccine and 103 million who have received the Pfizer-BioNTech vaccine.
Antibodies are produced by the body’s immune system in response to an infection — or a vaccine — and are often correlated with immune response, the study said. But antibody response is only one measure of immunity. This study did not evaluate other aspects of the immune response such as cellular immunity or the presence of B cells.
Senior authorship of the study is shared by Julie Parsonnet, MD, professor of medicine and of epidemiology and population health; Glenn Chertow, MD, professor of medicine and chief of the division of nephrology; Graham Abra, MD, clinical assistant professor of medicine; and Brigette Schiller, chief medical officer at Satellite Healthcare..
Other Stanford co-authors are biostatistician Jialin Han, PhD, and senior research engineer Maria Montez-Rath, PhD.
Other authors from Satellite Healthcare also contributed to the work..
Funding for the study included grants from the National Institutes of Health (R01DK127138 and K24DK08546). Garcia received funding from the American Kidney Fund Clinical Scientist in Nephrology Award and the Stanford University School of Medicine Leeds Compassionate Scholar Award.
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