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COVID-19 vaccine in solid organ transplant recipients



Introduction

The novel coronavirus (COVID-19) pandemic has infected more than 100 million patients worldwide and resulted in 2 million deaths. It is caused by the SARS-CoV-2 virus that leads to pneumonia and organ dysfunction. Solid organ transplant recipients are vulnerable, and they are prone to developing complications when they are infected.

Types of COVID-19 vaccine and common side effects

There are several vaccines under manufacturing and used in clinical trials. The HKSAR Government planned to provide these three vaccines to the public:

  1. Inactivated virus (Sinovac Biotech (Hong Kong) Limited)

  2. mRNA technology (collaboration between Fosun Pharma and BioNTech)

  3. Non-replicating viral vector (collaboration between AstraZeneca and the University of Oxford)

Individuals should receive two doses of the same vaccine in order to build up sufficient protection according to the manufacturer. The availability of vaccine is subjected to the approval of use by the regulatory party. According to the trial results, side effects are usually mild and self-limiting, and rarely severe. Common side effects include pain and swelling at injection site, fever, chills, headache and tiredness.

Should transplant recipients receive COVID-19 vaccine?

Although transplant recipients should not receive live attenuated vaccinations (such as measles and intranasal influenza vaccines), the current vaccines for COVID-19 are NOT live attenuated vaccines. Vaccines for coronavirus make use of inactivated virus, mRNA or nonreplicating viral vector as a mechanism of action. In other words, they do not pose a known risk to immunosuppressed patients.

It is necessary to be mindful that the protective effect and duration of the vaccines may be lower in solid organ transplant recipients than in general population.

At present, there was no COVID-19 vaccine clinical trial conducted on solid organ transplant recipients. In other words, there is limited data regarding the efficacy and safety profile. As many countries have begun rolling out the COVID-19 vaccination programme, we expect more clinical information, especially regarding its use in solid organ transplant recipients, to be available in near future.

It should be remembered that patients with organ transplant have more risk of severe disease and even death after infection by the SARS-CoV-2 virus. To balance the risk and benefits, the transplant recipients are recommended to receive the vaccine, unless there is other contraindication. If you have concern about whether you have other contraindication to vaccine, please refer to the Hong Kong HKSAR government updated COVID-19 Vaccination Programme website (www.covidvaccine.gov.hk) and discuss with your doctor.

Should transplant candidates receive COVID-19 vaccine?

In general, vaccine immunogenicity is often diminished in the setting of organ failure. Furthermore, we do not suggest vaccination to patients who have just received solid organ transplantation or those on high dose immunosuppression treatment. As such transplant candidates should be immunized as early in the course of their disease as possible.

What precautions should transplant recipients and their family members take?

We recommend solid organ transplant recipients to continue infection control measures, including wearing surgical mask properly, maintaining personal hygiene, and adhering to social distancing measures to minimize chance of infection. They should also receive annual influenza vaccination.

We also suggest vaccination to family members of transplant recipients in order to reduce the chance of cross infection.

Reference

COVID-19 Thematic Website, HKSAR Government: https://www.coronavirus.gov.hk

COVID-19 Vaccination Programme, HKSAR Government: https://www.covidvaccine.gov.hk

COVID-19 Information, American Society of Transplantation: https://www.myast.org/covid-19-information

COVID-19 Vaccine, Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/


Prepared on 5 March 2021

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