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Clin Kidney J . Humoral and cellular immunogenicity of a fourth dose BNT162b2 in children with chronic kidney diseases

tetano

Editor, Senior Moderator
Clin Kidney J


. 2025 Feb 21;18(3):sfaf052.
doi: 10.1093/ckj/sfaf052. eCollection 2025 Mar. Humoral and cellular immunogenicity of a fourth dose BNT162b2 in children with chronic kidney diseases

Jeffery C H Chan[SUP] 1 [/SUP], Eugene Yu-Hin Chan[SUP] 2 [/SUP], Samuel M S Cheng[SUP] 3 [/SUP], Daniel Leung[SUP] 1 [/SUP], Fanny Tsz-Wai Ho[SUP] 2 [/SUP], Pak-Chiu Tong[SUP] 2 [/SUP], Wai-Ming Lai[SUP] 2 [/SUP], Matthew H L Lee[SUP] 4 [/SUP], Stella Chim[SUP] 4 [/SUP], Leo C H Tsang[SUP] 3 [/SUP], Tsz-Chun Kwan[SUP] 3 [/SUP], Yin Celeste Cheuk[SUP] 1 [/SUP], Manni Wang[SUP] 1 [/SUP], Howard H W Wong[SUP] 1 [/SUP], Amos M T Lee[SUP] 1 [/SUP], Wing Yan Li[SUP] 1 [/SUP], Sau Man Chan[SUP] 1 [/SUP], Issan Y S Tam[SUP] 1 [/SUP], Jennifer H Y Lam[SUP] 1 [/SUP], Kaiyue Zhang[SUP] 1 [/SUP], Wenwei Tu[SUP] 1 [/SUP], Malik Peiris[SUP] 3 5 [/SUP], Jaime S Rosa Duque[SUP] 1 [/SUP], Yu Lung Lau[SUP] 1 [/SUP], Alison Lap-Tak Ma[SUP] 2 [/SUP]



Affiliations
Abstract

Background: Children with chronic kidney disease (CKD) are at risk of severe complications after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and are recommended to receive vaccine boosters. Although coronavirus disease 2019 (COVID-19) boosters are effective in providing immune responses among healthy children, data on the use of a fourth dose among children with CKD are limited.
Methods: We prospectively investigated the immunogenicity and safety of a fourth dose of BNT162b2 in children with CKD. Dosages were 0.1 mL and 0.3 mL for children aged 5-11 years and 11-18 years, respectively. Humoral and cellular immunogenicity was assessed at pre-dose 4, and at 1 and 6 months post-dose 4.
Results: Twenty-one children, with a median age of 14.0 years, were included for evaluation. A fourth dose of BNT162b2 elicited significant increases in humoral spike receptor-binding domain immunoglobulin G levels and T-cell responses. Antibody responses were significantly lower among kidney transplant recipients or children receiving calcineurin inhibitors than other CKD children at 1 month post-dose 4. Breakthrough COVID-19 occurred in three children after the fourth dose, and one was hospitalized. One child developed mild gross hematuria 1 day after the fourth dose, which spontaneously resolved. The overall safety profile was acceptable.
Conclusions: A fourth dose of BNT162b2 was immunogenic and safe in children with CKD.

Keywords: BNT162b2; COVID-19; children; chronic kidney disease; vaccine.

 
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