Sex: F
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 antibody test, SARS-CoV-2 test, Vaccination failure
Clinical narrative: kidney transplant recipients who developed COVID-19 more than 14 days after receipt of 2 doses of SARSCoV- 2 mRNA vaccine, administered at the recommended dosing interval; kidney transplant recipients who developed COVID-19 more than 14 days after receipt of 2 doses of SARSCoV- 2 mRNA vaccine, administered at the recommended dosing interval; This is a literature report. This author reported similar events in four patients. This is third of four reports.  Recently, a study showed that only 54% of organ transplant recipients developed a positive antibody response after 2 doses of SARS-CoV-2 mRNA vaccine and, among kidney transplant recipients, only 48% had an antibody response. At the center the seropositivity rate in organ transplant recipients was 37.2% .This suggests that a significant proportion of transplant recipients remain at risk for COVID-19 despite completing the vaccination series. The center encourages COVID-19 vaccination for all transplant recipients. Authors estimate an active follow-up of approximately 1,680 fully vaccinated kidney transplant recipients. Authors had 8 kidney transplant recipients who developed COVID-19 more than 14 days after receipt of 2 doses of SARSCoV- 2 mRNA vaccine, administered at the recommended dosing interval. All patients were symptomatic, most commonly with fatigue and cough. The median age was 65 years old (range 36-73), 50% had received a previous transplant, the median time from the most recent transplant to the first dose of mRNA vaccine was 31 months (range 3 - 248), and 3 out of 8 patients had received thymoglobulin for induction in the 6 months preceding vaccination. All patients were on calcineurin inhibitor (CNI)-based immunosuppression and 7 of the 8 were on mycophenolate mofetil. CNI level goals were not changed during illness, anti-metabolite doses were reduced or held based on symptoms and severity, at the discretion of the nephrologist. Symptom onset and SARS-CoV-2 testing occurred at a median of 56 days (range 18-77) and 59 days (range 20-77) after the second dose of the vaccine, respectively. Three patients received casirivimab/imdevimab as outpatient and did not require hospital admission. Three patients were hospitalized and had a length of stay of 3 to 5 days, without requiring ICU admission or mechanical ventilation. All were discharged to home without oxygen. None of the patients had anti-SARS-CoV-2 spike protein antibody checked after vaccination or disease and viruses were not sequenced. Data on the COVID-19 vaccine effectiveness is emerging, however, vaccine effectiveness in the immunocompromised population is lacking. It is encouraging that breakthrough cases of COVID-19 after vaccination were mild and associated with good outcomes. However, authors should continue to encourage patients to be vaccinated and also encourage vaccination of household members and close contacts. Recent guidance allowing fully vaccinated individuals to resume prepandemic activities probably should not apply to transplant recipients.  A 73-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE) dose 1 and dose 2 both via an unspecified route of administration on an unspecified dates (Batch/Lot number was not reported) as single doses for covid-19 immunisation.  Medical history included kidney transplant and immunosuppression. The patient's concomitant medications included Tacrolimus and azathioprine as immunosuppression.  The patient previously took thymoglobulin. It was reported kidney transplant recipients who developed covid-19 more than 14 days after receipt of 2 doses of sarscov- 2 mrna vaccine, administered at the recommended dosing interval on an unspecified date with outcome of unknown. Characteristics of the kidney transplant recipient who developed COVID-19 after two doses of mRNA vaccines were reported as follows: Time from transplant to 1st vaccine dose was 3 months. Type of vaccine was BNT162b2. Thymoglobulin 6 months prior to 1st vaccine dose. Maintenance IS (immunosuppression) -Tacrolimus, Aza (azathioprine).  MMF (mycophenolate mofetil)/ Aza stopped or reduced was Yes. Symptoms were Dyspnea, weakness, fatigue, cough. 18 Days from 2nd dose to symptoms. 20 Days from 2nd dose to SARSCOV-2 test (Positive). Casirivimab and imdevimab was No. Hospitalization was Yes. ICU was No. Mechanical ventilation was No. Disposition Home. Length of stay was 3 days. O2 supplement on discharge was No. Previous transplant was Yes. Duration of follow-up was 70 days. Status at last f/u was Alive. The patient underwent lab tests and procedures which included anti-SARS-CoV-2 spike protein antibody: positive.    No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender's Comments: Based on the information currently available, a lack of efficacy with bnt162b2 towards the breakthrough COVID-19 infection following vaccination in this patient cannot be completely excluded.,Linked Report(s) : US-PFIZER INC-202101115297 Same article/ drug/event and different patient