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

 

 

 

器官受贈者2019冠狀病毒病疫苗

 

 

簡介

2019冠狀病毒病全球大流行感染人數已超越一億,並造成近二百萬人死亡。病人會出現肺炎及器官衰竭等病徵。比起普羅大眾,器官受贈人士更容易受到感染和出現併發症

 

 

2019冠狀病毒病疫苗和常見副作用

現時有多種疫苗正進行臨床研究及測試。香港特區政府準備提供以下三類疫苗給市民接種:

  1. 滅活病毒疫苗(由科興控股(香港)有限公司研發)
  2. 信使核糖核酸疫苗(由復星醫藥與德國藥廠BioNTech共同研發)
  3. 病毒載體疫苗(由阿斯利康 AstraZeneca 及牛津大學共同研發)

市民須接種兩劑相同的疫苗以產生保護作用。疫苗供應計劃需視乎有關當局批准。根據廠方資料,疫苗副作用通常是輕微和短暫,只有少部分人會出現嚴重併發症。常見副作用包括打針位置痛及紅腫,發燒,發冷,頭痛及疲倦。

 

 

器官受贈者應接受2019冠狀病毒病疫苗嗎?

 

雖然器官受贈人不應接受減毒活疫苗(例如麻疹和鼻內流感疫苗),目前用於2019冠狀病毒病的疫苗不是減毒活疫苗。現時2019冠狀病毒病疫苗均使用滅活病毒,信使核糖核酸及病毒載體技術,與減毒活病毒疫苗不同。換句話說,它們不會給免疫抑制患者帶來已知風險。

要注意器官移植接受者對接種疫苗產生的保護作用和持續時間可能會比在一般人低。

目前,尚無針對實體器官移植接受者的COVID-19疫苗臨床試驗,關於功效和安全性的數據有限。由於許多國家已經開始實施COVID-19疫苗接種計劃,因此我們希望在不久的將來可以獲得更多的臨床信息,尤其是有關其在實體器官移植接受者中的使用的保護作用。

應該強調一點,器官移植患者感染SARS-CoV-2病毒後有更大的嚴重疾病甚至死亡的風險。為平衡風險和好處,我們建議移植接受者接種疫苗(除非有其他禁忌症)。如果您擔心是否還有其他疫苗禁忌症,請參考香港政府「2019冠狀病毒病疫苗接種計劃」網站 (www.covidvaccine.gov.hk),並諮詢您的醫生。

 

 


 

輪候器官捐贈者應接受2019冠狀病毒病疫苗嗎?

 

一般而言,疫苗在末期器官衰竭病人使用上的效果會較低。同時,我們並不建議在近期接受器官移植後,或正服用高份量抗排斥藥的病人接種。因此我們建議正輪候器官捐贈者應在器官衰竭前盡早接種疫苗

 

 

器官受贈者和家人的注意事項

 

我們建議所有器官受贈者繼續實行感染控制措施,包括正確佩戴外科手術口罩,保持個人衛生及遵從社交距離措施,以減低感染機會。器官受贈者亦應每年接種流感疫苗。

我們亦建議器官受贈者的家人接種疫苗,以減低交叉傳染的機會。

 

 

 

參考資料

香港特區政府2019冠狀病毒病專題網站: https://www.coronavirus.gov.hk

香港特區政府2019冠狀病毒病疫苗接種計劃網站: https://www.covidvaccine.gov.hk

美國移植學會2019冠狀病毒病資訊: https://www.myast.org/covid-19-information

美國疾病管制與預防中心2019冠狀病毒病疫苗資訊: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/

 

於2021年3月5日撰寫

 

Covid_vaccine_and_organ_transplant_recipient_HKST_Chinese.docx

Covid_vaccine_and_organ_transplant_recipient_HKST_English.docx