MIAMI — Administration of mRNA COVID-19 vaccines to veterans with cirrhosis resulted in a delayed and modest reduction in infection rates. Excellent protection against related hospitalization or death was achieved, however, according to a new study.
The report in JAMA Internal Medicine noted that patients with chronic illnesses, including cirrhosis, were excluded from clinical trials for two mRNA-based vaccines to prevent novel coronavirus infection. Researchers from the Bruce W. Carter VAMC and the University of Miami Miller School of Medicine, both in Miami, and colleagues pointed out that patients with cirrhosis have immune dysregulation that is associated with vaccine hyporesponsiveness.1
The study team set out to determine the association of receipt of the Pfizer BNT162b2 mRNA or the Moderna mRNA-1273 vaccines in patients with cirrhosis compared with a propensity-matched control group of patients at similar risk of infection and severe disease from COVID-19.
Researchers performed a retrospective cohort study of VHA patients with cirrhosis who received at least one dose of a COVID-19 mRNA vaccine. The 20,037 patients receiving at least one does were propensity matched with 20,037 controls to find out how vaccination influenced COVID-19 infection, hospitalization and death. The study was conducted between Dec. 18, 2020, and March 17, 2021.
COVID-19 infection was determined by polymerase chain reaction.
Vaccinated participants had a median age of 69.1, and both the vaccinated and unvaccinated patient groups were 97.2% male. The mRNA-1273 vaccine was administered in 10,236 (51%), and the BNT162b2 mRNA in 9,801 (49%) patients. Nearly all, 99.7%, of veterans who received the first dose of either vaccine with a follow-up of 42 days or more received a second dose.
Results indicated that the number of COVID-19 infections in the vaccine recipients was similar to the control group in days 0 to 7, 7 to 14, 14 to 21, and 21 to 28 after the first dose.
Researchers reported that, after 28 days, receipt of one dose of an mRNA vaccine was associated with a 64.8% reduction in COVID-19 infections and 100% protection against hospitalization or death due to COVID-19 infection. “The association of reduced COVID-19 infections after the first dose was lower among patients with decompensated (50.3%) compared with compensated cirrhosis (66.8%),” according to the authors, who added that receiving a second dose upped reduction in COVID-19 infections to 78.6%, while creating a 100% reduction in COVID-19-related hospitalization or death after seven days.
- John BV, Deng Y, Scheinberg A, Mahmud N, Taddei TH, Kaplan D, Labrada M, Baracco G, Dahman B. Association of BNT162b2 mRNA and mRNA-1273 Vaccines With COVID-19 Infection and Hospitalization Among Patients With Cirrhosis. JAMA Intern Med. 2021 Jul 13:e214325. doi: 10.1001/jamainternmed.2021.4325. Epub ahead of print. PMID: 34254978; PMCID: PMC8278308.
