COVID-19 vaccine protection against infection is lower and slower in people with liver disease

Study shows for the first time that people with cirrhosis who receive the COVID-19 mRNA vaccination have significant protection against more serious consequences like hospitalization and death. At the same time, however, vaccines offer less protection against SARS-CoV-2 infection and take longer to work in this population.

Prior to this research, published July 13 in JAMA Internal Medicine, the protection offered by vaccines to people with cirrhosis was unknown. Clinical trials of the vaccines have excluded most people with cirrhosis and other chronic diseases.

Thus, lead author Binu V. John, MD, MPH, and colleagues searched for their own answers, speculating that immune dysregulation in cirrhosis might alter the vaccine response.

Their study found that “being vaccinated is associated with 65% effectiveness after one dose and around 78% effectiveness in reducing COVID infection after the second dose,” said Dr. John, associate professor affiliated with the The University of Miami Miller School of Medicine chief of hepatology at Bruce W. Carter VA Medical Center in Miami.

Therefore, the protection against infection is “probably less than that of a healthy population,” said Dr John. “Patients with cirrhosis who are vaccinated can still get the infection, but they are unlikely to die or be hospitalized with COVID-19.”

Vaccinated vs unvaccinated

Researchers compared 20,037 people with cirrhosis nationwide who received at least one dose of the Pfizer or Moderna mRNA vaccine to the Veterans Health Administration. They compared the infections and outcomes in this group to 20,037 other matched patients with cirrhosis and similar risks of COVID-19 who were not vaccinated.

The vaccines were administered between December 18, 2020 and March 17, 2021. Interestingly, over 99% of participants eligible to receive a second dose in the CDC recommended six weeks after the first dose.

“It was very impressive,” said Dr John.

Another interesting find was the timeline. There was no difference between the vaccinated and unvaccinated groups during the first 28 days after the first dose.

“The difference starts to be felt after 28 days. This is when you start to see fewer cases in the vaccinated group and more in the unvaccinated group,” Dr John said. Clinicians who counsel people with cirrhosis may want to warn them about this delay in immune protection, he added.

Longer follow-up is needed

Vaccination has been associated with a 100% reduction in hospitalizations and deaths from COVID-19 after 28 days. No one died from COVID-19 in the vaccinated group compared to two deaths in the unvaccinated group, but longer follow-up is needed to better study the outcome of deaths in this population.

There was a downward trend vaccine protection in people with decompensated cirrhosis — defined as those who have symptoms due to their liver dysfunction — compared to those with compensated cirrhosis. cirrhosis with good liver function. However, the number of decompensated patients was low and the result needs to be further investigated. Dr John credits the collaboration and contribution of his co-authors, including Andrew Scheinberg, MD, a fellow and one of his interns, to the publication in the prestigious journal.

“The synergy that we have fostered between UM and the Miami VA is great,” he added. “It really helps to work closely with the MU contributors when submitting these articles. “

The study is called “Association of BNT162b2 mRNA and 1273 mRNA vaccines with COVID-19 infection and hospitalization in patients with cirrhosis.” In addition to UM and Miami VA, co-author affiliations include Yale University, West Haven VA, Virginia Commonwealth University, University of Pennsylvania, and Philadelphia VA.