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

One study shows for the first time that people with cirrhosis who receive COVID-19 mRNA vaccination get significant protection against more serious outcomes such as hospitalization and death. At the same time, however, vaccines offer less protection against SARS-CoV-2 infection and take longer to become effective in this population.

Prior to this research, published on July 13 a JAMA Internal Medicine, it was unknown what protection vaccines offered to people with cirrhosis. Clinical trials of vaccines excluded most people with cirrhosis and other chronic conditions.

Thus, lead author Binu V. John, MD, MPH, and colleagues sought their own responses, speculating that immune dysregulation of cirrhosis could alter the vaccine response.

His study reveals that “vaccination is associated with 65% efficacy after a dose and approximately 78% efficacy in reducing COVID infection after the second dose,” said Dr. John, associate professor affiliated with Miller College of Medicine head of hepatology at Bruce Medical Carter VA Medical Center in Miami.

Therefore, protection against infection is “probably lower than in a healthy population,” Dr. John. “Vaccinated cirrhosis patients may have the infection, but they are unlikely to die or be hospitalized with COVID-19.”

Vaccinated vs. not vaccinated

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

Vaccines were administered between December 18, 2020 and March 17, 2021. Interestingly, more than 99% of participants who were eligible to receive a second dose within the CDC recommended doing so six weeks after the first. dose.

“It was very impressive,” Dr. John said.

Another interesting finding was the chronology. There were no differences between vaccinated and unvaccinated groups in the first 28 days after the first dose.

“The difference starts to start after 28 days. That’s when you start to see fewer cases in the vaccine group and more in the unvaccinated group,” Dr. John said. Doctors advising people with cirrhosis may warn them about this delay in immune protection, he added.

Longer follow-up is needed

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

There was a downward trend vaccine protection in people with decompensated cirrhosis, defined as people with liver symptoms that do not work properly, compared to people with compensated compensation cirrhosis with good liver function. However, the number of decompensated patients was low and the finding needs to be further studied. Dr. John credits the collaboration and contributions of his co-authors, including Andrew Scheinberg, MD, a fellow and one of his students, for publication in the prestigious journal.

“The synergy we have fostered between UM and Miami VA is tremendous,” he added. “It really helps to work closely with UM collaborators when you submit these jobs.”

The study is titled “Association of BNT162b2 mRNA and mRNA-1273 vaccines with COVID-19 infection and hospitalization among 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.