Hybrid immunity, resulting from a combination of SARS-CoV-2 infection and vaccination, offers robust protection against COVID-19 in the general population. However, its impact on immunocompromised patients remains unexplored. We investigated the effect of hybrid immunity against the Omicron variant in a population of kidney transplant recipients receiving the fourth dose mRNA monovalent vaccination. By extracting data from the clinical records and performing individual interviews, participants were categorized into the hybrid cohort (previously infected and vaccinated individuals) and the vaccine cohort (vaccinated-only individuals). The study comprised 1114 participants, 442 in the hybrid and 672 in the vaccine cohorts. From April 2022 to August 2023, 286 infections, 38 hospitalizations and 9 deaths were reported. The cumulative incidence of infection was 12.1% (95% confidence interval [CI], 9.03-16.03) for the hybrid cohort and 36.54% (95% CI, 32.81-40.54) for the vaccine cohort after 300 days of follow-up. Hybrid immunity was associated to a 72% lower risk of infection (adjusted hazard ratio, 0.28; 95% CI, 0.21-0.38) and a 96% lower risk of hospitalization (adjusted hazard ratio, 0.04; 95% CI, 0.01-0.32). No deaths occurred in the hybrid cohort. Hybrid immunity was associated with a lower incidence of SARS-CoV-2 infection and severe COVID-19, underscoring its importance for risk stratification in this vulnerable patient population.

中文翻译：

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肾移植中针对 SARS-CoV-2 和重症 COVID-19 的混合免疫保护：一项回顾性、比较队列研究


由 SARS-CoV-2 感染和疫苗接种相结合产生的混合免疫为普通人群提供了针对 COVID-19 的强大保护。然而，它对免疫功能低下患者的影响仍未得到探索。我们调查了在接受第四剂 mRNA 单价疫苗接种的肾移植受者群体中对 Omicron 变体的混合免疫效果。通过从临床记录中提取数据并进行个人访谈，参与者被分为混合队列（以前感染和接种疫苗的个体）和疫苗队列（仅接种疫苗的个体）。该研究包括 1114 名参与者，其中 442 名是混合动力参与者，672 名是疫苗队列参与者。从 2022 年 4 月到 2023 年 8 月，共报告了 286 例感染、38 例住院和 9 例死亡。随访 300 天后，混合队列的累积感染率为 12.1% （95% 置信区间 [CI]，9.03-16.03），疫苗队列的累积感染率为 36.54% （95% CI，32.81-40.54）。混合免疫与感染风险降低 72% 相关 （校正风险比，0.28;95% CI，0.21-0.38） 和住院风险降低 96% （校正风险比，0.04;95% CI，0.01-0.32）。杂交队列中没有发生死亡。混合免疫与 SARS-CoV-2 感染和严重 COVID-19 的发生率较低相关，强调了其对这一脆弱患者群体风险分层的重要性。