JAMA. 2022;327(6):517. doi:10.1001/jama.2022.0727
Last June, health authorities in France authorized a fourth COVID-19 mRNA vaccine dose for solid organ transplant recipients who had not adequately responded to 3 doses. A study involving kidney transplants demonstrated that antibody levels increased for some poor responders after a fourth dose of either the BNT162b2 (Pfizer-BioNTech) or the mRNA-1273 (Moderna) vaccines. The case series, published in the Annals of Internal Medicine, included 92 patients from 3 university hospitals in France, all of whom had IgG titers lower than 143 binding antibody units (BAU) per milliliter a month after their third vaccine dose. Anti–SARS-CoV-2 spike protein IgG titers higher than 143 BAU/mL correlate with neutralizing antibodies against the wild-type virus and some variants, including Alpha and Beta. A month after the participants received a fourth vaccine dose, their median anti-spike IgG levels increased from 16.4 BAU/mL to 145 BAU/mL. Half of the group reached the 143 BAU/mL threshold, with no difference between BNT162b2 vaccine or mRNA-1273 vaccine recipients. Those who had a fourth shot of the mRNA-1273 vaccine developed higher titers—a median of 150 BAU/mL compared with 122 BAU/mL for the BNT162b2 vaccine recipients.
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