Immunogenicity of COVID-19 vaccines in patients with cirrhosis: Expected advantage for additional dose of vaccine

This article responds to:

Immunogenicity of COVID-19 vaccines in patients with cirrhosis: A meta-analysis

Dear Editor, we would like to share ideas on the publication “Immunogenicity of COVID-19 vaccines in patients with cirrhosis: A meta-analysis.”¹  According to Ouyang et al., patients with cirrhosis, especially decompensated cirrhosis, who have received all recommended doses of the COVID-19 immunization, ought to get ongoing care as well as preventative measures. In fact, even after receiving the full normal dose of the COVID-19 immunization, patients with a history of immunological deficiencies typically struggle to achieve acceptable immunogenicity. The meta-analysis’s conclusions imply that after receiving the routine COVID-19 immunization, individuals with cirrhosis – especially those with decompensated cirrhosis – show weakened immune responses. Compared to healthy people, these patients may be more vulnerable to breakthrough infections as a result of their lowered response. Consequently, there is a justification for administering an extra dose of the COVID-19 vaccine to cirrhosis patients in order to boost immunogenicity and improve protection against COVID-19 in this susceptible group, given the lower seroconversion rates and cellular immune responses in this patient population. In individuals with cirrhosis, additional doses may help enhance the immune response and vaccine efficacy, lowering the risk of serious consequences and breakthrough infections. When making judgments, healthcare providers should take into account the unique characteristics of each patient, particularly the degree of cirrhosis.

Finally, we would also like to mentioned about the expected usefulness of additional dose of COVID-19 vaccine for the patients with underlying cirrhosis. The can be estimated based on the clinical mathematical model as presented in the previous report.² The third dosage of the COVID-19 vaccine can be estimated for patients with cirrhosis using a methodology akin to that of the HIV-infected research. This entails predicting the immunoprotective impact of the third booster dosage in individuals with cirrhosis by mathematical modeling. The results of the meta-analysis on the immunogenicity of the COVID-19 vaccine in patients with cirrhosis indicate that the pooled seroconversion rate at the end of immunization was 92.4%. According to a prior study,² administering the third dose of the COVID-19 mRNA vaccine can provide an extra 23.3% protection, which implies that it can greatly boost immunoprotection for patients who have underlying cirrhosis.

Authors’ contribution

HP 50% ideas, writing, analyzing, approval.

VW 50% ideas, supervision, approval.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.