TY - JOUR
T1 - Adherence to preventive measures after SARS-CoV-2 vaccination and after awareness of antibody response in kidney transplant recipients in the Netherlands
T2 - a nationwide questionnaire study
AU - Frölke, Sophie C.
AU - Bouwmans, Pim
AU - Messchendorp, A. Lianne
AU - Vervoort, Johanna P.M.
AU - Abrahams, Alferso C.
AU - de Vries, Aiko P.J.
AU - Nieuwkerk, Pythia T.
AU - Hemmelder, Marc H.
AU - Gansevoort, Ron T.
AU - Hilbrands, Luuk B.
AU - Reinders, Marlies E.J.
AU - Sanders, Jan Stephan F.
AU - Bemelman, Frederike J.
AU - Geerlings, Suzanne E.
AU - Imhof, C.
AU - Idzinga, C.
AU - Siegert, C.
AU - Baan, C. C.
AU - Konings, C. J.A.M.
AU - van Kessel, C.
AU - van Baarle, D.
AU - Diavatopoulos, D. A.
AU - Standaar, D.
AU - ten Hoope, E.
AU - Til, E.
AU - Remmerswaal, E. B.M.
AU - van der Klis, F.
AU - Fritsen, H. R.
AU - Stijnman, I.
AU - Brinkman, J. N.
AU - Cheng, J.
AU - den Biggelaar, L.
AU - ten Dam, M.
AU - Steenhuis, M.
AU - Zwerink, M.
AU - Braks, M. H.J.
AU - Willems, M.
AU - Kho, M. L.
AU - Rots, N.
AU - Vart, P.
AU - van der Molen, R. G.
AU - van den Dorpel, R. M.A.
AU - Malaha, R. S.R.K.
AU - ter Meulen, R. C.G.
AU - Rispens, T.
AU - Steenvoorden, T.
AU - de Ronde, T.
AU - Peters, V. J.P.
AU - Konijn, W. S.
AU - Janssen, W. M.T.
AU - RECOVAC Collaborators
N1 - Funding Information:
The Netherlands Organization for Health Research and Development and the Dutch Kidney Foundation.We would like to thank the RECOVAC Collaborators: Y. M. R. Adema, Department of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; M. ten Dam, MD, PhD, Dutch Registry RENINE, Nefrovisie, Utrecht, the Netherlands; C. Imhof, MD, Department of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; T. Rispens and M. Steenhuis, Department of Immunopathology, Sanquin Research, Amsterdam, the Netherlands; T. Steenvoorden, MD, Department of Nephrology, Department of Internal Medicine, University of Amsterdam, Amsterdam University Medical Centre, Amsterdam, the Netherlands. The initiative to construct these questionnaires came from the RECOVAC patient representatives of the Dutch Kidney Patient Association (NVN), Bussum, the Netherlands, to not only focus on the immunogenicity of the SARS-CoV-2 vaccines in kidney patients, but also on the association between adherence to preventive measures and acquiring SARS-CoV-2 infection: W. S. Konijn, representing M. H. J. Braks, E. ten Hoope, C. Idzinga, and T. de Ronde. We thank our funding sources, The Netherlands Organization for Health Research and Development and the Dutch Kidney Foundation. A complete list of all collaborative authors is enclosed as a Supplemental file.
Funding Information:
We would like to thank the RECOVAC Collaborators: Y. M. R. Adema, Department of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; M. ten Dam, MD, PhD, Dutch Registry RENINE, Nefrovisie, Utrecht, the Netherlands; C. Imhof, MD, Department of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; T. Rispens and M. Steenhuis, Department of Immunopathology, Sanquin Research, Amsterdam, the Netherlands; T. Steenvoorden, MD, Department of Nephrology, Department of Internal Medicine, University of Amsterdam, Amsterdam University Medical Centre, Amsterdam, the Netherlands. The initiative to construct these questionnaires came from the RECOVAC patient representatives of the Dutch Kidney Patient Association (NVN), Bussum, the Netherlands, to not only focus on the immunogenicity of the SARS-CoV-2 vaccines in kidney patients, but also on the association between adherence to preventive measures and acquiring SARS-CoV-2 infection: W. S. Konijn, representing M. H. J. Braks, E. ten Hoope, C. Idzinga, and T. de Ronde. We thank our funding sources, The Netherlands Organization for Health Research and Development and the Dutch Kidney Foundation . A complete list of all collaborative authors is enclosed as a Supplemental file.
Publisher Copyright:
© 2023 The Author(s)
PY - 2023/8/1
Y1 - 2023/8/1
N2 - Background: Kidney transplant recipients (KTRs) were advised to tightly adhere to government recommendations to curb the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) because of a high risk of morbidity and mortality and decreased immunogenicity after vaccination. The aim of this study was to analyse the change in adherence to preventive measures after vaccination and awareness of antibody response, and to evaluate its effectiveness. Methods: In this large-scale, national questionnaire study, questionnaires were sent to 3531 KTRs enrolled in the Dutch RECOVAC studies, retrospectively asking for adherence to nine preventive measures on a 5-point Likert scale before and after SARS-CoV-2 vaccination and after awareness of antibody response. Blood samples were collected 28 days after the second vaccination. Antibody response was categorised as non-responder (=50 BAU/mL), low-responder (>50 = 300 BAU/mL) or high-responder (>300 BAU/mL), and shared with participants as a correlate of protection. Participants of whom demographics on sex and age, blood samples and completed questionnaires were available, were included. Our study took place between February 2021 and January 2022. The primary outcome of adherence before and after vaccination was assessed between August and October 2021 and compared via the Wilcoxon signed rank sum test. Logistic regression analysis was performed to estimate the association between antibody response and non-adherence, and adherence on acquiring SARS-CoV-2 infection. This study is registered at ClinicalTrials.gov (NCT04841785). Findings: In 2939 KTRs (83%) who completed the first questionnaire on adherence to preventive measures, adherence was higher before than after vaccination (4.56, IQR 4.11–4.78 and 4.22, IQR 3.67–4.67, p < 0.001). Adherence after awareness of antibody response was analysed in 2399 KTRs (82%) of whom also blood samples were available, containing 949 non-responders, 500 low-responders and 950 high-responders. Compared to non-responders, low- and high-responders reported higher non-adherence. Higher adherence was associated with lower infection rates before and after vaccination (OR 0.67 [0.51–0.91], p = 0.008 and OR 0.48 [0.28–0.86], p = 0.010). Interpretation: Adherence decreased after SARS-CoV-2 vaccination and in KTRs who were aware of a subsequent antibody response compared with those without. Preventive measures in this vulnerable group seem to be effective, regardless of vaccination status. This study starts a debate on sharing antibody results with the patient and future studies should elucidate whether decreased adherence in antibody responders is justified, also in view of future pandemics. Funding: The Netherlands Organization for Health Research and Development and the Dutch Kidney Foundation.
AB - Background: Kidney transplant recipients (KTRs) were advised to tightly adhere to government recommendations to curb the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) because of a high risk of morbidity and mortality and decreased immunogenicity after vaccination. The aim of this study was to analyse the change in adherence to preventive measures after vaccination and awareness of antibody response, and to evaluate its effectiveness. Methods: In this large-scale, national questionnaire study, questionnaires were sent to 3531 KTRs enrolled in the Dutch RECOVAC studies, retrospectively asking for adherence to nine preventive measures on a 5-point Likert scale before and after SARS-CoV-2 vaccination and after awareness of antibody response. Blood samples were collected 28 days after the second vaccination. Antibody response was categorised as non-responder (=50 BAU/mL), low-responder (>50 = 300 BAU/mL) or high-responder (>300 BAU/mL), and shared with participants as a correlate of protection. Participants of whom demographics on sex and age, blood samples and completed questionnaires were available, were included. Our study took place between February 2021 and January 2022. The primary outcome of adherence before and after vaccination was assessed between August and October 2021 and compared via the Wilcoxon signed rank sum test. Logistic regression analysis was performed to estimate the association between antibody response and non-adherence, and adherence on acquiring SARS-CoV-2 infection. This study is registered at ClinicalTrials.gov (NCT04841785). Findings: In 2939 KTRs (83%) who completed the first questionnaire on adherence to preventive measures, adherence was higher before than after vaccination (4.56, IQR 4.11–4.78 and 4.22, IQR 3.67–4.67, p < 0.001). Adherence after awareness of antibody response was analysed in 2399 KTRs (82%) of whom also blood samples were available, containing 949 non-responders, 500 low-responders and 950 high-responders. Compared to non-responders, low- and high-responders reported higher non-adherence. Higher adherence was associated with lower infection rates before and after vaccination (OR 0.67 [0.51–0.91], p = 0.008 and OR 0.48 [0.28–0.86], p = 0.010). Interpretation: Adherence decreased after SARS-CoV-2 vaccination and in KTRs who were aware of a subsequent antibody response compared with those without. Preventive measures in this vulnerable group seem to be effective, regardless of vaccination status. This study starts a debate on sharing antibody results with the patient and future studies should elucidate whether decreased adherence in antibody responders is justified, also in view of future pandemics. Funding: The Netherlands Organization for Health Research and Development and the Dutch Kidney Foundation.
KW - Adherence
KW - Behavior
KW - Kidney transplantation
KW - SARS-CoV-2
KW - Vaccination
U2 - 10.1016/j.eclinm.2023.102103
DO - 10.1016/j.eclinm.2023.102103
M3 - Article
C2 - 37533418
SN - 2589-5370
VL - 62
JO - EClinicalMedicine
JF - EClinicalMedicine
IS - 1
M1 - 102103
ER -