My Experience with a 3rd Dose of Vaccine

[Morello]

I want to share my experience with a 3rd dose of Covid Vaccine.

I had 2 doses of the Pfizer shot in January, and tested my antibodies at Labcorp in mid June. That spike protein receptor binding domain test came back at 21 U/ml. Not nothing, but not great. My immune-competent wife, who has had 2 doses of Moderna, took the same test; her result - 1400 U/ml. Probably the middle of the 'normal' response range for most healthy folks.

I received a 3rd dose at a local Rite-Aid by making an appointment, walking in and simply telling the tech that I wanted to get vaccinated. No problem. No questions asked. Here in Seattle there are many vaccine doses going unused. I received the Moderna vaccine for this third dose. I tested at Labcorp 2 weeks later, resulting in a 'score' of 963 U/ml.

I am well pleased. I shared my result with my nephrologist, and she is pleased. She wanted me to explain what I had done so she could share this with other interested patients. In her role as a nephrologist with a large HMO, she can't recommend this action yet, which I understand. And if a patient wants to advocate for their own health, and do their own research and accept the risks involved, she is willing to share this info with them.

That's why I want to share this with the group here. Many will wait for wider health policy changes to approve this in their local jurisdiction, like has already happened in France and Israel and elsewhere. Some will be able to weigh the risks and benefits, and if 3rd vaccines are available, they might choose this course. Everyone has their own model for healthcare decisions.

Final note - I'm not changing my behavior based on this lab result - I still wear an N-95 mask indoors when shopping, etc. I'm not flying anywhere -I canceled 2 important airline trips this spring and early summer due to my perceived risk. I'm not seeing my own patients in person - I will still work via telemedicine for the rest of the year. I just have a little more peace of mind, and I feel good about doing my research and advocating for my health in important ways like this.

I hope this information is helpful for some of the members of this group.

[76caddy]

That is great news and thanks for sharing. To get tested for the spike protein do you ask for the “spike protein receptor binding domain test” ?

[Morello in reply to 76caddy]

My only reasonable option to get an antibody test here was at Labcorp, and this 'Spike Protein Receptor Binding Domain' test is the only one I was offered at Labcorp. I hope that helps.

[A-A-B-J]

I got tested after 2 maderna shots. 0 was my number. I won’t get a 3rd vaccine as I was so sick with the 2nd one. I still wear a mask.

[KathleenMA]

Thanks for sharing. Did the pharmacist ask for your COVID vaccination card to update it? Any issues there? I’m seeing my nephrologist on Thursday. All I want to talk about is third dose. I also understand that an advisory committee at the CDC on immunizations have 3rd shot for immunocompromised on their agenda this week.

[theaurabesh]

Thank you for sharing your experience. Did you experience any side effects from the 3rd shot? Other than a sore arm, I did not have any side effects after my second dose.

[Morello in reply to theaurabesh]

I didn't mention this in my post, but I had almost no symptoms after the second dose, and in contrast I had a significant response after the third dose - very achy/painful at injection site, fatigue, malaise, headache etc. I took these symptoms as a good sign, and in my case I think they were. Symptoms lasted about 24 hours, then gone.

[LisaSnow]

Thank you for sharing. I am glad it worked out for you. Just a reminder to others that vaccination imposes unique risk to transplant patients. Multiple studies found that vaccination induced antiody formation against HLA - including transplant donors', in up to 20% of transplant patients. Donor specific antibodies are the cause of antibody-mediated rejection which has much fewer treatment option compared with acute rejection.

This is partly why transplant patients must discuss pros and cons of any procedure (especially those outside of your doctor's explicit recommendation) before getting them, so they can inform you of risks and keep an eye on you after to monitor signs of potential vaccine associated risks.

[Morello in reply to LisaSnow]

Hi Lisa - good point; there are risks to any course of action, especially in those of us with kidney transplants on strong immune-suppressant meds. In my case, I was in contact with my nephrologists before and after getting the 3rd dose of vaccine, and I monitored my kidney health with lab work. I would recommend this for any transplant patient. Anti-HLA antibody formation after doses of Covid vaccine has indeed been documented. After the flu vaccine also. Do you know the rate of formation of these anti-HLA antibodies after the 2nd Covid Vaccine in the solid organ transplant population? And what is the relative increase between formation after the 1rst, 2nd and possible 3rd dose? I wonder if those numbers are anywhere to be found.

[LisaSnow in reply to Morello]

Great questions! The induction of antibodies was first observed post flu vaccine, it isn't clear what specific type of vaccine is linked to the highest risk. I don't know if studies can answer the question easily because different patients are on different combination of immunosuppressive drugs of various doses, all of these factors can affect production of "any" antibodies. Moreover, the etiology that caused renal failure differs in different patients. Some diseases are antibody mediated making "false antibody production" easier. I wish more is known about how immune activation post vaccine can become dysregulated but it isn't an easy question to address scientifically.

[Balap in reply to LisaSnow]

Hi Lisa,

may I know the article in you are referencing "Multiple studies found that vaccination induced antiody formation against HLA - including transplant donors', in up to 20% of transplant patients"

I guess what are referring above is for patients awaiting renal transplantation, who have recovered from COVID disease, and their blood has class I HLA-Ab (not against HLA-A, HLA-B, HLA-C, HLA-DRB1, HLA-DP, DQ, DR which are important in kidney transplant)

ncbi.nlm.nih.gov/pmc/articl...

sciencemag.org/news/2021/07...

Two recently published studies have shown promising results. In the first, published last month in The New England Journal of Medicine, 68% of organ recipients produced antibodies after a third dose of the mRNA vaccine made by Pfizer, up from 40% after two doses.

In another study published last week in JAMA, doctors administered a third dose of Moderna’s mRNA vaccine to 159 kidney transplant patients who generated little to no antibodies after two doses. They found that 49% of these patients subsequently started to churn out antibodies.

The French government endorsed third doses for transplant patients in April. The United Kingdom’s National Health Service also plans to begin to offer a third vaccine dose to immunocompromised individuals beginning this fall.

[LisaSnow in reply to Balap]

The vaccines were not COVID vaccines but flu vaccine. The mechanism is similar across the vaccines as the purpose is to activate the recipient's immune system to recognize the target, but our immune system isn't perfect. I am at work but will send the article later. The antibody formation, if against the transplant organ's genotypes, is a terrible thing.

[Balap in reply to LisaSnow]

Below is another article that I have found in internet. It is good that transplant centre test for DSA (Creatinine is a late indicator)

ebm.bmj.com/content/early/2...

Happily, as more transplant patients went on to be vaccinated, early theoretical concerns of activation of the immune system by the vaccine, triggering episodes of rejection, have not been observed.

My transplant centre at the University of Pennsylvania tests for early signs of rejection in patients 1 month after the second dose of the vaccine by checking for donor specific antibodies (DSAs) and by monitoring the health of the transplant with regular blood tests. They want to check to see if an immune response triggered by the vaccine might also cause my body to be rejecting and/or recognising the transplanted kidney as a foreign body. This has become part of their clinical protocol for kidney, pancreas, kidney–pancreas, heart–kidney and a few other combinations of transplants that tests for DSAs. Thankfully, I got my tests done, and all was good with my kidney transplant.

[LisaSnow in reply to Balap]

You should probably put quotes around the text that came from the article.

Are you getting DSA tested? That test is a routine test with or without vaccination at mine. It is interesting to read that not all centers test for it because B cell mediated rejection is more difficult to treat.

[Balap in reply to LisaSnow]

I forgot to put those quotes! DSA tested once and 3 biopsies, so far good

[LisaSnow in reply to Balap]

As promised:

kidney.org/atoz/content/Ant... (Brief description of the clinical significance of anti-HLA antibodies)

pubmed.ncbi.nlm.nih.gov/285... (data demonstrating vaccine-associated formation ofAnti-HLA and anti-MICA Antibodies to be highest in transplant patients.)

onlinelibrary.wiley.com/doi... (data showing anti-HLA antibodies formed against both the "self" and the donor's after immunization.)

[LisaSnow in reply to Balap]

Also I am all in support of those who want a third booster shot. I myself would not need nor want one but it is a good idea for those who didn't get detectable SARS2 spike protein antibodies after the original dose(s) to get the 3rd booster shot when their transplant team recommends it to them.

[TeamO]

What was the name of the actual lab that you had drawn? My results came back “negative” vs a number that you reference. I had Pfizer fist dose in January, second in February. Was tested last week in Prep of getting a third shot.