Indian Journal of Transplantation

SPECIAL ARTICLE
Year
: 2021  |  Volume : 15  |  Issue : 1  |  Page : 1--3

NOTTO COVID-19 vaccine guidelines for transplant recipients


Vivek Kute1, Sanjay K Agarwal2, Jai Prakash3, Sandeep Guleria4, Sunil Shroff5, Ashish Sharma6, Prem Varma7, Narayan Prasad8, Manisha Sahay9, Subhash Gupta10, S Sudhindran11, Kewal Krishan12, Vasanthi Ramesh13, Sunil Kumar14,  
1 Department of Nephrology, Institute of Kidney Diseases and Research Center; Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat; Secretary, Indian Society of Organ Transplantation (ISOT), Delhi, India
2 Department of Nephrology, All India Institute of Medical Sciences, Delhi, India
3 Former Professor and Head Nephrology, Banaras Hindu University, Varanasi, Uttar Pradesh; President, Indian Society of Organ Transplantation (ISOT), Delhi, India
4 Department of Transplantation Surgery, Apollo Hospital; Past President, Indian Society of Organ Transplantation (ISOT), Delhi, India
5 Managing Trustee, MOHAN Foundation, Chennai, Tamil Nadu; President-Elect, Indian Society of Organ Transplantation (ISOT), Delhi, India
6 Department of Transplant Surgery, The Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
7 Department of Nephrology, Venkateshwar Hospital, Delhi, India
8 Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
9 Department of Nephrology, Osmania Medical College, Hyderabad, Telangana, India
10 Department of Liver Transplant Surgery, Max Center of Liver and Biliary Sciences at Max Hospital, Saket, Delhi; Past President, Liver Transplant Society of India (LTSI), Kochi, Kerala, India
11 Clinical Professor in Transplantation and Gastrointestinal Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala; President, Department of Cardiovascular Surgery Max Super Specialty Hospital, Saket, New Delhi, India
12 Department of Cardiovascular Surgery Max Super Specialty Hospital, Saket, New Delhi; President, Indian Society for Heart and Lung Transplantation, Delhi, India
13 Director, National Organ and Tissue Transplant Organization, Delhi, India
14 Director General of Health Services, Delhi, India

Correspondence Address:
Dr. Vasanthi Ramesh
Director, National Organ and Tissue Transplant Organization, 4th Floor, National Institute of Pathology, NIOP Building, Safdarjung Hospital Campus, New Delhi - 110 029
India

Abstract

In December 2019 Novel corona virus (SARS-CoV-2) infection started in Wuhan and resulted in a pandemic within few weeks' time. Organ transplant recipients being at a risk for more severe COVID-19 if they get SARS CoV-2 viral infection, COVID 19 Vaccine has a significant role in these patients. The vaccine is a safer way to help build protection and would either prevent COVID -19 infection or atleast diminish the severity of the disease. It would also reduce the risk of the continuing transmission and enhance herd immunity. Immuno compromised patients should not receive live vaccines as they can cause vaccine related disease and hence the guidelines suggest that all transplant recipients should receive age appropriate 'inactivated vaccine' as recommended for general population. Though trials have not been undertaken on transplant recipients, efficacy and safety of COVID-19 vaccine have been scientifically documented for few vaccines among the general population.



How to cite this article:
Kute V, Agarwal SK, Prakash J, Guleria S, Shroff S, Sharma A, Varma P, Prasad N, Sahay M, Gupta S, Sudhindran S, Krishan K, Ramesh V, Kumar S. NOTTO COVID-19 vaccine guidelines for transplant recipients.Indian J Transplant 2021;15:1-3


How to cite this URL:
Kute V, Agarwal SK, Prakash J, Guleria S, Shroff S, Sharma A, Varma P, Prasad N, Sahay M, Gupta S, Sudhindran S, Krishan K, Ramesh V, Kumar S. NOTTO COVID-19 vaccine guidelines for transplant recipients. Indian J Transplant [serial online] 2021 [cited 2021 Apr 11 ];15:1-3
Available from: https://www.ijtonline.in/text.asp?2021/15/1/1/312748


Full Text



 Introduction



With the use of COVID-19 appropriate behavior, in many countries, the incidence of COVID-19 is decreasing, though not with the same degree in every country. With the development of a safe vaccine against COVID-19, its global utilization is paramount. Transplant recipients being a high-risk group for COVID-19 infection, these vaccines are urgently required for these patients. The Centers for Disease Control and Prevention suggest that COVID-19 vaccination will help in the prevention of COVID-19, is a safer way to help build protection, and will be an important tool to help in stopping ongoing pandemic.[1]

Advantages of getting a COVID-19 vaccine[1],[2],[3],[4],[5],[6]

Risk of acquiring COVID-19 infection goes down substantiallyRisk of having severe COVID disease even if one acquires the infection is substantially reducedThe risk of continuing transmission to others will decreaseVaccine will help in the faster development of herd immunity.

 Rationale and General Principle for the Vaccination



Severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection has significantly impacted transplant recipients, with high morbidity and mortality (5%–35%).[7],[8],[9] Vaccination for these high-risk patients is a priority.

Patients with immunosuppression may have reduced response to vaccination because of altered T-lymphocyte functions. These patients may have lower antibody responses compared to the general population. Antibody response usually correlates with the degree of immunosuppressionIn general, in immunocompromised patients, live vaccines can cause vaccine-related disease; therefore, patients with organ transplants should not receive live vaccines.[10],[11],[12] Kidney Disease: Improving Global Outcomes and American Society of Transplantation-Infectious Disease Community of Practice guidelines suggest that all transplant recipients should receive age-appropriate “inactivated vaccine” as recommended for the general population[13],[14]Efficacy and safety of COVID-19 vaccine have been scientifically documented only for few vaccines and many are still under clinical trial.[15],[16],[17],[18] Initial trial of COVID-19 vaccine had included healthy volunteers, and patients with comorbidity but trials on transplant recipients have not been done till the publication of these guidelinesParticipating recipients can have minor side effects as seen in many other vaccines such as vaccine site pain, fever, fatigue, muscle and joint pain, and headache after administration of COVID-19 vaccine. These side effects do not mean vaccines are unsafe. Severe or long-lasting side effects are extremely rare. In addition, COVID-19 vaccines are continuously being monitored for safety in postmarketing surveys to detect rare adverse eventsIn cases of any adverse event, the transplant patient is required to report to health-care providers for appropriate management. After the completion of COVID-19 schedule, routine antibody testing is not required to confirm seroconversion. If needed for research, antibody testing can be done after 14 days of the second doseMore studies are required to document energy, duration of immunity, and requirement of a booster dose in case no antibodies develop. [Table 1] shows details of few common regulatory bodies' approved COVID-19 vaccine.{Table 1}

 COVID-19 Vaccine Guidelines



We recommend that all transplant team members should support and encourage appropriate uptake of vaccine by counseling transplant recipients and addressing vaccine hesitancyWe recommend using virtual platforms for information related to COVID-19 vaccine for all transplant team members, who are a major source of information for the transplant recipient communityBased on other vaccine guidelines for solid organ transplant recipients,[11],[12],[13],[14],[15] we suggest that transplant recipients and their household members should get vaccinated against any COVID-19 vaccine that is authorized or approved by their health regulators/agencies. Transplant recipients scheduled for transplantation should be given vaccine 2 weeks prior to surgery or 1 to 6 month posttransplant.[13],[14] Even after vaccination, COVID-19 appropriate behaviors such as wearing face mask, hand hygiene, cough etiquettes, and social distancing should be continued by all recipientsTransplant recipients who have previous COVID-19 infection and or have antibodies against COVID-19 are also required to be vaccinated. There is no need of testing for antibodies against coronavirus before giving COVID-19 vaccination. Transplant recipients should undergo an entire schedule of vaccination with only one type of vaccine and different COVID-19 vaccines should not be used in the same patient. In case, a transplant recipient misses the second dose of COVID-19 vaccine at the scheduled time, then the second dose is to be given as early as possible. Revaccination is not requiredTransplant patients with suspected or active SARS-Cov2 infection should not get the vaccination. Vaccination should be deferred for 4–8 weeks after symptom resolutionPlease see the details of COVID-19 vaccine operational guidelines updated as of December 28, 2020.[2],[3],[22]

Disclaimer: COVID-19 pandemic is evolving in a dynamic manner, therefore, this COVID-19 vaccine Guideline is a live and dynamic document and will be updated as per the evolving situation. This is consensus Guidelines of National Organ and Tissue Transplant OrganisationIndian society of Organ Transplantation, Liver Transplant Society of India and Indian Society for Heart and Lung Transplantation as on January 19, 2021.

Note: This special article is being published simultaneously in the Indian Journal of Transplantation and the Indian Journal of Nephrology, as per the decision of Editor-In-Chiefs of both these journals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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