Recent findings show that a third dose of the COVID-19 vaccine is highly effective in patients with cirrhosis of the liver. Patients who are affected by cirrhosis are more vulnerable to the infection, leading to higher hospitalisation and mortality rates than patients without liver disease. Cirrhosis leads to decreased responsiveness to vaccines, including the COVID-19 mRNA vaccines after two doses, compared to the healthy population; however, a booster vaccination significantly reduces occurrence, severe disease, and death from COVID-19, according to a new study.
Lead investigator Binu John, University of Miami Miller School of Medicine, Florida, USA, and collaborators performed a retrospective cohort study, including patients with cirrhosis who had received two or three doses of the Moderna mRNA-1273 vaccine or the Pfizer BNT162b2 vaccine, between 18th December 2020 and 11th February 2022. The researchers propensity-matched 13,000 participants who had received three doses with 13,000 controls who had received two doses.
The findings showed that the third dose significantly reduced severe outcomes, leading to an 80% decrease in the development of symptomatic or asymptomatic COVID-19, and a 100% reduction in severe or critical disease and death, compared to those who had received two doses. This suggests that the booster enables patients to overcome the vaccine hyporesponsiveness caused by cirrhosis. This was the case for patients with compensated and decompensated cirrhosis; however, the effects were more significant in patients with compensated cirrhosis.
While authors had anticipated that the third dose would offer better protection, they noted that the magnitude of the reduction was remarkable, and more significant than in the healthy population. They concluded that all patients with cirrhosis should receive the third vaccination, as well as other potential boosters. John stated: “These findings inspired us to focus on the next question: What is the additional benefit of booster doses in cirrhosis, and particularly against the Delta and Omicron variants.”