Immunocompromised patients need to know what to do.
All she wants to do is hug her grandchildren. My dear friend is 76 years old and has battled Rheumatoid arthritis for decades. She followed all of the rules. She sheltered in place, wore a mask, and continued her immunosuppression medication.
The worst part was she could not see her six grandchildren.
Hope arrived when she qualified for Covid vaccination. She received her two-dose regimen of the Moderna mRNA vaccine. Unfortunately, she did not generate antibodies.
Her life-saving immunosuppression medication blocked the vaccine response.
She is not alone. Seven million Americans (2.7%) have some form of immune system suppression. Multiple vaccine studies indicate these patients do not always develop immunity after vaccination.
Immunosuppressed patients are searching for answers on how to stay safe without coming off the medication they need to stay alive. Transplant recipients, people with HIV, cancer patients, and those with autoimmune disorders want to know what to do?
Immunocompromised patients face grim choices.
- Rely on immunity from vaccinated people in their community.
- Hope monoclonal antibodies are available if they get sick.
- Stop their necessary medication to allow the vaccine to work.
Another option deserves much more media and scientific attention. Should immunocompromised people get a third dose of the Covid vaccine?
As Covid cases increase across the country, immunosuppressed people need an answer now.
Millions of people around the world have a medical condition or take medication that affects the immune system. These medications help keep them alive but cause problems when it is time to get a vaccine.
Vaccines trigger the immune system to create antibodies to fight against infections. Our bodies use antibodies, T Cells, and B cells to protect against disease.
When the FDA approved Covid vaccines under the Emergency Use Authorization, scientists worried immunocompromised people might not be able to generate enough antibodies to be protected against Covid-19.
Unfortunately, the scientists' fears were spot on.
In the initial mRNA FDA approval trials, immunocompromised individuals were excluded. But subsequent research, focused mainly on transplant patients, shows a lower rate of immunity after vaccination.
This paper in JAMA evaluated 436 transplant recipients. Only 17% produced a positive antibody response to the SARS-CoV-2 spike protein after the first dose of mRNA vaccines. Patients taking specific medication (antimetabolite maintenance) had the lowest response.
A second JAMA study followed 658 transplant recipients to see how they responded to the second dose of the mRNA vaccine. The good news is the majority of patients had a positive antibody response. The bad news is the antibodies were lower than patients with normal immune systems indicating many immunosuppressed patients will not be protected from Covid-19 after a two-dose regimen.
A large study at the University of Pittsburg titled “Immunogenicity of COVID-19 Vaccination in Immunocompromised Patients” released interim results (not peer-reviewed). This paper also showed immunocompromised people have a lower antibody response after Covid vaccination.
- Vaccinated solid organ transplant patients: 37.2%
- Blood cancer patients: 54.7%
- Solid tumor cancer patient: 82%
- Autoimmune disorders: 83.8%
This study showed promising results for people living with HIV. 94.6% of patients generated antibodies.
The FDA and CDC recommend immunocompromised people get vaccinated., wear a mask in public and continue social distancing. Families can help protect their loved ones by getting themselves vaccinated. Increasing the overall vaccination rates in a community helps protect these patients with suppressed immune systems.
Evidence is starting to emerge, showing a third dose of the Covid-19 vaccine may help people with weakened immune systems get over the hump. A study published in the Annals of Internal Medicine offers promising results.
This paper evaluated patients who did not mount an antibody response after two doses. One in three people who got a third shot generated a positive antibody response.
France is already giving a third Covid-19 vaccine dose to the immunocompromised. A NEJM study of organ transplant recipients showed Covid antibodies increased from 40% to 68% after a third dose of the vaccine.
The French Vaccine Strategy Guidance Council announced recommendations for a third dose to be given four weeks after the second dose.
At this time, the US regulatory agencies have not updated guidelines recommending a third dose. It is time for the public health experts to weigh in on the evidence.
Immunocompromised patients need to know what to do. So do the doctors who care for them.
And my friend wants to hug her grandchildren.
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