Covid-19 vaccine for individuals with weakened immunity

With the recent approval of Covid-19 booster vaccines by the Federal Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC), I wanted to the touch on one specific high-risk population for which recommendations vary barely – individuals with immunocompromised systems. First, it is vital to notice that current FDA-approved Covid-19 vaccines don’t contain live viruses and could be safely administered to immunocompromised people. However, research has shown that some individuals with weakened immune systems don’t develop the identical level of immunity after vaccination and will profit from an extra dose (CDC, 2021a). Without producing adequate antibodies, these persons are at higher risk of critical illness from Covid-19.

People with moderate or severely compromised immune systems make up nearly 3% of the U.S. adult population. The study found that 44% of hospitalized breakthrough cases within the US were on this high-risk group (Oliver, 2021). The Advisory Committee on Immunization Practices (ACIP) encourages these individuals to receive an “extra” or third dose of the mRNA vaccine on a shorter timeline, not less than 28 days after completing the first 2-dose series (CDC, 2021b). This additional dose was found to reinforce the antibody response and increase the speed of vaccine responders. ACIP recommends that, at any time when possible, the identical mRNA vaccine be used for all 3 doses. If the identical mRNA vaccine just isn’t available, one other COVID-19 mRNA vaccine could also be administered.

CDC (2021b) currently recommends an extra dose of the mRNA vaccine for the next individuals who:

• They are undergoing cancer treatment for tumors or blood cancers
• He underwent a solid organ transplant and is on immunosuppressive drugs
• Received a CAR-T cell or stem cell transplant (inside 2 years of transplant or are taking immunosuppressive medications)
• Have moderate or severe primary immunodeficiency (i.e. DiGeorge syndrome, Wiskott-Aldrich syndrome)
• They have advanced or untreated HIV infection
• Are they receiving lively treatment with high-dose corticosteroids or other medications which will suppress the immune response, similar to:
  • High-dose corticosteroids (i.e. 20 mg of prednisone or more every day for 14 days or longer)
  • Alkylating agents
  • Antimetabolites
  • Transplant-related immunosuppressive drugs
  • Chemotherapeutic agents classified as highly immunosuppressive
  • Tumor necrosis factor (TNF) blockers.
  • Other biological agents with immunosuppressive or immunomodulatory effects

Booster dose for immunocompromised people?

There have been questions on whether immunocompromised people should proceed to receive a booster dose after completing the two-dose series of mRNA vaccines and a 3rd additional dose. The FDA recently approved booster shots for this high-risk group, and the CDC has updated its guidelines to point this alteration. The recent guidelines state that moderately or severely immunocompromised people aged 18 years or older who’ve accomplished a primary mRNA vaccine series against Covid-19 and have received an extra third mRNA vaccine can receive a single booster dose against Covid-19 (Pfizer-BioNTech, Moderna [half dose]or Janssen) not less than 6 months after receiving the third dose of the mRNA vaccine, for a complete of 4 doses (CDC, 2021c). People who initially received the Janssen/J&J single Covid-19 vaccine should receive a single Covid-19 booster vaccine (Pfizer-BioNTech, Moderna [half dose]or Janssen) not less than 2 months (8 weeks) after receiving your initial basal dose of Janssen. Do not give greater than two doses of Janssen. The patient’s caregiver and clinical team should determine the suitable timing and spacing of vaccinations in relation to other treatments.

General considerations

Advise your immunocompromised patients to proceed personal measures to scale back exposure to Covid-19 infection, similar to masking, physical distancing, and avoiding crowds, even after being fully vaccinated. Encourage household members and other close contacts of immunocompromised patients to also get vaccinated.

Centers for Disease Control and Prevention (2021a, October 18). Covid-19 vaccines for moderately and severely immunocompromised people. Downloaded from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html

Centers for Disease Control and Prevention (2021b, October 25). Covid-19 vaccination considerations for moderately and severely immunocompromised people. Downloaded from https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#considerations-covid19-vax-immunocopromised

Centers for Disease Control and Prevention (2021c, October 25). Considerations for using a Covid-19 vaccine booster. Downloaded from https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#considerations-covid19-vax-booster

Oliver, S. (2021). Data and clinical considerations for added doses in immunocompromised individuals. . Downloaded from https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-07/07-COVID-Oliver-508.pdf