COVID booster benefits immunocompromised people, experts say
Severely immunocompromised people should consider receiving a third dose of a COVID-19 vaccine, several members of a federal advisory committee said Thursday, and should certainly take other precautions such as wearing masks and making sure those who those around them are vaccinated.
The Advisory Committee on Immunization Practices (ACIP), which does not have the regulatory authority to officially recommend a third injection, presented data at its meeting on Thursday that suggested that a booster injection was not likely. to cause harm and could benefit an immunocompromised person because of cancer or on strong drugs to prevent autoimmune reactions or organ rejection.
“There is enough data to suggest that an additional dose would be helpful,” said Dr. Grace Lee, committee member and professor of pediatrics at Stanford University School of Medicine in California.
In four small studies of transplant and dialysis patients who did not develop antibodies in response to two injections, 33 to 50% developed them after a third.Lee said she hoped federal agencies would monitor people who receive a third dose to make sure those injections are safe.
The Centers for Disease Control and Prevention said booster injections are not yet necessary for the general public, as people continue to be well protected by their initial injections. Currently, 97% of people hospitalized with COVID-19 have not been vaccinated, according to the CDC.
While vaccines protect over 90% of healthy people against symptoms of COVID-19 and even more against serious illnesses, injections are less protective for people with cancer, especially blood cancers, people taking immunosuppressive drugs and transplant patients.
Immunocompromised people are at an above average risk of becoming seriously ill if they catch COVID-19, CDC’s Dr Sara Oliver told the committee. They are also more likely to pass the virus on to people they live with. And more than 40% of people hospitalized with COVID-19 after being vaccinated are immunocompromised.
About 2.7% of the population – or 900,000 Americans – are immunocompromised, she said.
Some immunocompromised patients are already receiving booster shots on their own, without being studied or monitored to make sure they are safe, Dr Dorry Segev, transplant surgeon and researcher at Johns Hopkins Medicine,who is not related to the committee said after the meeting.
“Every time you give someone a vaccine, you are trying to activate their immune system,” Segev said in an interview. In a transplant patient, activating the immune system could damage their donated organ, despite medications aimed at preventing the body from rejecting it. The first two doses of COVID-19 vaccine appear to be safe for transplant patients, but only a few dozen patients have been followed so far after a third.
Blood cancer patients also appear to be able to take the first two doses of the COVID-19 vaccine safely, said Dr. Gwen Nichols, chief medical officer of the Leukemia and Lymphoma Society, a research group. and support.
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But it’s not yet clear whether a booster will be safe and effective for people with leukemia, lymphoma or multiple myeloma, she said.
“We should all act without being vaccinated, especially patients with blood cancer,” she said. “Continue to avoid places where you cannot control your surroundings. Don’t let people embarrass you for wearing a mask.”
In a study of 1,500 blood cancer patients published online Thursday, 75% developed a measurable immune response after receiving both doses of the vaccine, but 25% did not.
Many patients who did not produce antibodies were not on active treatment, suggesting that their disease, and not their treatment, is undermining their immune response, said Nichols, whose organization is still seeking volunteers for its register of vaccinated patients.
It is not known what level of antibodies protects against infection or serious illness. The immune system has other defenses besides antibodies, so just because someone doesn’t have antibodies doesn’t mean it’s completely dangerous.
In addition, antibody levels decline over time, while protection against vaccination appears to remain strong for at least 6 to 12 months. And antibody levels are recorded differently by different tests.
This is why the CDC discourages people from checking their antibody levels to decide if they are properly protected.
But Segev said he is using antibody tests to screen candidates for his research trials, hoping to identify those who need a boost most. To participate in one of its trials, a patient must have no detectable antibodies or measure less than 50 units per milliliter more than one month after two injections of Pfizer or Moderna vaccine, using the Roche Elecsys anti-Receptor test Binding Domain (RBD).
Segev recently received a $ 40 million grant from the National Institutes of Health to study ways to better protect kidney transplant recipients.
He plans to enroll the first patients next month in a pilot study in Johns Hopkins and then expand it nationwide.
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It’s crucial, Segev said, to follow patients as they try different approaches to protection to make sure they’re safe and others can learn from their experiences.
Dr Jason Goldman, who represented the American College of Physicians at Thursday’s meeting, said he saw six COVID-19 patients in his clinic on Wednesday, all vaccinated, as well as a newborn baby, who had been infected with an unvaccinated family member.
“I’m concerned that the boosters may not be more effective in the immunocompromised than in the initial series (of shots),” said Goldman, who practices in Coral Springs, Fla. “We need to stress the importance of creating a circle of protection for ourselves and our families, friends and loved ones… making sure everyone gets vaccinated.”
Contact Karen Weintraub at [email protected]
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