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What immunosuppressed patients should know about the coronavirus vaccines

Cancer patients. Organ transplant recipients. Individuals with HIV. Those with autoimmune or chronic inflammatory conditions such as lupus, multiple sclerosis and rheumatoid arthritis.

Millions of people in the United States are considered immunocompromised, including those who were born with immune-system deficiencies. It often makes them more susceptible to infections and puts them at higher risk of experiencing a more severe outcome when they become ill. So it makes sense why many would want to inoculate themselves against covid-19, the illness caused by the novel coronavirus — and public health authorities have advised them to do it.

But even though the coronavirus vaccines authorized for emergency use by the Food and Drug Administration are considered safe for people with compromised immune systems, they may not work as well, or at all, for some Americans. Even those who do make antibodies have expressed concern about them waning, particularly as the highly transmissible delta variant has become the dominant strain in the United States. Indeed, a small study in Israel showed that about 40 percent of the 152 breakthrough infections that resulted in hospitalization were in people with compromised immune systems.

That’s why public health authorities have been working to understand more about vaccine effectiveness within the immunocompromised community and how to protect the most vulnerable. In fact, the Centers for Disease Control and Prevention now recommends a third dose of the two-dose messenger RNA vaccines — Pfizer-BioNTech and Moderna — for people who are moderately to severely immunocompromised.

I’m immunocompromised. Will the vaccines work for me?

No one knows yet for certain, and it will probably depend on a number of factors — the individuals, the illnesses and which immune-suppressing treatments are involved in their care.

U.S. clinical trials did not specifically study the effectiveness of the coronavirus vaccines in people with compromised immune systems, so there is not yet conclusive data to show how they will ultimately respond. But early research seems to suggest it will be a mixed bag — that although some immunocompromised individuals may make antibodies, others may not. And for those who do, it is not known whether the antibodies will be effective at neutralizing SARS-CoV-2, what level of antibody will be needed to protect against infection or how long the antibodies will last.

Many of these questions remain unanswered for the general population, as well.

Coronavirus vaccines may not work in some people. It’s because of their underlying conditions.

Ghady Haidar, an infectious-diseases physician at the University of Pittsburgh Medical Center who specializes in organ transplant recipients, said he and his team studied immune responses in blood-cancer patients who received both doses of one of the mRNA vaccines and discovered that 46 percent of them did not produce any antibodies against covid-19. Haidar has since led a subsequent study showing that the vaccine-induced antibodies varied depending on the type of underlying immune system issue.

“These were expected results, as disappointing as it is,” Haidar said of the findings.

Similarly, a research letter that was published in JAMA found that 46 percent of 658 transplant patients did not mount an antibody response after completing either the Pfizer or Moderna vaccine series. And some research suggests that some treatments may impact immune responses. One preprint showed that patients with chronic renal insufficiency who were on hemodialysis had less vaccine-induced immunity.

Haidar said each flu season, he urges his cancer and transplant patients to get the flu shot, telling them that although it’s “probably not going to work as well as with someone with a healthy immune system, it might soften the blow.”

“My hope is the same will hold true for covid-19,” he said.

All of that said, some early studies are showing that, for some patients, the vaccines are producing antibodies.

In fact, a study out of Mount Sinai’s and New York University’s medical schools documented detectable antibodies in inflammatory bowel-disease patients who received at least one dose of either the Pfizer or Moderna vaccines.

Charlotte Cunningham-Rundles, an immunologist at the Icahn School of Medicine at Mount Sinai who was not involved in the previously mentioned study, said she has also seen an immune response in some of her patients after coronavirus infection and vaccination. Cunningham-Rundles treats many patients with congenital immune-system deficiencies.

However, she said, a “big caveat” to her observations is whether the detected antibodies are capable of fighting infection and for how long they will be able to do the job.

CDC backs third vaccine dose for immunocompromised people

These are reasons why the Food and Drug Administration amended its emergency use authorizations to include a third mRNA dose for immunocompromised individuals. The CDC now recommends that people who are moderately to severely immunocompromised — including those being treated for certain cancers, those who have received an organ transplant and those who have chronic medical conditions that can weaken immune responses — get a third shot at least 28 days after completing the initial two-dose mRNA series.

This article originally appeared in The Washington Post. Read more here.

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