They’re cancer patients. Transplant recipients. People with lupus, rheumatoid arthritis, HIV/AIDS, sickle cell disease, kidney failure and Crohn’s disease. Plus millions of others who have conditions or take medications that weaken their immune systems.
That makes them—millions of teens and adults—what doctors call immunocompromised.
And that puts them at much higher risk of serious illness if they get COVID-19, which is why many states prioritized them for vaccination early this year.
Now, most of them are now eligible for even more protection.
The FDA and CDC have just approved and recommended an additional dose of mRNA COVID-19 vaccines as part of a primary series for moderately and severely immunocompromised people.
The additional dose should be the same mRNA COVID-19 vaccine as the first two shots the person received before, and should be administered at least 28 days after completion of the initial primary series of two shots. Specifically, those who have had two doses of the Pfizer vaccine can get a third dose of that vaccine, and those who have had two doses of the Moderna vaccine can get a third dose of that vaccine.
This is not considered a “booster shot,” but rather an additional dose to the recommended use of COVID-19 vaccines in these individuals. It’s being recommended because they have likely not produced an adequate immune response after getting the first two doses of COVID-19 vaccine.
Currently there is not data to support giving a dose of mRNA COVID-19 vaccine to immunocompromised people whose previously received the one-dose Johnson & Johnson/Janssen vaccine. A recommendation for immunocompromised people who got that vaccine is still being developed.
Immunocompromised people are more likely to get severely ill from COVID-19, are at higher risk for prolonged viral infection and shedding of the virus, are more likely to transmit the infection to people they live with, and show a lower immune response to vaccination compared to non-immunocompromised people, says Pamela Rockwell, D.O., a Michigan Medicine family physician and associate professor at the University of Michigan Medical School.
She represents the American Academy of Family Physicians on the CDC advisory panel that just approved the new recommendation.
“As COVID-19 surges across the country, vaccinated people who are immunocompromised and have completed a two-dose series of either the Pfizer or Moderna COVID-19 vaccine series should obtain a third dose of the same mRNA vaccine that they have already received, at least 28 days from their second vaccine dose. This includes children and adolescents 12 and older who are immunocompromised,” said Rockwell.
“If you aren’t sure if you or your child falls into this group, talk with a trusted health care provider,” she added. “And if you fall into the third-dose group, but you haven’t gotten vaccinated at all yet, or haven’t finished your two-dose series, now’s the time to do it.”
Other steps immunocompromised people should take
Vaccination is not all people in this group should do, she adds.
“It’s important for immunocompromised people to wear masks in public, maintain social distancing of at least 6 feet from people they do not live with, avoid crowds and poorly ventilated indoor spaces until advised otherwise by their healthcare provider, and to encourage everyone over the age of 12 who interacts with them closely to get vaccinated if they aren’t already,” she said.
“They may not realize how much they are putting you at risk, or that your immunocompromised state puts you at high risk of severe COVID-19,” she added. “Ask them to help protect you.”
Rockwell also encourages people who get a third dose of COVID-19 vaccine to sign up for the CDC’s V-safe system, which will text them occasionally to ask them to report any reactions to the vaccine. This will help collect data that will guide the vaccination process and look for any rare effects.
Surging spread poses risk to immunocompromised people
The new approval couldn’t have come at a better time, given the fact that nearly the entire country is now experiencing high levels of spread of the coronavirus because of the highly contagious Delta variant.
It’s also a reminder of the fact that immunocompromised people remain vulnerable to severe cases of COVID-19 even after they’ve gotten vaccinated.
And some of them may not have gotten vaccinated yet, because their doctors are following recommendations that advise them to wait a certain amount of time after they finish a cancer therapy or get a transplant.
While the overwhelming majority of people hospitalized for COVID-19 right now are unvaccinated adults and children, many of the rest of those in hospitals for COVID-19 care have a condition or take a medication that affects their immune system.
Advanced age can also affect immune response, but the new recommendation is not age-based. And a recent study by a U-M team found that nearly 3% of insured United States adults under the age of 65 take medications that weaken their immune systems. The findings, made using data from over 3 million patients, focused on people taking chemotherapy medications and steroids such as prednisone.
Who’s eligible for a third dose?
Here’s a partial list of the conditions and treatments that could qualify someone for a third dose of COVID-19 vaccine.
If you have one of these conditions or are on one of these treatments, or have another condition or take another medication that affects your immune system, contact your health provider or your child’s provider to see what they recommend.
Primary immune deficiency diseases
Cancers (solid tumors or blood cancers like leukemia and lymphoma) currently being treated with any treatment that reduces immune response, or treated in the past two years with a stem cell (bone marrow) transplant or CAR-T therapy
Organ transplant for any condition (liver, heart, kidney, lung, pancreas) now taking anti-rejection medications
HIV infection or AIDS
Chronic use of corticosteroids such as prednisone, especially high doses equivalent or larger than 20 milligrams of prednisone per day
TNF blockers such as Remicade, Enbrel, Humira, Cimzia, and Simponi, and other biologic agents that suppress or modify the immune response in order to treat an autoimmune diseases such as lupus, rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriasis or other condition
People with end-stage kidney disease and people on dialysis
Anyone who has had their spleen removed for any reason
Other options for all at-risk teens and adults
Rockwell said that individuals whose health providers do not yet recommend a third dose for them should refrain from seeking a third dose at this time.
But, she adds, recommendations could change in future to include them as well. The CDC committee she serves on will also examine the issue of booster shots for other individuals.
She also noted another new FDA approval that could help immunocompromised people, and others over the age of 12 who aren’t fully vaccinated and have risk factors for severe COVID-19.
The FDA just approved the use of monoclonal antibody therapy as a preventive therapy, for high risk people who know they’ve been exposed to an infected person or live in a facility where someone has gotten COVID-19.
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Should you get a third dose of COVID vaccine? (2021, August 17)
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HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
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