Immunocompromised people have a reduced ability to fight infections and are more vulnerable to severe COVID-19. That is why the U.S. Centers for Disease Control and Prevention (CDC) is recommending that people with moderately to severely compromised immune systems receive an additional dose of the Pfizer-BioNTech or Moderna vaccine.
In this Q&A, Meenakshi Rana, MD, Associate Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai, and the Director of Transplant Infectious Disease, explains why immunocompromised people, who make up almost three percent of the U.S. population, should get this third vaccine dose and why it is important to take other protective measures.
What did the CDC recommend?
The CDC and the Advisory Committee on Immunization Practices took an important action to prevent COVID-19 infection in our immunocompromised population and among transplant recipients. They now recommend that people who are moderately to severely immunocompromised receive an additional dose of an mRNA COVID-19 vaccine, either Pfizer or Moderna, at least 28 days after the completion of the initial series. The Food and Drug Administration (FDA) now allows for the additional dose for these people as well.
To be clear, this is not considered a booster dose. A booster dose is given to a patient whose immunity to the vaccine may have waned over time. This is considered an additional dose, given to immunocompromised patients to improve their initial response to the vaccine series. These patients are essentially receiving a three-dose mRNA vaccine series instead of a two-dose series.
Who is considered immunocompromised and should get the third dose?
Meenakshi Rana, MD
Immunocompromised patients are a very large and heterogeneous group. For the purposes of an additional COVID-19 vaccine, the CDC has defined a specific moderately to severely immunocompromised group, which includes:
- Patients who have been receiving active cancer treatment for tumors or cancers of the blood
- Patients who had a solid organ transplant, such as a heart, lung, liver or a kidney, and currently take immunosuppressive medications
- Patients who had a bone marrow transplant within two years or had a bone marrow transplant and are currently taking immunosuppressive therapy, or patients who receive CAR T-cell therapy.
- Patients who have advanced or untreated HIV
- Patients who have another medical condition that require high-dose steroids or immunosuppressive therapy for that medical condition
If you think you fall within this category, it’s important that you speak to your physician to determine if you are eligible for an additional dose of mRNA COVID-19 vaccine.
Why is the CDC taking this action?
Patients who are considered moderately to severely immunocompromised are more vulnerable to COVID-19. They are more likely to have severe disease, and more likely to be hospitalized with COVID-19. In addition, there has been data suggesting that moderately to severely immunocompromised patients may not have as strong an immune response to the initial COVID-19 vaccine series, and we have seen breakthrough infections in vaccinated immunocompromised patients, occasionally requiring hospitalization. The CDC also now has data suggesting that a third vaccine would be safe.
What should I do if I think I am affected by this action by the CDC?
If you think you are considered moderately to severely immunocompromised, talk to your doctor to see if you are eligible for an additional dose of COVID-19 vaccine. The CDC recommends that you receive a third dose with the same mRNA vaccine. For example, if you received an initial Moderna vaccine series, then you should complete your series with an additional third dose of the Moderna vaccine.
What if I am immunocompromised and I received the Johnson & Johnson vaccine?
When the CDC made this recommendation, they did not have enough data on whether immunocompromised patients who received the J&J vaccine would have an improved response after receiving an additional dose of the same vaccine. For this reason, we are currently awaiting more guidance from the CDC on what to recommend for these patients.
If I am immunocompromised, what else should I do to protect myself?
In addition to receiving an additional dose of an mRNA vaccine, you should continue to practice all those protective precautions that we’ve been discussing: social distancing, hand hygiene, and masking. It’s also very important that all of those around you, your family and your friends, are all vaccinated.
The FDA has also authorized the use of a medication, known as a monoclonal antibody, for what is termed “post- exposure prophylaxis.” That means, if you are exposed to a loved one or family member with COVID-19, this medication can be given to you to prevent COVID-19 and progression to severe disease or hospitalization with COVID-19. You should call your physician to see if you are eligible.
Should I get an antibody test to see if I am eligible for the third dose?
We are not recommending that you get an antibody test for this purpose, because we don’t know what level of antibodies is considered protective. We recommend that if you are considered immunocompromised, you should receive an additional vaccine dose, regardless of antibody response.