COVID Vaccination in Immunosuppressed Patients Produces Weak Response
An article by Dorry Segev, MD, PhD for MedPage Today reveals poor results for COVID vaccination in immunosuppressed patients, with concerning implications.
Dr Segev professor of surgery and epidemiology and associate vice chair of surgery at Johns Hopkins University School of Medicine and Bloomberg School of Public Health.
Dr Segev and colleagues launched a national study of vaccine immune responses in immunosuppressed solid organ transplant recipients. Among 436 COVID-naïve participants who received their first mRNA vaccine dose, only 17% of them mounted detectable antibodies to SARS-CoV-2. The researchers also found that those taking anti-metabolites (eg, mycophenolate or azathioprine) were less likely to develop antibody responses, with 8.75% with detectable antibody found in those taking anti-metabolites versus 41.4% in those not taking them.
“Naturally, we were disappointed to see these findings, as we were hoping to be able to tell our immunosuppressed patients that the vaccines seemed to work well for them. Given this observation, the CDC should update their new guidelines for vaccinated individuals to warn immunosuppressed people that they still may be susceptible to COVID-19 after vaccination,
Dr Segev wrote.
The current CDC guidelines are worded in a way that suggests vaccination translates into immunity, Dr Segev pointed out, but the study demonstrates that for most transplant recipients, as well as other immunosuppressed patients that the vaccine does not automatically confer immunity. This could also be a concern for the some 37.9 million people around the world living with HIV, although the effects of achieving viral suppression with antiretroviral therapy have so far not been well investigated in relation to COVID. Vaccine trials so far have not had sufficient numbers of participants living with HIV to draw any conclusions.
Notably, their previous research did show that rates of COVID infection and mortality were not greater for immunosuppressed transplant patients.
Dr Segev noted that there are some implications for immunosuppressed patients; firstly, that they should at the very least receive the second dose of their vaccination (the current research is only on the effects of the first dose), and secondly, immunosuppressed patients should be aware that they may not necessarily be immunised after receiving a vaccination. They should speak to their provider about an antibody test to determine if the immunisation has been achieved.
The researchers are continuing to investigate other aspects of immune response besides antibodies, such as T and B cells, and are also looking at other vulnerable populations.
Source: MedPage Today
