The Centers for Disease Control and prevention (CDC) announced new vaccination guidelines in mid-February, focused specifically on the “moderately to severely immunocompromised” population, updating their recommendations from last summer, when the Food and Drug Administration (FDA) and the CDC recommended that the immunocompromised receive an additional, or third dose of the mRNA vaccines.
My goals in this essay are to review what is generally considered “immunocompromised”, clarify some of the jargon that you’ll encounter should you pursue this subject further, and provide the highlights of the new guidelines.
After two years of COVID, Americans should probably be aware that there is extensive scientific evidence indicating that immunocompromised individuals are at increased risk for both serious COVID complications, and a higher mortality rate than the population at large. In addition, the immune response following vaccination may be weaker or of shorter duration in the immunocompromised.
Simply put, these are people whose immune system isn’t working “as well as it should” to provide protection against infection. This increased risk was corroborated in a study published last year in the Journal of the American Medical Association (JAMA).
The Immunocompromised:
Epidemiologists estimate that about 3 percent of the population of the United States, — well over a million people, are considered “moderately to severely immunocompromised,” and are at much greater risk for serious illness if they contract COVID, even after vaccination.
Note that the prevalence of individuals, who have an immunocompromising condition of some sort or are taking medications that suppress the immune system, is substantially higher. A study, published last year in “JAMA Network Open”, found that over 3 percent of Americans between the ages 18 and 64, were prescribed medications that suppressed the immune system.
However, many conditions and treatments can cause a person to be immunocompromised; and other health conditions may weaken the immune system. For example, some studies link alcohol addiction with a suppressed immune system.
In addition, age is also a factor; and, according to Dr. Jessica Lancaster, a Mayo Clinic immunologist, “our immune systems start to gradually decline as we age, and have a much more delayed immune response when faced with infection. Those over the age of 65 have a weakened immune system, and those 80 and older are considered immunocompromised.”
You’re going to encounter some jargon, and two particularly important terms are the “mRNA vaccines”, which are the Pfizer and Moderna vaccines, which do not use a weakened or attenuated “germ” to stimulate the immune response; and the “primary series”, which in the context of the two mRNA vaccines, refers to their administration in two doses, one month apart; followed by a third “dose, one month after the second dose, for immunocompromised individuals.”
Note that, in this case, the CDC avoided the term, “booster”, rather emphasizing that the third dose should be considered part of a normal vaccination course, or “primary series”, for the immunocompromised.
The New Guidelines:
The CDC’s new recommendations include:
- organ and stem cell transplant recipients, who are taking medications to fight rejection by suppressing the immune system
- people with advanced or untreated HIV
- people being treated for cancer with chemotherapy or radiation
- individuals taking medications like high-dose corticosteroids, that weaken the immune system.
Not included at this time are people with chronic medical conditions like diabetes or heart disease.
The new guidance relates only to the two most commonly administered vaccines: Moderna and Pfizer; and not to the J& J vaccine, which has not been extensively studied among the immunocompromised.
Note that in Connecticut, the Pfizer vaccine was administered in nearly 59 percent of cases; Moderna in nearly 38 percent; and J&J in the remainder, or roughly 3 percent.
The fundamental and most important change in these new guidelines is the recommendation that a 4th dose be administered to the “moderately to severely immunocompromised” in certain age groups. Here, the CDC considers the 4th dose as a “booster”.
In the following, I highlight the latest CDC recommendations for vaccines within a few age groups in the “moderately to severely immunocompromised population”
- Children 5 to 11 years old should complete the “primary series”; with no “booster”.
- Children 12 to 17 should complete the “primary series”; with a “booster” 3 months after the third dose.
- People age 18 and older should complete the “primary series”; with a “booster” 3 months after the third dose.
People who have received a J&J vaccine can follow the link below for details on the CDC’s new recommendations for J&J recipients.
COVID-19 Vaccines for Moderately or Severely Immunocompromised People | CDC
A Few Nuances:
The FDA has approved the use of the Moderna vaccine on people who are 18 and older. It has not yet been approved for lesser ages.
The Pfizer vaccine is the vaccine of choice for children age 5 to 11 and 12 to 17.
Pfizer is currently testing its vaccine in children less than 5-years-old, and anticipates an FDA submission near mid-year.
Author’s Notes: I have not attempted to provide an exhaustive list of all immunocompromising conditions. If you have concerns about your own medical history, you should, of course consult whomever you see for medical advice. However, I have used some fairly robust sources in drafting the above; and based this report on information from the CDC, Ledge Light Health District (LLHD), the Johns Hopkins Coronavirus Resource Center, and the Yale School of Medicine. This is complicated stuff, and I hope that I’ve brought some clarity to the new guidelines.
Note that I received my 4th dose last week at LLHD HQ; and they also have frequent vaccination clinics there and at locations throughout Southeast CT. You can find these on their website.
I think that the bottom line is that getting this additional “booster” can help restore protection against COVID, which may have decreased over time (i.e. since your first dose.)
Cogent to the max. Thanks for this information