Six Things to Know If You Are Immunocompromised and Considering a 3rd ShotClick to enlarge this image toggle caption Christiana Botic/Boston Globe via Getty Images Christiana Botic/Boston Globe Via Getty ImagesTo increase their protection against COVID-19, people with compromised immune systems can get a third dose of Moderna or Pfizer vaccines.Many patients and doctors have been requesting this decision for months. Federal health agencies made their decision this week.Pat Beale (59), Boise, Idaho. He has a liver transplant. His immune system suppressor medication is what he takes. He expects to receive his third dose in the next week.Research shows that immunocompromised patients such as transplant recipients or those on immuno-suppressing drugs have shown weak reactions to vaccines.Houston Methodist Hospital's Dr. Marc Boom said that the authorization for third shots was urgently needed for the large number of patients in his hospital's transplant program.Boom states, "We are immediately pulling these people in, getting them the doses." Boom applauds FDA's decision but believes the FDA could have acted sooner. He points out that other countries, such as Israel, France, and the U.K, have made similar moves.Friday's Centers for Disease Control and Prevention recommendations leave many questions unanswered about who is eligible for additional doses and how they can be obtained. Here are the facts.1. Why should people with immunocompromised bodies get a third shot.A compromised immune system can increase your risk of serious illness or death from COVID-19. Studies have shown that people with compromised immune systems are more likely to receive lower doses of vaccine than those without severe immune deficiencies. This is a difference between 59% and 72% for people with weak immune systems and 90% to 94% for those who have no serious health issues.Patients with weakened immune systems are more likely to get a breakthrough infection than those in normal health. A U.S. study found that 40% to 44% hospitalized breakthrough cases were in immunocompromised patients."If I were someone on one of these medications, you know I would almost consider me unvaccinated at that point," Dr. David Karp, who is the head of the Division of Rheumatic diseases at UT Southwestern Medicine Center, says.Karp said that although the delta surge is mostly affecting unvaccinated individuals, immunosuppressed patients who have been vaccinated are also landing at hospitals with COVID-19.Karp, who is also the president of the American College of Rheumatology, stated that "for this group of patients you know, a 3rd shot is going to enhance their response to vaccine and thus lessen their chances of contracting the disease"Patients like Valen Keefer in California who received a kidney and liver transplant are relieved to know that there is another way.She says, "This is an incredible and so important step and necessary for a while to our transplant community." It's been difficult to know when and what to do.2. Who should take the third shot?Only a small number of people with weak immune systems are eligible for the third dose. It is recommended for people with moderately or severe immunocompromised, as well as those who have:Received active treatment for cancers of blood or tumorsHave had an organ transplant. Are taking medication to suppress the immune systemIn the past two years, received a stem cell transplant or are on medicine to suppress your immune systemModerate to severe primary immunodeficiency (such a DiGeorge syndrome or Wiskott Aldrich syndrome).HIV infection that is untreated or advancedHigh-dose corticosteroids and other drugs may be used to suppress your immune system.Because the Moderna vaccine is not yet approved for adolescents, this recommendation is restricted to adults over 18 years of age. Pfizer has approved the vaccine for adults and adolescents 12 years and older.3. Although I don't know if my immune system is compromised, I have a chronic condition that renders me susceptible to severe COVID-19. Should I get a third shot?Some people may be more at risk for serious illness from COVID-19 because of their age or pre-existing conditions. They may need another dose of vaccine. For now, however, additional shots are not recommended for those who meet the CDC criteria for immunocompromised.Patients with chronic conditions, even those that are more likely to develop severe COVID-19, are not allowed to receive an additional dose.Dr. Amanda Cohn, chair of the CDC committee, stated that "this would not include long term care facility residents, people with diabetes, or persons with heart disease these types of chronic medical conditions aren't the intention here."Although it is not yet clear if or when boosters will be more widely recommended to vulnerable populations, this is being done in Israel and other countries. Officials from the Health Department are currently monitoring how immune responses hold up to vaccine clinical trials. Officials from both the FDA, and CDC state that these trials will help determine when booster shots should be administered.4. Do I have to sign up for the shot? Or should I consult my doctor first? Do I need to show that I am immune-suppressed?Talk to your doctor about your immune-suppressing condition. At vaccine sites, a doctor's note will not be necessary. A person needs to simply inform staff they are moderately or severely immunocompromised. It is best to consult your doctor before you get the shot. Dr. Dorry Segev is a Johns Hopkins University transplant surgeon who studies COVID-19 vaccinations among organ transplant recipients.Your doctor can help you decide if third shots are worth the risks. He says, "My hope is this will be an individual patient and provider shared decision."Segev warns that people with compromised immune systems should be aware that "everytime we activate the immune system there is a chance," Transplant recipients, for example, could be at risk of rejection. He says, "These things must be done in a very carefully, deliberate, and thoughtful way with people’s medical teams."Karp explains that it is possible for patients with certain conditions to temporarily stop taking immune-suppressing medication to allow the third dose of vaccine to take effect. Talk to your doctor to discuss your specific situation and ways to improve your chances of getting the vaccine to work.5. How good is my protection if I get another shot?People can become immunosuppressed for many reasons. It could be due to their age, medical condition, and the drugs or treatments they are currently taking. Although studies have shown that third-generation vaccines can increase antibody responses in certain people, they are not guaranteed to work for everyone.When a third shot is given to immunocompromised patients, it's important to remember that they are not always immune from COVID-19. Dr Helen Keipp Talbot warned this during an ACIP committee meeting.They'll be safer but still have a high risk of severe diseases and death. Talbot also says that everyone they meet should be vaccinated to protect them.The CDC's Dr. Kathleen Dooling presented to the committee that immunocompromised persons, even those who have received an additional dose of vaccine, should continue to adhere to prevention measures. These include wearing a mask and staying six feet away from people they don't know, and avoiding crowds or poorly ventilated indoor areas. She also advised close friends of immunocompromised persons to get vaccinated, if not already.6. Do I have to get the same vaccine that I received for my first dose? What do I do if the J&J vaccine is given to me?The CDC recommends that you get the same vaccine as you received for your first two doses. For example, if you had the Moderna or Pfizer first two doses of the vaccine, you should get that one for the third. If that is impossible, the CDC committee stated that an additional dose of the other mRNA vaccine can be given.At the moment, only Pfizer or Moderna vaccines can be used for an additional dose. You are still not eligible if you have the J&J.According to the FDA, there was not enough data to allow for an extension of the authorization for additional J&J shots. Representatives from both the FDA & CDC stated that they are "actively involved" in determining the best course for Johnson & Johnson vaccine recipients and anticipate learning more "very soon."
