How Soon Should Immunocompromised People Get the COVID Booster Shot?

Q: With the FDA authorizing third doses of the COVID vaccines for the most vulnerable, how soon can someone who is immunocompromised schedule an appointment?

A: On August 12, 2021, the FDA updated its emergency use authorization for both Pfizer-BioNTech’s and Moderna’s COVID-19 vaccines for immunocompromised individuals, specifically, solid organ transplant recipients (kidney, liver, intestines, heart, lung and pancreas) or those who are diagnosed with conditions considered to be at the same level of immunocompromise.

Transplant recipients have to be very careful because their immune systems are suppressed to reduce the chances of their bodies rejecting the new organs they receive. Overall, immunocompromised people are at increased risk for poor outcomes from COVID-19, and studies have shown a reduced antibody response for this patient population after vaccination.

On October 20, 2021, the FDA amended the EUA to include booster shots of all three vaccines (Pfizer, Moderna and Johnson & Johnson). For Pfizer and Moderna, the parameters are patients:

• Age 65 and older.
• Age 18 through 64 at high risk of severe COVID-19.
• Age 18 through 64 whose frequent institutional or occupational exposure to SARS-CoV-2 puts them at high risk of serious complications of COVID-19 including severe COVID-19.

Additionally, the Johnson & Johnson vaccine booster was cleared for all recipients age 18 and up who received the single dose that one-shot vaccine. The FDA is also allowing a “mix and match” system for boosters. In other words, once you’ve completed your original vaccine dose, you can receive any of the available vaccines as a booster.

In July, the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) presented “Data and Clinical Considerations For Additional Doses In Immunocompromised People” during a meeting. One finding in this presentation was that recent studies have indicated that additional COVID-19 vaccine doses in immunocompromised people enhanced antibody responses and increased the proportion that responded. In smaller studies, the immunological responses of the third dose were about the same as prior doses.

Currently, the CDC recommends that moderately to severely immunocompromised people receive an additional dose. This includes people who have:

• Received active cancer treatment for tumors or cancers of the blood.
• Received an organ transplant and take medicine to suppress their immune system.
• Received a stem cell transplant within the last 2 years or take medicine to suppress their immune system.
• Moderate or severe primary immunodeficiency (such as DiGeorge syndrome or Wiskott-Aldrich syndrome).
• Advanced or untreated HIV infection.
• Active treatment with high-dose corticosteroids or other drugs that may suppress your immune response.

If you qualify, you can get the third dose of a COVID vaccine as soon as possible. However, talk to your healthcare provider first to determine if you should.

— Hematologist Matt Kalaycio, MD