Points of View: COVID Vaccines in the Immunocompromised

Calabrese, Rheumatology: There have been many different concerns brought by patients surrounding COVID vaccines that encompass misinformation to something they read or encountered.

It’s important to understand the source of patients’ desire to not be vaccinated or fear in order to have this conversation that I know we're going to have.

Patients think that because they have autoimmune diseases, they don’t need to be vaccinated or they shouldn’t be vaccinated. This has been very interesting to me and actually something I’ve heard many times from patients about the flu shot that someone told them they shouldn't get the flu shot because they have an autoimmune disease, so that’s out there.

Many patients are concerned about risk of flaring their underlying immune-mediated inflammatory disease with vaccines, in particular the mRNA vaccines after reading about the reactogenicity that can occur. Those are two of the bigger ones as well as concern that they won’t respond well depending on what medicine they're on or because they are immunocompromised.

Soiffer, Hematology/Oncology: Immunocompromised patients do not have the ability to fight many different types of infection and that, of course, includes COVID-19. They have diminished cellular and often humeral immunity, that is inadequate T-cell function, inadequate NK cell function, and deficient antibody production. In particular, patients with hematologic malignancies who've received therapies that target B cells have a difficulty producing antibodies. A particular drug is, of course, rituximab, CD20-directed antibodies, rituximab or the many other types of CD20-directed antibodies. As well, there are medications out there that impact B cells in other ways and T-cell in other ways. It makes the patient less able to fight an infection.

Patel, Allergy: Immunocompromised patients are a different group that we consider to be at increased risk for severe disease, hospitalization, and death. We take immune compromised patients very seriously, and have a conversation about staying healthy. Now, that includes being up to date on all vaccines, including a COVID vaccine, to try and mitigate or reduce the severe infection.

Patients are at risk, for not only our immune compromised patients at risk, but they can be at risk just from household contact. It is important to also address a vaccines and getting boosted with COVID vaccines in order to protect that individual or individuals who are in the immunocompromised patient’s household.