Points of View: COVID Vaccines in the Immunocompromised

Soiffer, Hematology/Oncology: We’re trying to follow the guidance of the CDC and infectious disease experts as to how to position booster vaccines. As I may have mentioned, there is a general 2- to 3-month lag between booster shots, probably a 3-month lag between booster shots. At the present time, as we speak, we’re encouraging patients to get the bivalent Omicron booster. Even in individuals who are very much on board with getting vaccinated, there is some degree of vaccination fatigue, and they will ask, “Do I have to go and get yet another shot?”

Not that the shot is particularly uncomfortable, but there can be a little arm soreness, there can be a little bit of fever, and patients may not feel well for a day or two. To many patients, it seems like just one more thing that they have to do. Nonetheless, we do recommend that they do it. And that's borne out by the fact that, although we are still seeing COVID, we haven’t wiped it out, the number of cases have decreased and certainly the number of hospitalizations have decreased, the number of ICU admissions have decreased, the number of deaths have decreased.

We particularly have to be vigilant in our cancer population, particularly our blood cancer population, because these patients are quite immune-suppressed and they are indeed a special category.

Calabrese, Rheumatology: With everything we do in our visit with our patients, vaccines have always been kind of cast aside pre COVID. And that’s one of the main reasons many immunocompromised patients are not up to date with vaccines.

So now to add this extra layer of COVID and really needing to take a moment and see how many vaccines they have had and when their last one was and if they’ve had COVID, there’s lots of layers to address now.

The recommendations for the new bivalent booster out there, we still don't have any human data on the size of the benefit, if any, they will confer for patients. If a patient is on methotrexate and has had four COVID vaccines and had COVID within the past 4 to 6 months, it’s unclear to us that that person needs another booster right now. But we do talk about, mention the new vaccine. Certainly, make sure they're at least boosted up to this date appropriately. And then if patients have had COVID, especially in the Omicron era, that's another level of boosting with hybrid immunity.

It's important to know that these new boosters are not going to cause harm. They can only help. The caveat being someone who did have a problem after one of the mRNA vaccines. That’s another story. But we will await real world clinical effectiveness data and recommend that our patients get up to date by wintertime. Might be a bit of a different discussion for more risky patients where we have other avenues of protection like EVUSHELD. And what remains most important is that they know to be aware that they can still get COVID, that it can be really mild, that they need to tell us. That there are time sensitive treatments we can give them, and we need to know how to give them. It is a never-ending loop of patient and provider education.

Patel, Allergy: In order for us to make sense and keep up to what is new and what is latest guidelines we created the Covid vaccine task force for the American College of Allergy and Immunology. We have a resource on online that patients and health care providers can access. It has a list of all the vaccines that are available in the US as well as the timing of the vaccine, when to get the booster, the intervals.

With so many vaccines that are out with so many guidelines for whether immunocompromised or not, and who should get the booster at what age, it's important to have a set of guidelines that physicians, health care providers, and patients can easily refer. There will be new recommendations coming up for a pediatrics for boosters. The landscape is changing. There's more and more guidelines and recommendations. So it's important that we are cognizant of those recommendations that we know quickly where to find them.