CDC panel recommends COVID-19 booster for immunocompromised patients
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A CDC advisory panel voted unanimously in favor of recommending a third dose of the COVID-19 vaccine in patients who are moderately or severely immunocompromised, according to an American College of Rheumatology press release.
The decision from the Advisory Committee on Immunization Practices will permit patients being actively treated with high-dose corticosteroids, alkylating agents, antimetabolites, tumor-necrosis factor (TNF) inhibitors, and other immunosuppressive biologic agents to receive a booster dose of either the Pfizer-BioNTech or Moderna mRNA COVID-19 vaccines.
The CDC approval came shortly after the FDA announced it would be updating its emergency use authorization for the Pfizer-BioNTech and Moderna messenger RNA vaccines to allow a third dose “in certain immunocompromised individuals, specifically, solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise.”
“This will be enormously important for our immunocompromised patients, and we are thankful to the FDA and CDC for hearing our concerns, recognizing the needs of this population and moving forward,” David Karp, MD, PhD, president of the American College of Rheumatology, said in a press release. “We look forward to working with the agencies as they communicate this new recommendation.”
According to the CDC, the third dose should be administered at least 28 days after a second dose of the same vaccine to eligible patients aged 18 years or older for the Moderna vaccine and 12 years or older for the Pfizer-BioNTech vaccine.
Research has shown that immunocompromised patients do not respond optimally to COVID-19 vaccination and could benefit from an additional dose. The results of the first randomized, placebo-controlled trial of a third vaccine dose in transplant recipients were published this week in The New England Journal of Medicine and showed that an additional dose enhanced protection.
However, even with the booster dose, the ACR advised all immunocompromised patients to continue to follow prevention measures, including wearing a mask, remaining 6 feet apart from those who are not close contact, and avoiding crowds and poorly ventilated indoor spaces until advised otherwise by their health care providers.
“Not all medications that our patients take have been shown to have significant effects on responses to vaccination. Patients should ask their provider if they are likely to see a beneficial effect from additional vaccination,” Karp said in the press release. “Luckily, we have not seen any safety signals in patients with autoimmune and rheumatic diseases from the COVID-19 vaccines, so there should be no concern for the third dose.”
The ACR announced that its COVID-19 Vaccine Clinical Guidance Task force will be meeting on Monday, Aug. 16 to discuss potential changes to the ACR’s clinical guidance and is expected to share recommendations shortly after.
Perspective
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David A. McLain, MD, MACR, FACP, FRCP
Few foresaw the second major wave of COVID-19 after the one in January following the Christmas holidays; however, some have pointed to the infection curves of the Spanish Flu that show a similar pattern. Most people thought that, by now, COVID-19 would be fading as it appeared to be in late spring.
Our patients need boosters and the ACR position has a 28-day waiting period after completing the first series of mRNA vaccines to receive the booster. This differs from the impending CDC guidelines for the general public, which reportedly will be a 6-8 month waiting period.
Our patients on rituximab, abatacept, and mycophenolate mofetil are at highest risk due to the poor antibody response to the vaccines. Fortunately, studies on the rituximab patients revealed T-cell immunity from the vaccines. I have been writing letters for patients based on this ACR guideline stating that the patient needs a booster and that 28 days after the last vaccine in the series is the ACR recommendation.
Perspective
Back to TopCassandra Calabrese, DO, and Leonard Calabrese, DO
We think a third mRNA vaccine dose is an important step in protecting our vulnerable patients against COVID-19, although we want to stress the point that a booster dose is not a Get Out of Jail Free card to stop practicing nonpharmaceutical interventions.
Patients must be reminded they still have to mask, etc., which was also called out by CDC/ACIP and we think it is very important: “Immunocompromised people (including those who receive an initial mRNA dose) should be counseled about the potential for reduced immune response to COVID-19 vaccine and need to follow prevention measures (wear a mask, social distance, etc.).”
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