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Covid-19: Boosters, Antibodies, and Continued Risk for the Immunocompromised

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World-leading specialist shares latest information on Covid-19 in transplant patients

On February 24th, CareDx hosted a webinar with NYU’s Dr. Dorry Segev, one of the world’s leading experts on the impact of Covid-19 on immunocompromised patients. When the pandemic hit, Dr. Segev shifted his research to better understanding vaccines in the immunocompromised, for which he has received a Letter of Commendation from Dr. Anthony Fauci. His research has been published in JAMA, and featured on CBS, NBC, NPR, and the New York Times, among other publications. In recognition of his contributions to health care, Dr. Segev was recently elected to the National Academy of Medicine.

We adapted our webinar conversation with Dr. Segev for this article, editing only for clarity and length. Read the full article here.

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CDC: Some Immunocompromised People Can Get a Fourth Dose

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“Moderately or severely immunocompromised” adults ages 18 and up who received an additional dose of Pfizer or Moderna’s mRNA vaccines may now receive a booster dose of Pfizer, Moderna, or Johnson & Johnson at least 6 months after completing their third dose, the agency said.

They added that if a moderate to severely immunocompromised adult has received a two-dose series of Pfizer or Moderna, and more than 28 days has elapsed, that person should “immediately” receive an additional dose of Pfizer or the full-dose volume of 100 μg for Moderna, followed by a single booster dose with any of the three authorized vaccines at least 6 months later.”

Read more, here.

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U.S. FDA authorizes COVID-19 vaccine boosters for the immunocompromised

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“The U.S. Food and Drug Administration authorized a third dose of COVID-19 vaccines from Pfizer Inc (PFE.N) and Moderna Inc (MRNA.O) for people with compromised immune systems.

The amended emergency use authorization paves the way for people who have had an organ transplant, or those with a similar level of weakened immune system, to get an extra dose.

“After a thorough review of the available data, the FDA determined that this small, vulnerable group may benefit from a third dose of the Pfizer-BioNTech or Moderna vaccines,” Janet Woodcock, U.S. FDA’s acting commissioner, said in a tweet on Thursday.”

Read more, here.

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NIH launches study of third COVID-19 vaccine dose in kidney transplant recipients

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“A pilot study has begun to assess the antibody response to a third dose of an authorized COVID-19 mRNA vaccine in kidney transplant recipients who did not respond to two doses of the Moderna or Pfizer-BioNTech COVID-19 vaccine. The Phase 2 trial is sponsored and funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The lifelong immunosuppressive therapy that organ transplant recipients must take to prevent organ rejection blunts their immune response to both pathogens and vaccines. Research has shown that many organ transplant recipients do not develop antibodies against SARS-CoV-2, the virus that causes COVID-19, after receiving an authorized COVID-19 vaccine regimen. The purpose of the new study is to determine whether a third dose of one of the mRNA COVID-19 vaccines could overcome this problem for at least some kidney transplant recipients. This is particularly important because this population has a high prevalence of conditions that are risk factors for severe COVID-19, such as cardiovascular disease and diabetes.”

Read more, here.

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FDA authorizes Covid antibody treatment as preventive after exposure

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“The unvaccinated or people with weak immune systems at high risk of severe disease can receive an injection if exposed to an infected person.

People at considerable risk of developing severe Covid-19, including millions of Americans with compromised immune systems, now have the option of receiving a preventive monoclonal antibody treatment if they have been or are at risk of being exposed to the coronavirus.

The Food and Drug Administration’s action on Friday brings hope to the estimated 3 percent of Americans who are immunocompromised, including those with autoimmune diseases, HIV patients, cancer patients and organ transplant recipients, who may still be vulnerable to Covid even after being fully vaccinated.

This is the first time an injectable coronavirus antibody treatment has been approved for use as a prevention of Covid after someone has been exposed to the virus.”

Read more, here.

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FDA decision on booster shots for immunocompromised expected soon

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“The nation’s top infectious disease doctor says he believes booster shots for the COVID-19 vaccine should be given “reasonably soon” to people with weakened immune systems.

“We need to look at them in a different light,” Dr. Anthony Fauci said on CNN’s ‘Fareed Zakaria GPS’ on Sunday. “We would certainly be boosting those people before we boost the general population that’s been vaccinated, and we should be doing that reasonably soon.”

The comments from the lead medical adviser to the White House on the pandemic are a change in messaging from about a month ago.”

Read more, here.

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Should You Recommend a COVID Booster to Patients?

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“Certain at-risk groups need to consider extra protection now.”

What’s the Current Booster Landscape?

“Several studies offer preliminary evidence on the benefits of boosters, especially for certain populations. A recent French study in JAMA showed that about 50% of 159 kidney transplant patients with low or no measurable antibodies after two doses of an mRNA vaccine mounted a response with a third shot, and with no serious side effects or rejection episodes. A study in the Annals of Internal Medicine also showed the benefits of a third dose in solid organ transplant patients. Pfizer data (that has not yet been peer reviewed) show antibody levels rise 11-fold in patients ages 65 to 75 after a booster.

Around the world, some countries and localities have gotten an early start on boosting. Boosters are being offered to patients over 60 years old in Israel. France is giving a booster dose to the severely immunocompromised 4 weeks after the second dose, and Hungary, Turkey, Thailand, Bahrain, and the United Arab Emirates are starting booster programs. The Mississippi Health Department is now recommending physicians consider boosters for the immunocompromised.”

Read more, here.

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Immunocompromised to unvaccinated: You’re still a community

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3 Clark County women hope unvaccinated people stop and consider those who are at high risk of serious complications from COVID-19

“As people across the United States continue to flout the COVID-19 vaccine and cases of the delta variant surge, those living with compromised immune systems have a dire plea: consider the safety of others.

Jennifer Browning, Nicole Arneson and Laura Ellsworth are three friends living in Clark County who have all had kidney transplants. For them, life during the pandemic means strictly following the same COVID measures mandated for the general public before a vaccine ever became available.

“We don’t do the things that vaccinated people are doing and because we’ve been told by our medical providers that you need to continue to live as if you’ve been unvaccinated,” said Ellsworth.”

Watch the interview here.

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Call in the T-Cell Cavalry to Fight COVID in the Immunocompromised

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“Last year was one of collective confinement. The majority of us shuttered our doors to visitors, worked from home, and ventured out sparingly in hopes of evading the grasp of COVID-19. Now in 2021, thanks to vaccination rollout, those who have been vaccinated are hopefully on the path to normalcy. But not everyone is so fortunate. For some, 2021 will bring more isolation and loneliness than ever before, which is hard to imagine. I’m talking about immunocompromised adults and children. While much of the rest of the populace clinks glasses, hugs loved ones, and joins parties, immunocompromised individuals do not have the security of an effective vaccine, and for their health and safety will maintain their distance and watch the social revelry from the sidelines.”

Read more, here.

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CDC advisory committee voices support for immunocompromised people getting boosters

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During the last year and a half, immunocompromised people have been at extremely high risk for the virus. And for many, the COVID vaccine didn’t change that.

That’s why a group of independent Centers for Disease Control and Prevention experts at a Thursday meeting largely voiced support for allowing immunocompromised people to talk to their doctors about getting a third shot, a booster, that could increase their antibody response to vaccines.

Read more, here.

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