Should people with immune problems get the third dose of the vaccine?

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Should people with immune problems get the third dose of the vaccine?

When it came to being vaccinated against the coronavirus, the third time was Charm Esther Jones, a dialysis nurse in rural Oregon. After two doses of the Pfizer-BioNTech vaccine failed to jolt her immune system to produce antibodies, she sought out a third, this time with Moderna’s.

It worked. Blood tests revealed a reasonable antibody response, although lower than what would be detected in healthy people. She received a fourth dose last month in hopes of increasing levels even more.

Ms. Jones, 45, underwent a kidney transplant in 2010. To prevent organ rejection, she has taken medications that suppress the immune response since then. I expected to have trouble responding to the coronavirus vaccine, and enrolled in one of the few studies to date to test the benefit of a third dose in people with compromised immune systems.

Since April, healthcare providers in France have routinely A third dose is given A two-dose vaccine for people with certain immune diseases. The number of transplant recipients with antibodies increased to 68 percent four weeks after the third dose from 40 percent after the second dose, one team of French Researchers recently reported.

The study that Mrs. Jones attended appeared Similar results in 30 transplant recipients who purchased a third dose themselves.

Being susceptible to infection Even after vaccination, Dr. Dore Segev, the transplant surgeon at Johns Hopkins University who led the study, said it was “very scary and frustrating” for immunocompromised people. “They have to continue to act without vaccination until we figure out a way to give them better immunity.”

But in the United States, there are no concerted efforts by federal agencies or vaccine manufacturers to test this approach, leaving people with low immunity with more questions than answers. The Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health actually We recommend even in against the test To find out who is protected. And academic scientists are frustrated by the rules that limit access to vaccines.

Dr. Balaz Halmos, an oncologist at Montefiore Medical Center in the Bronx, who led a study that showed some cancer patients did not respond to vaccines. “Our little team here in the Bronx shouldn’t be trying to figure it out.”

It is estimated that 5 percent of the population is immunocompromised. The list of reasons is long: Some crabsAnd the member plantingChronic liver disease and kidney failure Dialysisand drugs such as Rituxan, Steroids And the methotrexate, which is taken approx 5 million people To treat disorders from rheumatoid arthritis and psoriasis to some types of cancer.

Jose Yu Sher, a rheumatologist at NYU Langone Health who led the study said: methotrexateeffect on vaccines.

Not everyone who has one of these risk factors is affected. But without more research, it’s impossible to know who might need additional doses of vaccines and how many. Besides the risk of contracting Covid-19, there is also evidence of it low immunity May allow the virus keep repeating in the body for long periods, which may lead to new variables.

Infusion of monoclonal antibodies may help some people who don’t produce antibodies on their own — but then again, the idea hasn’t been thoroughly explored, said John Moore, a virologist at Weill Cornell Medicine in New York.

The use of monoclonal antibodies, he said, “makes a lot of sense for this group of people, so I’d like to see companies more active in this area.” “Government support or pressure will also help.”

The third dose approach has widespread support among researchers because there is a clear precedent. Immunocompromised people are given booster doses of hepatitis B and influenza vaccines, for example. And the Stop taking methotrexate After getting a flu shot Vaccine improvement Efficacy – the evidence that forced the American College of Rheumatology to do so We recommend temporarily stopping the use of methotrexate For a week after vaccination against the Corona virus.

Many studies have shown That a third dose of the corona virus vaccine you may succeed In patients who did not have Detectable antibodies After the first or second dose. But the search was delayed.

Moderna is Preparing To test a third dose in 120 transplant recipients, Pfizer — which produces some immunosuppressive drugs — is Planning to study 180 adults and 180 children with immunodeficiency.

The companies turned down at least two independent teams who had hoped to study the effects of a third dose.

The National Institutes of Health is Recruit 400 people with immunodeficiency For a trial that would track levels of antibodies and immune cells for up to 24 months — but it has no trials looking at a third dose.

“It takes time, unfortunately, especially as a government agency,” said Emily Ricotta, an epidemiologist at the National Institute of Allergy and Infectious Diseases. “We have to go through a lot of regulatory and approval processes to do these kinds of projects.”

But this interpretation does not satisfy some researchers. Dr. Scheer noted that many medical centers already have groups of patients who have not responded to vaccines, so federal agencies can organize a clinical trial without much difficulty. “It’s a very simple study,” he said. “There is no rocket science here.”

Previous studies indicated that many people with cancer would not respond to vaccines, but those analyzes were done after patients had received vaccines. single dose. A new study published this month by Dr. Halmos of Montefiore Medical Center and colleagues put some of those concerns to rest. Vaccines appear to work well in patients with a wide variety of solid and liquid tumors, according to great analysis.

But 15 percent of those with leukemia and 30 percent of those who took drugs that suppress the immune system had no detectable antibodies after the second dose. Dr. said. Halmos He and his colleagues are excited to test whether a third dose could benefit these individuals, but they haven’t yet had access to vaccines.

In a previous study, Dr. Segev’s team found that less than half of 658 organ transplant recipients It has measurable antibodies After every two doses of an mRNA vaccine made by Pfizer-BioNTech or Moderna.

But to follow the result, they had to resort to recruiting volunteers like Ms. Jones who got third doses on her own. Scientists found that a third dose Increased levels of antibodies In some transplant recipients who had low or undetectable levels of antibodies, more than half saw no improvement.

Ms Jones said many people like her felt abandoned by the federal government – especially with the threat of more infectious variants circulating in the US.

She said some members of a Facebook group for immunocompromised people who desperately need protection got a third dose at mass vaccination sites where providers don’t check records, or even cross state limits. However, most continue to wear masks to protect themselves – and have sometimes had to endure harassment as a result.

“It’s really sad that so many people in this world have made the mask such a super political thing when it shouldn’t be,” she said. “This makes it more difficult for us to take care of ourselves.”

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