What Immunocompromised Patients Should Know About The COVID-19 Vaccine

Updated on August 17, 2021 – The CDC is recommending a third dose of the vaccine for certain immunocompromised individuals, who previously received the Pfizer or Moderna COVID-19 vaccine. Currently, an additional dose is not recommended for those who are immunocompromised and received a Johnson & Johnson COVID-19 vaccine.

For further information, please see COVID-19 Vaccines for Moderately to Severely Immunocompromised People | CDC.

If you qualify for a third dose of vaccine, please call your provider treating you for the immunosuppressed condition(s).

Your immune system is your body’s first line of defense against infection. If it becomes weakened or compromised, then you become highly susceptible to infection and illness, including COVID-19.

Although the majority of COVID-19 cases are mild, the virus may be severe if you are immunocompromised and lack the defenses to fight it. The COVID-19 vaccine could help protect you. Before taking it, however, you should consult your doctor about its risks and benefits. In the meantime, here’s what else you need to know.

The Vaccine Is Safe

Three manufacturers (Pfizer BioEnTech, Moderna, Johnson & Johnson) have produced the COVID-19 vaccine, and they are all equally safe. Because the vaccine does not contain live virus, it cannot infect you with COVID-19, according to Kristen Marks, MD, Associate Professor of Medicine at Weill Cornell Medicine.

Only in very rare cases have people experienced serious allergic reactions to the vaccine, and these have generally occurred in individuals with a history of serious allergic reactions. As long as you are not allergic to any of the vaccine’s ingredients, and any medications that you take--such as immunosuppressive drugs--do not interact negatively with it, then you can safely take it, even if you are immunocompromised or have an autoimmune condition. In fact, since being immunocompromised increases your risk for severe COVID-19, the Centers for Disease Control urges you to get the shot.

“We know from very large studies that there were no serious events attributed to the vaccine,” Dr. Marks says. “Because the risk of COVID-19 is so high, concern about an extremely rare side effect shouldn't prevent people from getting the vaccine now.”

All Vaccines Prevent Severe COVID-19

All three vaccines are highly effective. You may have heard that the Johnson & Johnson vaccine is less effective than the other two, but when it comes to preventing severe COVID-19 and resulting complications--which can be particularly dangerous if you are immunocompromised--all the vaccines do the job equally well. They all significantly decrease your risk of becoming acutely ill from the virus and being hospitalized or dying from it.

“In studies, the vaccine nearly eliminated severe infections that required people to need oxygen or be hospitalized,” Dr. Marks says.

Does being immunocompromised make the vaccine less effective?

Many conditions and treatments can compromise or weaken your immune system, such as having a solid organ, blood, or bone marrow transplant; HIV; a primary immunodeficiency; long-term use of corticosteroids; chemotherapy; or other therapies, like radiation, CAR T-cell therapy, or immunotherapy.

What’s more, these treatments may make the vaccine less effective or compromise your body’s ability to tolerate its side effects. “The vaccine can cause fever, body aches, headaches, or fatigue, and you have to be able to tolerate these sorts of things to have the best chance of responding to it,” Dr. Marks notes. It is important, therefore, to speak with your doctor about the best time for you to take the vaccine. This does not mean you should skip it. As Dr. Marks emphasizes, “The benefits of the vaccine far outweigh the risks.”

Is there an ideal time for vaccination?

Data do not yet exist indicating when people on immunosuppressive drugs should receive the COVID-19 vaccine. According to experts, it would be ideal to receive both doses of the Pfizer or Moderna vaccine (the Johnson & Johnson vaccine requires just one shot) at least two weeks before you start immunosuppressive therapy. If you cannot do this, then you can still be vaccinated.

Don’t postpone immunosuppressive therapy so that you can finish your vaccine regimen, unless your physician has recommended you do so. And remember: every patient is different and will respond differently to the COVID-19 vaccine, which is why consulting your doctor beforehand is critical.

Public health experts urge all vaccinated individuals to continue wearing a mask, washing their hands regularly, maintaining physical distance, and avoiding poorly ventilated spaces.

Why do certain immunocompromised patients now need an additional dose of vaccine?

New studies have indicate some immunocompromised people may not always build the same level of immunity after vaccination, in the ways that non-immunocompromised people do. Thus, these patients may benefit from an additional dose of the vaccine to ensure adequate protection against COVID-19.

In small recent findings, fully vaccinated immunocompromised people comprised a larger percentage of hospitalized “breakthrough cases.”

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