Another shot at protection: Immunocompromised qualifies for a fourth COVID-19 vaccine


Pfizer vaccine in Mexico. (Courtesy: Baja California Health Department)

RALEIGH, N.C.(WNCN)- Since the start of the pandemic, immunocompromised people have been the most vulnerable. Even after vaccines were made available, the CDC found they did not develop a good enough immune system response to provide adequate protection.

Back in August, the FDA and CDC panel decided that the third dose would be part of the primary series of doses for people with a weakened immune system. The extra dose was applied to people who got the Moderna and Pfizer COVID-19 vaccines.

Data presented by the CDC showed 40 percent of transplant patients didn’t build up protection after the first dose, but they did after the second dose. Of those who did not build up protection after dose one, 68 percent built protection after the third dose.

The recent approval of the boosters for Moderna, Pfizer, and Johnson and Johnson has opened up the opportunity for fourth shots for the immunocompromised.

New CDC guidance says moderately and severely immunocompromised people over the age of 18 years who completed primary series from Moderna or Pfizer and received an additional dose may sign up for the booster shot. That booster could be from any of the three vaccines.

This fourth shot can be given at least six months after the third dose. With the third dose authorized in August, that makes February the soonest someone can get the fourth shot.

For immunocompromised who have received an initial series of the Moderna vaccine and have not received their third shot, the CDC urges them to do so “immediately”. They recommended this group get their booster six months later.

Guidance for a fourth shot does not apply to people who got an initial dose of the Johnson and Johnson vaccine. Those patients are urged to get a second dose of any other vaccine at least two months after their first shot.

The CDC estimated just three percent of the population falls within the immunocompromised category. The CDC listed the following conditions and treatments as qualifiers for an extra shot:

  • Active treatment for solid tumor and hematologic malignancies
  • Receipt of solid-organ transplant and taking immunosuppressive therapy
  • Receipt of CAR-T-cell therapy or HCT (within 2 years of transplantation or taking immunosuppression therapy)
  • Moderate or severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome)
  • Advanced or untreated HIV infection (people with HIV and CD4 cell counts <200/mm3, history of an AIDS-defining illness without immune reconstitution, or clinical manifestations of symptomatic HIV)
  • Active treatment with high-dose corticosteroids (i.e., ≥20 mg prednisone or equivalent per day when administered for ≥2 weeks), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor necrosis factor (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory.

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