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CDC: Some Immunocompromised People Can Get a Fourth Dose

Maya142

Moderator
Staff member
Anyone heard anything about this from their doctors?

Certain immunocompromised people can now receive, and in some cases should receive, a fourth dose of COVID-19 vaccine, the CDC said in updated interim clinical guidance this week.

"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.

However, a moderate or severely immunocompromised "person who received one primary dose of [Johnson & Johnson] COVID-19 vaccine should not receive more than two COVID-19 vaccine doses," according to the guidance.

These individuals should receive a second dose of Pfizer, Moderna (at the booster dose volume of 50 μg) or Johnson & Johnson at least 2 months later. "A patient's clinical team is best positioned to determine the appropriate timing of vaccination," the recommendations said.

CDC noted the difference in the two recommendations, bolding the word "may" for those who received a primary series with mRNA vaccine and "should" for those who received a primary series with Johnson & Johnson.

This had been a topic of intense debate at a recent CDC Advisory Committee on Immunization Practices meeting, with CDC Director Rochelle Walensky, MD, noting that more specific recommendations about boosters in certain populations would be forthcoming.

In addition, the agency recommends individuals who developed myocarditis or pericarditis after a dose of mRNA vaccine should defer receiving a subsequent dose "until additional safety data are available."
 

Maya142

Moderator
Staff member
More info from the CDC website:
People who are moderately and severely immunocompromised and COVID-19 vaccine booster dose

Moderately and severely immunocompromised people aged ≥18 years who completed an mRNA COVID-19 vaccine primary series and received an additional mRNA vaccine dose may receive a single COVID-19 booster dose (Pfizer-BioNTech, Moderna, or Janssen) at least 6 months after completing their third mRNA vaccine dose. In such situations, people who are moderately and severely immunocompromised may receive a total of four COVID-19 vaccine doses. A person who is moderately or severely immunocompromised and has received two doses of an mRNA vaccine and ≥28 days has elapsed since the second dose, should receive an additional mRNA dose immediately (if Moderna COVID-19 vaccine is used, administer 100µg in 0.5ml), followed ≥6 months later by a single COVID-19 vaccine booster dose (if Moderna vaccine booster is used, administer 50µg in 0.25ml).

Moderately and severely immunocompromised people aged ≥18 years who received a single dose Janssen COVID-19 vaccine primary series should receive a single COVID-19 booster vaccine (Pfizer-BioNTech, Moderna or Janssen) at least 2 months (8 weeks) after receiving their initial Janssen primary dose. If the Moderna vaccine is used in this circumstance, the booster dose and dose volume should be used (50µg in 0.25ml). A patient’s clinical team is best positioned to determine the appropriate timing of vaccination. A person who received one primary dose of Janssen COVID-19 vaccine should not receive more than two COVID-19 vaccine doses as detailed in Appendix A.
 
Location
San Diego
Anyone heard anything about this from their doctors?
Not yet. It just came out and hasn't had time to percolate down to where the action is. Plus, this news was sort of drowned out by the data and committee recommendations coming out about young kids getting the vaccine.
 

my little penguin

Moderator
Staff member
I read it and assume it will be similar to others who get a booster
Booster will be 6 months after the last dose in the series (mRNA third shot ) for immunocompromised
So they have time to figure it out .
Ds got his in the middle of august so booster wouldn’t be needed until Feb at earliest .
Will keep watch until then
 

Maya142

Moderator
Staff member
Yes, my older daughter won't need hers till February either. It does make sense, it just caught me off-guard because I hadn't heard anything about it before today.
 

Lisa

Adminstrator
Staff member
Location
New York, USA
Interesting.....

To go with this, I'll continue to post my antibody levels showing how they change for me as time goes on.....waiting on results from 2 weeks post-booster to see if there is a change...
 
Interesting! I was just half joking with my GI last week at my appointment that I was waiting to hear about 4th doses for immunocompromised folks as our 3rd dose wasn't considered a “booster.” I’ll have to reach out to her about this, but I’m in the same boat as others and got my 3rd dose in August, so wouldn't need the booster until February.

Lisa - I just got my antibody levels checked after my 3rd dose and it did increase things (though I still wish it were higher)! I had a 3.4 when I was tested in June after my 2 doses. My 3rd dose brought me up to a 14 now.
 

my little penguin

Moderator
Staff member
@dreamintwilight
The antibody level numbers vary widely by the test type (semi quantitative vs quantitative, igg vs igm and where they are processed …
My kiddos was igg quantitative and 92 after second shot -148 after 3rd shot …
No one in the study will tell us what the numbers may mean ….
So we wait
 
@dreamintwilight
The antibody level numbers vary widely by the test type (semi quantitative vs quantitative, igg vs igm and where they are processed …
My kiddos was igg quantitative and 92 after second shot -148 after 3rd shot …
No one in the study will tell us what the numbers may mean ….
So we wait
I am also enrolled in the Prevent COVID study, which I believe is the same as your kiddo. I suppose kids are also supposed to be better at building antibodies too though, I believe. So, it would make sensefor their levels would be higher than mine (a 37 yr old)!
 

Maya142

Moderator
Staff member
It also depends on what meds you're on @dreamintwilight. Some biologics are more immunosuppressive than others and if you're on 6MP or Imuran, those are even more immunosuppressive. So is MTX, but most GIs tell you to stop that for a week after the vaccine, which should help somewhat.
 

my little penguin

Moderator
Staff member
The researchers found that the effectiveness of the mRNA vaccines against laboratory-confirmed cases of COVID-19 was 77% in immunocompromised patients, compared to 90% efficacy for those with typical immune systems.

But not all immunocompromised people even reached a 77% effectiveness, the researchers pointed out, noting, “vaccine effectiveness varied considerably among immunocompromised patient subgroups.” Specifically, people who had organ or stem cell transplants were more likely to have a 59% efficacy, while those who had a rheumatic or inflammatory disorder like rheumatoid arthritis saw efficacy numbers up to 81%.
From
 
It also depends on what meds you're on @dreamintwilight. Some biologics are more immunosuppressive than others and if you're on 6MP or Imuran, those are even more immunosuppressive. So is MTX, but most GIs tell you to stop that for a week after the vaccine, which should help somewhat.
Right! It’s just finally interesting to hear/see “firsthand” accounts of how people’s antibody levels varied since I don't know many people in my every day life who take biologics or meds similar to mine. My mom is enrolled in the same study and jumped from a 7.1 (while on Remicade that wasnt working) to a 206 after switching to Stelara with steroids to bridge. I thought steroids were supposed to be pretty suppressing and figured she may have similar levels as me, but seems like my weekly Humira + azathioprine/Imuran is more suppressing after all. 😖
 
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