StemCell Therapy

For the immunocompromised even those fully vaccinated are feeling vulnerable as New Zealand loosens the restrictions designed to protect them. How worried should they be? Joanne Naish investigates.

For the immunocompromised, Covid-19 is terrifying but while those who get vaccinated arent quite as safe as the general vaccinated population, the degree of added risk is variable.

Immunocompromised, or people whose immune systems might not work as well as they should for several reasons, are at higher risk of severe outcomes from Covid-19 but misinformation spreading online incorrectly suggesting the vaccine is equally useless for all immunocompromised people (from those with high blood pressure to organ recipients) is creating unnecessary anxiety.

Several studies have shown it is not all doom and gloom for the immunocompromised while vaccine effectiveness is lower for them than the immunocompetent, they can still get good protection from severe illness and death.

A US report from the Centers for Disease Control and Prevention showed the need for ventilation or death was reduced by 74% for people who received an mRNA vaccine compared to 92% for the immunocompetent.

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An American study showed 63.1% of organ recipients showed positive antibody response from three doses, and in two studies, 50% of recipients with no or minimal antibody response after three doses of mRNA vaccine mounted an antibody response after a fourth dose.

Elena mozhvilo/Unsplash

Many immunocompromised people are fearful of catching Covid-19 even if they are fully vaccinated

How much protection immune deficient people get from the vaccine depends on what their condition is and how old they are.

The Ministry of Health has a long list of conditions that make people immunodeficient and therefore eligible to receive three initial doses instead of two of the vaccine prior to a booster including leukaemia, aggressive lymphomas, HIV/AIDS with a low CD4 count and people who have had received a stem cell transplant or are receiving immunosuppressive therapy for an organ transplant.

Immunologist Graham Le Gros said immunocompromised was being used as a catch-all term for anyone who might not have good outcomes if they catch Covid-19, but also for people who are believed to not have effective coverage from the Covid-19 vaccine.

He said cancer patients were one of the biggest cohort of immune-compromised people in New Zealand.

However, it was not the cancer that made them immune deficient it was treatment like chemotherapy that zapped their immune system.

National Cancer Institute/Supplied

People receiving cancer treatment should be boosted beforehand to make sure they are protected from Covid-19.

The good news was if patients receive their booster dose before their treatment, the antibodies created would offer good protection from severe illness for the entire time they underwent their cancer treatment, Gros said.

For another rare group of people who were genetically immune deficient, an extra vaccine dose might be required to give them the same protection.

Theyve got a disorder where the immune system doesnt work very well like the boy in the bubble, or they are missing some very specific kind of immune receptor that means their immune system doesnt work well. They need multiple vaccines to get their sluggish immune systems up to speed with the right protection, he said.

However, a small number might never gain an immune response in which case they should continue to isolate themselves or have access to therapies like injecting other peoples antibodies into them or antiviral drugs, he said.

Jericho Rock-Archer/Stuff

Malaghan Director Graham Le Gros says immune deficient people are justifiably worried about Covid-19.

The elderly were also inherently immunocompromised.

We know that over 65, the immune system doesnt normally work quite as well as when you are 25 or 35 and so for the flu vaccine they give an extra dose, a larger dose, to get over that kind of sluggishness. We know for Covid-19 we can get around it by being a bit more regular with the booster you can kick along enough to make it good.

Emerging evidence was revealing people with type 2 diabetes also needed an extra dose to boost their immune response, he said.

Gros says despite the positives, people with known immune deficiencies were justifiably worried about Covid-19.

What I am seeing is those people are really scared that they want people to wear masks they feel very vulnerable. Thats who the Government has been trying to protect. Thats who goes down in the pandemic. We could have lost a lot of us.

Theres hundreds of thousands of them, and we would have lost them if wed just let the virus come through [before vaccination]

Chris McKeen/Stuff

Vaccinologist Associate Professor Helen Petousis-Harris says immunocompromised people were at higher risk of not making a good immune response.

Vaccinologist Helen Petousis-Harris said immunocompromised people were at higher risk of not making a good immune response to the vaccine and were less likely to be protected.

She said the term immunocompromised covered anyone who had either a condition or was on medication that impacts various important aspects of their immune system.

How effective the vaccine was for those people also very much depended on the individual and what part of their immune system was affected.

RYAN ANDERSON/Stuff

People should continue to wear masks to protect those who do not get effective protection from the vaccine.

She said immunocompromised people were acutely aware of the risks to them.

I think there is a lack of appreciation by many people that these seriously immunocompromised people need to got to the supermarkets and other places, and it could be terrifying for them, especially when there are people objecting to wearing masks, she said.

They were understandably worried about the move to orange setting and the reopening of the borders, even if they were up-to-date with their vaccines.

Given they are less likely to be protected by the vaccine it is understandable if they are worried about any of the loosening of restrictions. They have done all they can to protect themselves, so it is up to the rest of us to continue to be considerate as we open up, she said.

Tom Lee/Stuff

Extra doses of the Covid-19 vaccine are available for those who meet the criteria

A Ministry of Health spokesperson said it did not have a figure for the number of immunocompromised people in New Zealand because it was a moving variable.

Individuals who are severely immunocompromised are at a higher risk of severe outcomes from Covid-19 and might not produce a sufficiently strong immune response after two doses, they said.

Age is the biggest risk factor for Covid-19 so for elderly with immuno-compromising conditions are at higher risk of severe illness and death, as Covid infection is more severe in the elderly anyway and risk factors are cumulative.

The Ministry said it was difficult to say exactly how many immunocompromised people had received a third dose but 31,646 third doses have been given out in total.

This group also tends to have a prolonged infection and viral shedding period, are at higher risk of developing a new variant, and are more likely to transmit the virus to any contacts compared to non-immunocompromised consumers.

Data about the number of immunocompromised people who have died of Covid-19 was not available yet.

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I'm immunocompromised - how worried should I be about Omicron? - Stuff.co.nz

This entry was posted on April 26, 2022 at 1:50 am and is filed under Immune System. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed. |