Vaccination in immune compromise

Are COVID-19 vaccines safe for people with weakened immune systems?

Professor Ellie Barnes, Oxford University

Causes of immunosuppression

Auto-immune conditions (e.g. lupus, rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease,

Crohn’s disease)

Genetic conditions

Chronic diseases, liver, kidney disease, cancer

Post organ or bone marrow transplant

Complications of vaccination in immunocompromise

Problems with live vaccines

Measles, mumps, rubella

Smallpox

Yellow fever

Reduced immune response may lower vaccine efficacy

Are the COVID vaccines safe for people who are immunocompromised?

Currently in UK, Oxford/AstraZeneca vaccine and the Pfizer vaccine

Neither of these are live vaccines.

And because of that, there's no theoretical reason why these vaccines would not be completely safe, even

for people who are severely immunocompromised

Pfizer mRNA vaccine

No virus involved with that at all

Oxford/AstraZeneca vaccine

Viral vector carries RNA to cells

Cannot replicate in cells or cause disease

These vaccines have been shown to be very safe

There's no reason why an immunocompromised person would have a different adverse effect profile, compared to a healthy person after receiving a COVID-19 vaccine

Allergies

Extremely rare

Not expected to be more likely in immunocompromised people

Vaccine efficacy in immunocompromise

The phase three vaccines studies generally recruited healthy people and excluded people with severe disease and immunosuppressive therapy

Although it’s likely that vaccines can provide some level of protection for people who are immunocompromised,

right now we don’t have any solid data on how well COVID-19 vaccines will work in people with weakened immune systems

OCTAVE study

British Society for Immunology

While COVID-19 vaccination might provide a lower level of protection in people who are immunosuppressed or immunocompromised compared with the rest of the population,

it is still very important that you get vaccinated as it will offer you a certain amount of protection against catching COVID-19.

It is important that you receive two doses of the vaccine to maximise the protection that vaccination offers you.

COVID-19 vaccination will work best if you have a functioning immune system.

It’s important to remember that the COVID-19 vaccines can protect you from getting seriously ill with COVID-19,

although if your immune system isn’t functioning optimally this protection will not be complete.”

Professor Ellie Barnes

The vaccines will not harm you, and they may give you some protection

So my advice to patients currently is: if you're offered a vaccine, take it

When You’ve Been Fully Vaccinated

Two weeks after second dose in a 2-dose series, like the Pfizer or Moderna vaccines

Two weeks after a single-dose vaccine, like Johnson & Johnson’s Janssen vaccine

What Hasn’t Changed

Keep taking precautions in public places, wearing a mask, 6 feet, avoiding crowds, poorly ventilated spaces until we know more

In public

Gathering with unvaccinated people

Visiting an unvaccinated person

Still avoid medium or large-sized gatherings

Still delay domestic and international travel

Still watch out for symptoms

Still get tested if symptomatic

Still self isolate

Still need to follow guidance at your workplace.

What’s Changed

Gather indoors with fully vaccinated people without wearing a mask

Gather indoors with unvaccinated people from one other household, unless any of those has an increased risk of severe illness

If you’ve been around someone who has COVID-19, you do not need to stay away from others or get tested unless you have symptoms.

However, if you live in a group setting, and are around someone who has COVID-19, you should still stay away from others for 14 days and get tested, even if you don’t have symptoms

What We Know and What We’re Still Learning

We know COVID-19 vaccines are effective at preventing COVID-19 disease, especially severe illness and death.

We’re still learning how effective the vaccines are against variants

We know that prevention measures help stop the spread of COVID-19, and that these steps are still important

We’re still learning how well vaccines prevent spread

We’re still learning how long vaccines can protect people.

Estonia

New lockdown from Thursday, education and shops

UK variant

Detection dogs in Germany

Esther Schalke, Armed forces school for service dogs

94% accuracy, even if asymptomatic

From 1,000 + samples

coronavirus odor, emitted from cells in infected people

Holger Volk, Hanover's University of Veterinary Medicine