The Centers for Disease Control and Prevention quietly updated the Covid-19 vaccine guidance On Monday, a large group of immunocompromised people said they could receive a booster dose of the Covid vaccine at least six months after completing their initial vaccination series.
But unlike the boosters for the vast majority of Americans, a booster shot for an immunocompromised individual may be the fourth shot of Covid.
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Last August, the Centers for Disease Control and Prevention (CDC) recommended that immunocompromised individuals who were initially vaccinated with either the Pfizer-BioNTech vaccine or the Moderna mRNA vaccine — but not the Johnson and Johnson vaccine — receive a third dose of the mRNA vaccine. This overdose was not considered a booster, but was part of the initial vaccination series.
The new booster dose could be any of the available vaccines, including the Johnson & Johnson vaccine, according to the CDC.
Research has shown that people with weakened immune systems do not have an adequate immune response after vaccination, and the purpose of the third dose is to raise their immune levels to what is seen in people with normal immune systems after two doses.
The goal of this fourth dose will be different: to combat weakened immunity. It will serve the same purpose as a booster dose given to immunocompromised people six months after they were initially vaccinated.
It is estimated that 2.7 percent of adults in the United States are immunocompromised, according to the CDC. This includes organ transplant recipients, some cancer patients, and people with HIV.
“We know that after six months of reaching a good level of protection, your protection has diminished … and we need to reinforce that,” said Dr. Dore Segev, a professor of surgery at Johns Hopkins University, who studies Covid vaccine responses in immunocompromised. Persons. “This is for people with normal immune systems and people who are immunocompromised.”
But not every immunocompromised American will need a fourth dose.
“Of the 11 million immunocompromised people in this country, some were fine with two doses,” Segev said. “Some of them weren’t okay with three doses. Some of them needed a fourth.”
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The change in the Centers for Disease Control and Prevention’s (CDC) clinical considerations comes less than a week after an agency advisory panel formally approved a booster dose for both the Moderna and J&J Covid vaccines.
The question of how and whether to provide a booster dose to immunocompromised individuals who may have already received a third dose was raised during last Thursday’s advisory committee meeting.
“Under EU law, an immunocompromised person who receives a third initial dose of the series will be eligible after six months for a booster dose,” said Dr. Doran Fink, deputy clinical director of the Food and Drug Administration’s Division of Vaccines and Related Products, He told the committee.
In a statement to NBC News, CDC spokeswoman Kristin Nordlund said, “Clinical considerations have been updated as a result of that discussion.”
Dr. Balaz Halmos, MD, director of chest oncology at Montefiore Einstein Cancer Center in New York City, described the decision as logical from a scientific standpoint but not necessarily data-driven.
Dr. Matt Calaichio, MD, former chief of the division of hematology and medical oncology at Cleveland Clinic, agrees.
“I am not aware of the data supporting a fourth dose in immunocompromised patients,” he said. “It’s not clear to me what data the CDC relies on to reach its conclusions.”
However, since the third dose for immunocompromised patients was just approved in August, and a booster dose is recommended six months after that, any fourth dose for this group is not “imminent,” Halmos said.
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