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Does the COVID vaccine keep organ transplant patients safe?

transplant patients covid vaccine
Photo via Global Panorma/Flickr (CC BY SA 2.0)

Since the CDC updated its guidelines for fully vaccinated people, the culture of mask wars has pivoted from shaming individuals who refuse to wear masks to shaming those who won’t stop. But for millions of Americans who are immunocompromised or suffer from underlying conditions, including organ transplant patients, getting the COVID vaccine still may not be enough to provide ample protection from the coronavirus. 

The Washington Post cites emerging research that seems to indicate anywhere from 15-80% of people with conditions including specific blood cancers, HIV, and autoimmune disorders like rheumatoid arthritis—along with those who have had organ transplants—are generating fewer antibodies than healthy people who have received the COVID vaccine.

For those highest at risk, the CDC ruling is only contributing to senses of fear, isolation, and confusion that immunocompromised people now face. Many who are left behind feel that the new guidelines only restrict their freedom as fully vaccinated people now feel empowered to leave their masks at home.

The reason for the disparity is due to the rush to get vaccines on the market. Since pharmaceutical companies were forced to exclude immunocompromised people from clinical trials, there is still limited data on how effective the vaccines are to these groups.

And now, even as the CDC continues to loosen restrictions, neither the federal government nor Pfizer-BioNTech and Moderna have plans to conduct a comprehensive study about whether the vaccines protect people with immune disorders. Though some academic research has been undertaken, it tends to be independent and often results in wildly different conclusions.

Transplant recipients and patients with blood cancer seem to be at the highest risk of a weakened response—likely due to the immunosuppressive drugs required to prevent organ rejection and other commonly prescribed steroids.

To that point, a JAMA Network study published on May 5 found that 46% of 658 transplant patients did not mount an antibody response, even after two doses of the Pfizer or Moderna COVID vaccines.

“Although this study demonstrates an improvement in antispike antibody responses in transplant recipients after dose 2 compared with dose 1, these data suggest that a substantial proportion of transplant recipients likely remain at risk for COVID-19 after two doses of mRNA vaccine,” the authors wrote. “Future studies should address interventions to improve vaccine responses in this population, including additional booster doses or immunosuppression modulation.”

Dorry Segev, a Johns Hopkins University School of Medicine researcher who co-authored the study, expressed his dismay with the findings.

“The overwhelming majority of transplant patients, even after a second dose of the vaccine, appear to have suboptimal protection—if any protection—from the vaccine, which is frightening, disappointing, and a bit surprising,” Segev told the Washington Post.

Segev added that, until recently, few transplant recipients had become ill with COVID-19, because most had been diligent about quarantining and social distancing for most of the pandemic. Over the past two months, however, as people get vaccinated, they’re now seeing an average of one newly infected patient per day. 

Many of these patients had felt safe enough after being fully vaccinated to relax social distancing precautions.

“The irony of it all is [that] transplant patients were being very, very careful. It’s a very scary problem,” Segev said. “We expected a slightly blunted effect, not something this stark.”

There still may be hope for transplant patients who get the COVID vaccine

As the JAMA study suggests, scientists are developing potential ideas to treat immunocompromised and transplant patients.

Booster shots (or otherwise high-doses) of the vaccine may be one possible solution. In that situation, those at high risk could end up receiving three doses of the Pfizer or Moderna vaccines instead of two.

Proteins called “monoclonal antibodies” may present another potential solution. These lab-produced white cell clones have primarily been used to treat those already infected with the coronavirus until now. However, they could also be used as a preventative treatment for those who are immunocompromised.

But time is running short to study these options, which need to be available as soon as possible. In the meantime, many physicians continue to urge immunocompromised patients to continue practicing social distancing, wearing masks out in public, and taking other safety precautions as necessary.

Sources: Washington Post, JAMA


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