Santa Barbara Doctors ExtraCare – August 2021 Newsletter

August 2021 ExtraCare
Newsletter

As summer draws to a close and kids start heading back to school it’s hard to believe that this COVID-19 pandemic continues to drag on. Given the latest delta variant surge and new restrictions, the topic on everyone’s mind these days is booster shots. Yesterday the FDA announced the emergency use authorization for booster shots in certain individuals and we wanted to be sure to help you understand exactly what that means.

Since the first doses of COVID-19 vaccine were distributed throughout the world in December 2020 we have been gathering data in regards to it’s efficacy. Now, 9 months later, we are starting to see patterns emerge in certain populations suggesting the need for booster shots. This, in light of the recent delta variant surge, prompted the FDA to announce yesterday an amendment of it’s emergency use authorization for both the Pfizer and Moderna mRNA COVID-19 vaccine. They now allow for the use of an additional dose in certain immunocompromised individuals, specifically, solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices is scheduled to meet today to discuss further clinical recommendations regarding immunocompromised individuals.

The authorizations for these vaccines have been amended to allow for an additional, or third, dose to be administered at least 28 days following the two-dose regimen of the same vaccine to individuals 18 years of age or older (ages 12 or older for Pfizer-BioNTech) who have undergone solid organ transplantation, or who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise

So, who does this pertain to…
The CDC states that immunocompromised people comprise ~2.7% of U.S. adults.
These include patients with
-Solid tumor and hematologic malignancies

-Receipt of solid-organ or hematopoietic stem cell transplant

-Severe primary immunodeficiencies

-Persons living with HIV

-Treatment with immunosuppressive medications such as cancer chemotherapeutic agents,TNF blockers,certain biologic agents (e.g.,rituximab) and high-dose corticosteroids.

In a study out of Mayo Clinic, analyzing antibody response following a standard two dose vaccine regimen in 1,500 patients with hematologic malignancies researchers reported that the majority of patients with non-Hodgkin lymphoma  failed to mount an adequate antibody response, while, in contrast the majority of patients with Hodgkin lymphoma developed antibodies. Other conditions that interfered with antibody responses were mantle cell lymphoma, maginal zone lymphoma, chronic lymphocytic leukemia, Waldenstrom’s macroglobulinemia and large B cell lymphoma. In contrast, the majority of patients with acute myeloid leukemia, acute lymphocytic leukemia and chronic myeloid leukemia were able to mount adequate immune responses., as were patients with multiple myeloma and smoldering myeloma.

Solid Organ Transplant recipients are especially at risk for mounting an inadequate immune response to COVID-19 vaccine. In a small observational study out of Johns Hopkins of 30 transplant patients, less than 1/3 of the patients developed an antibody response to the standard two dose mRNA vaccine regimen. In this and other studies, the seroconversion rate of those receiving a third vaccine dose was 30-50%.

The American College of Rheumatology has issued guidelines on how to manage COVID-19 vaccine in patients on various immunosuppressant drugs. These include holding certain medications for a period of time following vaccine or timing vaccine around immunosuppressant dosing

Patients in our practice have an advantage, in that our laboratory is able to reliably measure your COVID-19 antibody response and the majority of patients who require a booster shot have already been identified.

If you believe that you may fall into this category of immunocompromised individuals and qualify for a booster shot, please reach out to us to discuss