What do we know about the COVID-19 vaccines in people who are immunosuppressed?

Biology/Immunity Vaccines

A. While data on the relative effectiveness in these groups is still limited, COVID-19 vaccines are safe for immunosuppressed people and help protect against severe COVID-19 disease.


➡️ None of the vaccines contain live virus and cannot cause infection.
➡️ Even if immune response is lower in the immunosuppressed, the vaccine will induce some immunity and protection against COVID-19 disease
➡️ Some protection against vaccine-preventable infections is better than none.

People who are on treatment that suppresses their immune system or those who have an inherited defect of the immune system are “immunosuppressed”. Immunosuppressed people were not excluded from the original clinical trials, but their overall numbers were small and thus separate efficacy estimates were not possible. Their were no safety concerns from the trials, and tens of thousands of immunosuppressed people have already safely received the vaccine globally.

👍 Should immunosuppressed individuals receive vaccines?

Vaccine-preventable infections can be more severe in immunosuppressed people. Vaccination is therefore an extremely important infection-prevention strategy in immunosuppressed people, even if they may not develop as robust an immune response to vaccination as healthy people do.

🛡️ Some protection against vaccine-preventable infections is better than none!

However, not all types of vaccines are suitable for immunosuppressed people. Vaccines that make use of weakened live strains of viruses or bacteria (e.g.; MMR (measles, mumps, rubella), chicken pox vaccine) may themselves cause infections in some immunosuppressed people. Vaccines that make use of a part of a virus or bacteria, or that use killed bacteria or viruses can be used, and in fact are recommended for immunosuppressed people in order to induce some amount of protection against infection. Data gathered in immunosuppressed people including HIV-infected patients and organ or bone marrow transplant recipients who were given the flu vaccine showed that while most of these people did not make a strong response to the flu vaccine, the vaccine was safe, and the benefits of vaccination far outweighed the risks.

💉 How about COVID19 vaccines? Are they safe for immunosuppressed people?

The U.S. Centers for Disease Control and Prevention (CDC) guidelines state that these vaccines may be given to immunosuppressed people after consultation with their doctors. As more people are becoming eligible for vaccination, questions regarding the risks and benefits of these new vaccines for people on immunosuppressive therapy, replacement immunoglobulin therapy (IVIG), or who may have an inherited immunodeficiency disorder continue to arise. The main purpose of the COVID19 vaccine clinical trials was to establish that healthy people made a good response to the vaccine. This data allowed several COVID19 vaccines to go through approval for use. A small number of HIV positive people with well-controlled disease were included in the Pfizer, Moderna and Johnson & Johnson vaccine trials. The Johnson & Johnson vaccine trial also included 79 people who were on immunosuppressive treatment following transplant. No safety issues were identified in these people. Several studies are in progress in the UK and Europe that will provide data on the vaccine response in people with cancer or who are on dialysis and who may therefore be immunosuppressed.

It is important to note that the mRNA vaccines (Pfizer, Moderna) and viral vector vaccines (Johnson & Johnson, Astrazeneca, Sputnik) vaccines are not live vaccines. The Pfizer and Moderna vaccines make use of mRNA (the genetic code) for a portion of the SARS-CoV-2 virus, while the Johnson & Johnson, Astrazeneca, and Sputnik vaccines are ‘viral vector’ vaccines which use a non-replicating cold virus to deliver the SARS-CoV-2 virus protein to cells. Importantly, the cold virus in the viral vector vaccines is merely a delivery system and not a live virus that can cause infection.

❓ When should a COVID19 vaccine be given to an immunosuppressed person?
❓ Should immunosuppressive therapy be discontinued prior to vaccination?
❓ How long after stem cell transplant can the vaccine be given?
❓ What are the benefits or risks to people with specific inherited immune defects?

🩺 These questions should be carefully weighed on an individual basis and in consultation with healthcare professionals. Because a good immune response to vaccination needs a fully functioning immune system, immunosuppressed people may not have all of the necessary functioning immune cells, and therefore may not develop a good immune response. People who are on immunoglobulin replacement therapy can receive COVID19 vaccines if recommended by their healthcare provider. However, measuring antibodies after vaccination may not be useful in these people.

Given the good safety profile of the current COVID19 vaccines, the benefits of getting vaccinated are likely to outweigh any potential risks. Even if you are vaccinated, it is important to continue to exercise precautionary measures such as wearing a mask, washing your hands and social distancing.

COVID-19 vaccines are safe for immunosuppressed individuals and some protection against vaccine-preventable infections is better than none!

Those Nerdy Girls

Further reading:

Recommendations of the Advisory Committee on Immunization Practices (ACIP): Use of Vaccines and Immune Globulins in Persons with Altered Immunocompetence:

Ongoing clinical studies in immunocompromised individuals:

From clinicaltrials.gov

From JAMA Network

Additional guidance regarding the use of COVID19 vaccines in immunosuppressed individuals is available here:

Answers to Your Questions about Immunocompromised Patients from AAAAI

Patients with compromised immune systems, whether due to chemotherapy or a bone marrow transplant, should plan to be vaccinated against coronavirus disease from AJMC

Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States from the CDC

COVID-19 and Vaccines for the Immunocompromised: Frequently Asked Questions from the American Society of Hematology

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