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Immunodeficiency must be cautious, COVID vaccine is not protective

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Dr. Dolly Segev, Physician at Johns Hopkins Medical Center
The world quickly became less secure for immunosuppressed people.

Segev is studying the effectiveness of a third dose, hoping that “there is something that can ultimately be done for transplant patients.”

He wants to start a formal intervention trial soon and provide a third shot in the clinical setting to ensure safety and track participants’ reactions.

A handful of patients have already begun Get an extra shot – simply appear at the vaccination center and do not admit that you are already vaccinated. It’s much safer for them to take the third dose through clinical trials, Segev said. He is currently looking for volunteers at plantvaccine.org.

“It’s really important that this is there, as people know that this is happening,” he said.

Segev hoped that even if the transplant patient did not develop the antibody, there might be some protection against COVID-19.

Unfortunately, he and other hospitals are beginning to accept transplant patients infected with COVID-19 after being completely vaccinated. “It’s almost unprecedented in the general public,” he said. “This is seen at a much higher rate in transplants.”

Segev, who recently examined 30 patients who received the third injection, said there were no safety issues, except for one who had low-grade rejection one week after the final dose. However, the problem may have started before the shot. “There are no strong signs so far,” he said of the possibility of refusal.

Dr. Dolly Segev will investigate whether transplant patients who do not respond after two doses of the mRNA vaccine made by Pfizer-BioNTech and Moderna will succeed after booster shots.
David Zalubowski, Associated Press

Segev will also investigate whether transplant patients who do not respond after two doses of the mRNA vaccine produced by Pfizer-BioNTech and Moderna will succeed after booster immunization. (His previous study was by a single J & J The vaccine was even less protective against transplant patients than the two-shot vaccine. )

Data are not available fast enough for those who are worried that the vaccine may not be safe, Montgomery said.

“This is currently the number one problem in our field,” he said.

Fortunately, most other immunocompromised people will receive better protection than transplant patients, experts say.

Vaccines appear to be just as safe to them, and most seem to have at least some protection.

The problem is that at this point it is impossible to know how safe someone is. For the general public, who are more than 90% protected by the vaccine, there is no need to worry, experts said.

For people with immunodeficiency, there is no good way to know if they are protected. Dr. Gil Melmed, who directs clinical research on inflammatory bowel disease at the Cedars Sinai Medical Center in Los Angeles, said antibody tests looking for certain protective antibodies couldn’t give the big picture, they were just a snapshot of time. Said not. The CDC discourages people from using tests.

In all people, antibodies are likely to decline over time, and it is not clear which level is protective.

Vaccines also produce T cells, often referred to as soldiers of the immune system. This seems to provide longer-term protection, but there are no commercial tests to look for them.

Dr. Rajesh Gandhi, an infectious disease specialist at Massachusetts General Hospital, said that people with immunodeficiency would be vaccinated to ensure their safety and that everyone around them would be vaccinated. You need to “build a wall of defense.”

Researchers believe that people develop long-term protected T cells in response to vaccination, but they are difficult to test.

Researchers believe that people develop long-term protected T cells in response to vaccination, but they are difficult to test.
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“I don’t think I’m ready to pay attention to the wind,” added Dr. Joshua Katz, a neurologist at Tufts University School of Medicine, also in Boston. He recommends that his patients continue to take precautions such as masking to ensure that the people around them are vaccinated.

Dr. Samir Palek, an expert on multiple myeloma at the Tissue Cancer Institute in Mount Sinai, New York, uses accurate antibody tests to determine if immunocompromised patients are at specific risk. He states that he needs to talk to his doctor about this. “We recommend testing patients with myeloma who are receiving immunosuppression from cancer and chemotherapy,” he said.

For patients with irritable bowel syndrome, the vaccine appears to be safe and provide about 80% protection, which is lower than in perfectly healthy people, but still better, Melmed said.

He runs a registry that tracks 1,800 patients with inflammatory bowel disease and understands their response to vaccination. He said it was premature to know if IBD patients had more “breakthrough infections” after vaccination than the general population, but no bad results were seen among his registered members. It was.

Melmed hopes that the registry will help researchers teach researchers about the decline in vaccine protection, and whether vaccine protection will decline faster in people like immunocompromised IBD patients.

COVID-19 vaccine protection varies

Patients with multiple sclerosis have been “riding a roller coaster” for the past year, Katz said, raising concerns and fears about COVID-19. They turned out not to increase the risk of catching COVID-19, and vaccination does not pose an extra risk to sick people, he said.

The National Multiple Sclerosis Society encourages everyone with MS to be vaccinated with COVID-19.

The effectiveness of vaccination in patients with multiple sclerosis appears to depend on which of the 16 to 17 available treatments they are receiving, Katz said. For example, most people taking the drug Mavenclad were well protected with the COVID-19 vaccine, but about 20% of people taking Gilenya and Ocrevus. Only made the antibody.

However, a study of ocrelizumab suggests that even those who did not make antibodies produced extra white blood cells after vaccination and gained some protection, he said.

For cancer patients, the amount of protection depends on the type of cancer and the location of treatment.

According to a study published this month in the journal Cancer Cell, about 98% of people with solid tumors developed protective antibodies after vaccination. By comparison, only 85% of patients with hematological cancer and about 70% of patients receiving intensive immune system treatment developed antibodies.

If a cancer patient becomes infected with COVID-19, the availability of monoclonal antibodies should be considered, said Dr. Craig Banell, chief medical officer and breast cancer expert at the Dana-Farber Cancer Institute in Boston.

If a cancer patient becomes infected with COVID-19, the availability of monoclonal antibodies should be considered, said Dr. Craig Banell, chief medical officer and breast cancer expert at the Dana-Farber Cancer Institute in Boston.
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Dr. John Zia, who heads the gene therapy center in Hope, which runs a cancer center in California, said vaccination should be done before starting chemotherapy if possible. If that is not possible, he said, vaccination should be postponed until the end of chemotherapy treatment to get the best response to the injection.

Zaia is leading the study of the COVID-19 vaccine developed specifically for cancer patients at the City of Hope, using a platform designed for bone marrow transplant patients who lose protection from all vaccines during transplantation. .. Zaia said the vaccine has been tested in 60 healthy people so far and then its efficacy is compared to the Pfizer-BioNTech vaccine.

Dr. Craig Bunnell, Chief Medical Officer and Breast Cancer Specialist at Dana-Farber Cancer, said that if a cancer patient becomes infected with COVID-19, he should consider obtaining monoclonal antibodies that help reduce the likelihood of serious illness. I have. Boston Institute.

He added that the same drug may prove effective in preventing infections in people such as cancer patients who cannot get protection from the vaccine. Research is underway to confirm this.

High-risk life in a maskless world

Unfortunately, Nadeem-Baker belongs to the group with the least protection from vaccines and the highest risk of catching COVID-19.

Last month, the CDC’s decision to remove mask recommendations for vaccinated people made her life worse. Even unvaccinated people took off their masks.

“Dropping the Maskman date heightened my fear,” said Nadim Baker, who turned from a former corporate communications executive to an advocate for blood cancer patients. She is particularly worried about the variants that appear to spread more rapidly.

“I want to return to normal life, like everyone else,” she said. “I feel like I’m out of life.”

Michele Nadeem-Baker, patient with chronic lymphocytic leukemia
Like everyone else, I want to return to normal life.

Her college son moved to protect her. Her husband strips just inside the front door and puts all his clothes in a trash bag for washing.Her sisterBecame a widow last year, Immediately enter quarantine to pay for her first visit. “I couldn’t hug her,” she said.

With the blessing of a doctor, she can only spend her time comfortably walking in nature with her dog, riding a horse, or eating in the backyard with her vaccinated friend.

Nadeem-Baker wants to better understand people like her who strangers have to keep wearing masks. “We are doing our best,” she said. “I’m tired of explaining it.”

She considered taking part in a clinical trial to see if the third shot would help people like her.

“I hope that helps,” she said. “I just want something that works.”

Contact Karen Weintraub at [email protected]

Health and patient safety coverage at USA TODAY was partially made possible by grants from the Masimo Foundation for Ethics, Innovation and Competition for Healthcare. The Masimo Foundation does not provide editorial input.

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