CDC panel unanimously recommends Covid vaccine booster shots for vulnerable Americans

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Close-up of Moderna vaccine at the Park County Health Department COVID-19 vaccination clinic for seniors 80 years and older on January 28, 2021 in Livingston, Montana.
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A key Centers for Disease Control and Prevention panel unanimously voted Friday to recommend booster shots of Pfizer’s or Moderna’s Covid-19 vaccines to immunocompromised Americans, clearing a major hurdle enabling vulnerable patients to get a third dose.

The decision by the Advisory Committee on Immunization Practices follows the Food and Drug Administration’s approval Thursday of the booster shots for immunocompromised patients. The CDC, which has the final say, is expected to adopt the panel’s recommendation later Friday. With both agencies’ OK, booster doses could start being administered immediately.

“Over the past almost year and a half I have taken care of many patients with life threatening disease, and including deadly disease, and even after a vaccination” who are immunocompromised, Dr. Camille Nelson Kotton, a transplant and infectious disease specialist at Massachusetts General Hospital, told the panel in strongly supporting boosters for patients with weak immune systems. “They’re just suffering from a lack of good vaccine protection, we know that vaccine efficacy is diminished in this population.”

The FDA approved third doses of Pfizer and Moderna vaccines for “solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise.” The agencies didn’t clear boosters for other fully vaccinated individuals or for recipients of Johnson & Johnson’s vaccine manufactured under its Janssen vaccine division.

“Currently there are not data to support the use of an additional mRNA COVID-19 vaccine dose after a primary Janssen Covid-19 vaccine in immunocompromised people. FDA and CDC are actively working to provide guidance on this issue,” the CDC’s Dr. Neela Goswami wrote in her presentation to ACIP.

The CDC recommended a third dose for vulnerable Americans 28 days or more after completing the initial two rounds of shots. Booster doses are also recommended for cancer patients and HIV patients after data showed that immune responses after the initial two doses in those patients did not provide adequate protection against Covid-19 and its variants.

The extra shots were recommended for Pfizer recipients who are 12 or older and Moderna recipients who are 18 and older. The panel said it would revisit the shots for younger Moderna recipients after the FDA clears the shots for kids.

Immunocompromised patients make up roughly 2.7% of the U.S. adult population and 44% of hospitalized breakthrough infections, where someone gets infected even after they’ve been fully vaccinated.

Studies suggest that a third vaccine dose might help patients whose immune systems don’t respond as well to a first or second dose. Five small studies cited by the CDC showed that 11% to 80% of people with weakened immune systems didn’t have detectable antibodies to fight Covid after two shots.

Among immunosuppressed patients who had no detectable antibody response, 33% to 50% developed an antibody response after receiving an additional dose, according to the CDC.

Vulnerable patients are also more likely to experience prolonged Covid infections, the panel said. Data also suggests they are likely to shed more virus and potentially infect more people than those who are not immunocompromised.

Early data from small studies of the effects of booster doses in immunocompromised patients didn’t show any severe adverse effects from a third shot of an mRNA vaccine and symptoms beyond those already identified after the initial two-dose regimen.

Several countries including Israel, the Dominican Republic, France, the United Kingdom and Germany have either already begun administering booster doses of Covid-19 vaccines or are considering it.

Immunocompromised patients who receive a third dose should still wear a mask and social distance, the panel said.

Survey data from hesitant immunocompromised patients indicate that many are still worried about side effects from the vaccines and the speed in which the shots were developed as well as general distrust of the vaccines, according to a panel presentation by the CDC’s Dr. Kathleen Dooling.

About 10% of immunocompromised patients say they will “definitely not” be receiving a Covid vaccine, another 9% say they are “unsure” or will “probably not” receive a shot and 44% said they “definitely will” receive a vaccine. Those who are hesitant tend to be younger, part of an ethnic or racial minority or female.

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