The challenge of Covid-19 vaccines for those with immunosuppression

In addition, antibodies are not the only defense that the body deploys to create immunity: we also make it T cellsmemory B cells and others. Clinical trials of the vaccine have not attempted to measure the number of cells required to create an effective defense against the virus. just report Patients End points, such as whether someone became seriously ill or died from the disease. So focusing on antibodies alone may miss important parts of the immune response.

Haider, who is the principal investigator for bigger study It recruits people with a range of immune deficiencies, including HIV, in order to study the response to the Covid vaccine. “I am afraid it will lead to reluctance to receive the vaccine if the messages are that the vaccine is not working for you. I think we should be more accurate in calculating the complexities that vaccines could have accelerated other elements of the immune system.”

Even in the few studies conducted to date, it is clear that the immune response to vaccines varies, depending on the age of the patient, the type of immune deficiency they have, the type of transplant they received, the specific medications they are taking, the length of time since transplant or the last dose and combination of other factors. The potential for abundant antibody production appears to be higher, for example, in patients taking immunosuppressive drugs for the treatment of chronic inflammatory diseases than in transplant patients and cancer patients. Studies by Segev and his team show better rates of antibody production in these patients afterwards One And the two doses. But a separate preliminary version, prepared by the Washington University School of Medicine in St. Louis and the University of California at San Francisco, Offers A wide range of responses depending on the medication regimen the patient is taking.

This may provide a guide to managing the vulnerability of patients, so that they can get closer to the kind of immune protection that healthy people get from Covid vaccines. “One thing we say to patients who are suppressed, who have not yet been vaccinated, is to consider keeping their medication,” says Alfred H.J. Kim, senior author of this study and assistant professor of rheumatology and immunology at the University of Washington. “Obviously, if you’re carrying medications, you risk having a flare-up. And if you’re going to flare, it could exacerbate the side effects of the vaccine, or it could make the vaccine itself less effective. It’s a really tough situation.”

Legally, doctors cannot currently advise patients to seek additional doses of the Covid vaccine. The US Food and Drug Administration has allowed only one or two doses of all vaccines it has allowed to enter the US market. For Segev’s team’s study, doctors didn’t prescribe third doses — patients found third doses on their own, in ways the study didn’t specify. The Hopkins team tracked the results.

However, there is some evidence in the medical literature to support the benefit of additional doses. For example, the French government I recommend A third dose for those who suffer from immunodeficiency. And in the United States, it has been understood for years that a file second dose seasonal influenza vaccine and larger doses Hepatitis B vaccine to create immunity.

But it will be necessary to collect more data to be sure. The Hopkins team is considering a larger trial in which immunosuppressed patients seeking third doses would be enrolled and followed in a formal manner. And despite the appeal of high protection, they don’t urge immune-compromised patients to start getting their third shots liberally. “There are risks to taking third doses,” Segev says. “There is a risk that the third dose will activate your immune system and cause either an outright rejection or some sort of subclinical thing where you start to develop more antibodies against the transplanted organ. It is important that people who go out for third doses either are part of the protocols research or do so in collaboration with their physicians who have evaluated the risks and benefits.”

If such experiments can yield data—another onerecently announced, being conducted by the National Institutes of Health — it can do more than allow immunocompromised people to return to daily life. They can also shed light on aspects of the immune system and its interaction with vaccines that are still not well understood. And that will come in handy not only during this pandemic but for everything we need to protect ourselves from the next.

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