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Too Soon to Celebrate? Covid-19 Vaccinations and Immunosuppressed Patients

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I celebrated my recent Covid-19 vaccination by tearing up the “Do Not Enter – Immunosuppressed Person Inside” sign on our front door. I assumed that I had 90% immunity now that I had my second dose of the Moderna vaccine in my arm. It turns out I may have celebrated too soon.

Like 11 million other U.S. residents, I am taking a medication that suppresses my immune system. Some leukemia survivors like me underwent a stem cell transplant and take tacrolimus or a similar drug to tamp down our immune systems. Other patients have undergone a heart, lung, or kidney transplant and take anti-rejection drugs. Still others suffer from autoimmune diseases like lupus or IBS and take drugs to suppress their immune systems.

We probably all celebrated when Pfizer and Moderna announced that their vaccines had shown a 90% plus efficacy in patients including seniors. What we did not know was that immunosuppressed patients were excluded from the double blind placebo studies.

The world’s first reported trial to examine the level of immune protection after the Pfizer vaccine in cancer patients, shows that anti-SARS-CoV-2 antibody responses at week three, following the first dose of the vaccine, were only 39% and 13% in the solid and blood cancers respectively, compared to 97% in those without cancer.  

A recent nationwide study by doctors at Johns Hopkins published in JAMA has caused concern for all of us in the immunosuppressed community. In a recent interview, one of the doctors who conducted the study, organ transplant surgeon Dorry Segev, M.D. , stated:

“Among 436 COVID-naïve participants who received a first dose of mRNA vaccine, only 17% mounted detectable antibodies to SARS-CoV-2. This is in stark contrast to immunocompetent people who were vaccinated, of whom 100% mounted detectable antibody; that was true for people who had received either the Pfizer-BioNTech or Moderna vaccine. We also found that those taking anti-metabolites, such as mycophenolate or azathioprine, were about five times less likely to develop antibody responses (8.75% detectable antibody in those taking anti-metabolites versus 41.4% in those not taking them).”

Dr. Segev was disappointed to see these findings, as he was hoping to be able to tell his immunosuppressed patients that the vaccines seemed to work well for them. As a result of his study, Dr. Segev believes the CDC should warn immunosuppressed patients that the vaccines may very well not protect them from contracting Covid-19. He believes it is important for immunosuppressed individuals to realize that they are not necessarily immune after receiving the vaccine. He recommends that we talk to our providers about antibody testing before relaxing protective behaviors. “Fortunately, semiquantitative antibody tests like the ones used in our study are widely available, and correlate well with neutralizing immunity.”

I plan to follow his advice and to get an antibody test before I start to relax my precautions. I’ve been through too much and come too far to slip up now. Onward and upwards my friends.


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