Vaccines, antibodies, antivirals: How some immunocompromised people can cut their risk of Covid

As more and more Americans wear masks, Immunocompromised people may be worried about their level of risk among undisguised crowds.

The latest change comes on Monday, when a Federal judge overturns Centers for Disease Control and Prevention rule stipulates that all visitors must wear masks on public transport, including planes and trains.

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But experts say that although immunocompromised people are still at greater risk of contracting Covid, the landscape looks much different than it did a year ago, with a number of tools available to provide additional guidance. protection they need.

Options now include additional doses of vaccines and boosters, preventive monoclonal antibody injections, and antiviral drugs that can help some immunocompromised people take steps to keep going. more normal life.

Dr Bob Wachter, chair of the Department of Medicine at the University of California, Berkeley, said the tools are now available to immunocompromised patients, although not as effective as when offered to people with healthy immune systems. strong, but can still allow them to feel more comfortable. , San Francisco.

“For an immunocompromised patient who says, ‘I still feel like I need to stay home,'” says Wachter. “I think at this point it’s not necessary.”

Alfred Kim, a rheumatologist at Washington University in St. Louis, acknowledges the progress that has been made.

“Definitely, we are in much better shape than we were last year,” Kim said. However, “when you consider all the masks,” a high-quality mask like the N95 remains an important tool for people with weakened immune systems.

Wachter agrees that wearing a mask remains an “important measure of protection,” especially in indoor spaces.

One estimated 2.7 percent of adults immunocompromised in the United States. This includes organ transplant recipients, some cancer patients, and people with HIV or other medical conditions that weaken the immune system.

Some groups, such as organ transplant recipients, are at particularly high risk, while others, such as those with rheumatoid arthritis, may still have some type of immune response.

Additional vaccines

Although the Covid vaccine has been offered to immunocompromised patients for more than a year, scientists’ understanding of how best to use the vaccines in this group has grown.

Last August, the Food and Drug Administration and the CDC signed off on an additional dose for immunocompromised people. This dose is not considered a booster – rather, it is part of the main series.

“For immunocompromised people, that supplement is the mainstay, where three doses are similar to two doses” in people with a weakened immune system, said Dr. David Boulware, an infectious disease physician at the University. healthy immune system, says Dr. David Boulware, an infectious disease physician at the University of Minnesota School of Medicine.

Data suggest that additional doses of the vaccine have been shown to be beneficial.

One learn published in January in the CDC’s Morbidity and Mortality Report found that three doses of the vaccine increased protection by 88 percent in immunocompromised adults, an increase of nearly 20 percent. in people who have just received two doses. Study takes place when delta variation predominates in US

Since then, two additions booster dose authorized, to fight Impaired immunity. That means a person with a weakened immune system can get a total of five shots.


Kim, University of Washington, says the most essential tool for showing up is EveldFDA approved in December.

Evusheld, manufactured by AstraZeneca, is a monoclonal antibody cocktail, injected twice, to block Covid. For those who cannot respond to immunity even with vaccination, the drug provides the patient with a direct infusion of antibodies. Patients may receive an additional dose every six months.

“It gives them antibodies that can protect them from Covid that they should have produced by vaccination but can’t” due to their weakened immune systems, Kim said.

In clinical trials, Evusheld was found to be 83 percent effective against symptomatic disease more than six months.

Antiviral drugs

Antiviral drugs such as Paxlovid — a pill made by Pfizer — could also be an option for people who are immunocompromised, if they become infected, Kim said.

However, this medicine is not sure to be suitable for everyone, as it may react with some other medicines, some of which are essential for people with weakened immune systems.

This is “a bit of a tricky one, because you’ll have to keep some of your autoimmune diseases on hold so you can treat Paxlovid even for a short period of time,” Kim said.

The FDA does not recommend Paxlovid for people with severe liver or kidney disease.

At UCSF, Wachter says doctors and staff are working to raise awareness of the resources that immunocompromised individuals have available to prevent both infection and serious illness.

“I think it’s important for people to understand that if they’re still in bow-and-wait mode, it’s important for them to really look at that and say, what are you waiting for?” he say. “Because it can’t get any better than this.”

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