Protecting immunocompromised patients in the COVID-19 pandemic

By AstraZeneca

Additional protection may be needed for this high-risk population.

The COVID-19 pandemic has affected millions of people worldwide,1 especially vulnerable populations such as elderly and immunocompromised people.2 With highly-effective options available to the public, vaccines have reduced the number of patients who are hospitalized due to COVID-19, as well as their likelihood of dying from the disease.3 Yet, even with the promise these vaccines bring, one population remains uniquely vulnerable to the coronavirus—the immunocompromised.3

Although immunocompromised people represent less than 3 percent of the American adult population,4 data have shown they account for a disproportionately large number of people who become infected with the coronavirus despite being vaccinated. According to research, immunocompromised people account for more than 40 percent of these “breakthrough infections.”5,6

For that reason, many in the healthcare community consider it critical to find new solutions for protecting these vulnerable patients. And, thanks to technological and scientific advancements, immunocompromised patients now have more options in the fight against COVID-19—offering hope to this high-risk population.

Who is considered “immunocompromised”?

Immunocompromised patients are people whose immune system is weakened either because of underlying health conditions, such as patients who are receiving active treatment for blood cancers, advanced or untreated HIV infection, or taking immunosuppressive therapies (see the infographic below).7-9

People with cancer are vulnerable, as chemotherapy treatments can attack the immune system, reducing the number of white blood cells that constitute a critical line of defense against infection.10

In some cases, patients can develop acquired immune deficiency. This may be caused by a virus such as human immunodeficiency virus (HIV), or after taking certain medications, such as drugs to prevent organ rejection after a transplant. In other cases, patients are born with a weak immune system (primary immune deficiency).7,11

For these immunocompromised patients, additional protection may be needed to supplement vaccines.

Why additional protection may be needed for immunocompromised patients

A vaccine works with a person’s immune system to strengthen defenses against an infection.12 Typically, vaccines contain part of a virus or an inactivated virus, which triggers the immune system. If the body encounters the real virus, it can call on this biological memory to help protect against infection. More recently, a genetic material called mRNA has been used in vaccines. This material teaches cells how to make a protein that will trigger an immune response inside our bodies.  The process triggered by all of these vaccines is called “active immunity.”13,14

Active immunity, however, may not be achieved for millions of immunocompromised patients around the world. Research shows that after initial vaccination moderately or severely immunocompromised people may not mount a protective immune response.6, 8, 15, 16 For immunocompromised patients, an extra layer of protection in addition to the vaccine could be helpful.17

Antiviral agents are another type of treatment that have garnered attention during the pandemic. These work by disrupting the mechanisms that allow the virus to replicate.18 For immunocompromised patients, such as Dr. Brian Koffman of the Chronic Lymphocytic Leukemia Society (or CLL Society), the need for additional protection beyond vaccines is evident. “What’s important is we protect all who are seeking protection against the pandemic,” Dr. Koffman said.

In the video below, Dr. Koffman explains more about why additional options may be advisable for the immunocompromised.

Dr. Brian Koffman of the Chronic Lymphocytic Leukemia Society (or CLL Society)

Hope for the vulnerable

According to Dr. Koffman, now is the time for immunocompromised communities to discover additional options for prevention of COVID-19. “We want to put other options into their hands to give them a chance to reengage in the world,” Dr. Koffman said.

One option for immunocompromised individuals may come from monoclonal antibodies. This is a type of antibody that has been designed in a laboratory to bind to a specific target, such as sites on the surface of a virus.17

These antibodies may be of particular benefit to immunocompromised patients because, unlike vaccines, they do not depend on a fully functioning immune system to be effective. Rather, they can act as substitute antibodies and imitate the immune system’s attack on a specific pathogen.19

Research over the past several years has led to advances in this new generation of antibodies. Monoclonal antibodies are currently being studied for prevention of a range of infectious diseases such as malaria and influenza, as well as COVID-19.17,20,21

“If you or a loved one is immunocompromised, talk to your doctor about whether the use of monoclonal antibody therapy in addition to a vaccine for the prevention of COVID-19 is right for you,” Dr. Koffman said.

Sources: 

  • World Health Organization. Coronavirus (COVID-19) Dashboard. Available from: https://covid19.who.int/. Last accessed on November 16, 2021
  • Centers for Disease Control and Prevention. People with Certain Medical Conditions. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Last accessed on November 16, 2021
  • Centers for Disease Control and Prevention. Science Brief: COVID-19 Vaccines and Vaccination, Available from: https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html. Last accessed on November 16, 2021
  • Oliver, S MD. Data and clinical considerations for additional doses in immunocompromised people. CDC ACIP Meeting July 22, 2021. Available at: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-07/07-COVID-Oliver-508.pdf. Last accessed on November 16, 2021
  • Tenforde MW, Patel MM, Ginde AA, et al. Effectiveness of SARS-CoV-2 mRNA vaccines for preventing Covid-19 hospitalizations in the United States. medRxiv [Preprint]. 2021 Jul 8:2021.07.08.21259776.
  • Brosh-Nissimov T, Orenbuch-Harroch E, Chowers M, et al. BNT162b2 vaccine breakthrough: clinical characteristics of 152 fully vaccinated hospitalized COVID-19 patients in Israel. Clin Microbiol Infect. 2021 Jul 7:S1198-743X(21)00367-0.
  • Centers for Disease Control and Prevention. ACIP Altered Immunocompetence Guidelines for Immunizations. Available from: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html. Last accessed on November 16, 2021
  • Centers for Disease Control and Prevention. Interim Clinical Considerations for Use of COVID-19 Vaccines.  Available from: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html. Last accessed on November 16, 2021
  • Centers for Disease Control and Prevention. COVID-19 Vaccine Indications for Patients Who Are Immunocompromised. Available from: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/immunocompromised.html. Last accessed on November 24, 2021
  • American Cancer Society. Why People with Cancer Are More Likely to Get Infections. Available from: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/low-blood-counts/infections/why-people-with-cancer-are-at-risk.html. Last accessed on November 16, 2021
  • Johns Hopkins Medicine. Disorders of the Immune System. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/disorders-of-the-immune-system. Last accessed on November 17, 2021
  • World Health Organization. How do vaccines work? [Internet]. WHO.int; 2020 [cited 2021 October 24]. Accessed from: https://www.who.int/news-room/feature-stories/detail/how-do-vaccines-work.
  • Centers for Disease Control and Prevention. Understanding mRNA COVID-19 Vaccines. Available from: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/how-they-work.html. Last accessed on November 16, 2021
  • Centers for Disease Control and Prevention. Types of Immunity to a Disease. Available from: https://www.cdc.gov/vaccines/vac-gen/immunity-types.htm. Last accessed on November 16, 2021
  • Rabinowich L, Grupper A, Baruch R, et al. Low immunogenicity to SARS-CoV-2 vaccination among liver transplant recipients. J Hepatol. 2021 Aug;75(2):435-438.
  • Simon D, Tascilar K, Fagni F, et al. SARS-CoV-2 vaccination responses in untreated, conventionally treated and anticytokine-treated patients with immune-mediated inflammatory diseases. Ann Rheum Dis. 2021 Oct;80(10):1312-1316.
  • Taylor PC, Adams AC, Hufford MM, et al. Neutralizing monoclonal antibodies for treatment of COVID-19. Nat Rev Immunol. 2021 Jun;21(6):382-393
  • Holman, W., Holman, W., McIntosh, S. et al.Accelerated first-in-human clinical trial of EIDD-2801/MK-4482 (molnupiravir), a ribonucleoside analog with potent antiviral activity against SARS-CoV-2. Trials. 2021. https://doi.org/10.1186/s13063-021-05538-5
  • U.S Food and Drug Administration. COVID-19 Frequently Asked Questions. Available from: https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-frequently-asked-questions. Last accessed on December 14, 2021
  • Salazar G, Zhang N, Fu TM, An Z. Antibody therapies for the prevention and treatment of viral infections. NPJ Vaccines. 2017 Jul 10;2:19.
  • Gaudinski MR, Berkowitz NM, Idris AH, et al. A monoclonal antibody for malaria prevention. N Engl J Med. 2021;385(9):803-814.

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