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A Napa woman died of COVID-19 despite being fully vaccinated, providing a stark reminder that vaccinated people are not immune, especially if they are medically compromised and the virus continues to spread widely.
“No vaccine is 100% effective, but that does reduce the urgency and importance of getting vaccinated, especially as more diverse strains emerge,” Napa County Public Health Officer Dr. Karen Relucio said. “Vaccines provide exceptional protection against death and disease from the virus and all residents must continue to receive the vaccination to protect themselves and others.”
The woman, whose identity has not been released, died on Wednesday after a lengthy hospitalization period. She had underlying medical conditions and was over 65 years old.
Of the more than 17 million Californians who have been fully vaccinated, 5,305 post-vaccination cases of COVID-19 were identified as of May 26 — a “breakthrough” rate of 0.03%, according to the state’s Department of Public Health.
Of those, at least 373 people were hospitalized and at least 40 people died. CDPH said it was not known if the main cause of hospitalization or death was COVID-19 or if there were other causes.
There is little data on the effectiveness of vaccines in people with underlying health problems, especially immunocompromised, because they were not included in initial vaccine trials.
But there is mounting evidence that people who are immunocompromised may not have a strong response to the vaccine.
Health experts say this underscores the importance of widespread vaccination. Vulnerable people are only isolated when everyone else is vaccinated, so the virus can’t find enough people to infect and stop its deadly spread.
It’s especially important to get friends and family members vaccinated for people with weakened immune systems, said Dr. Brian Schwartz, professor of medicine in the division of infectious diseases at UCSF Health.
“You want to build an immunity wall at home,” he said. “That will greatly reduce the chance of infection.”
He said people with weakened immune systems should wear masks and keep away from themselves and people who are not immunized.
In March, a fully vaccinated Chicago man died of COVID-19 after dining out with friends, one of whom tested positive for the virus in the days following the meal. The man who died was diagnosed with chronic lymphocytic leukemia in 2019.
Schwartz said people can be immunocompromised for various reasons.
“It’s a heterogeneous group. There are a lot of different drugs that affect different pathways of the immune system, so you would expect to see different responses to vaccines,” he said.
They may be on medications to suppress their immune system if they have an autoimmune disease such as rheumatoid arthritis, multiple sclerosis, lupus, or an inflammatory bowel disease, such as ulcerative colitis.
Some medications — such as rituximab, methotrexate and prednisone — deplete B cells that the body needs to make antibodies, according to Dr. Leanne Gensler, MD, associate professor of medicine in the division of rheumatology at the San Francisco Department of Veterans Affairs.
When vaccinated, their bodies produce antibodies – but not enough of them. In one study, there was a threefold decrease in antibody levels in people who had been vaccinated with autoimmune diseases, compared to healthy people. Steroids produced a tenfold drop.
Chemotherapy to treat cancer also undermines the immune system. Some types of blood cancers can also put people at risk. While people with breast cancer and gastrointestinal cancer have a 95% response to the vaccine, those with chronic lymphocytic leukemia have only a 23% response.
People who have had bone marrow and organ transplants and take anti-rejection medications, which reduce their natural defenses, are at risk. One study found a modest 38% to 59% antibody response to vaccines in people who had an organ transplant.
Medical tests – specifically, a test that measures an “anti-elevated IgG antibody” – can reveal the strength of the immune response. But it is not yet known how many antibodies are necessary to be protective. These tests do not measure the second arm of the immune system, including T cells.
Even partial immunity can help. For people who have been vaccinated but still get sick, there is evidence that their risk of severe illness and death is lower than for those with similar risk factors who have not been vaccinated, according to the US Centers for Disease Control and Prevention.
The CDC is working with state and local health departments to investigate cases of COVID-19 vaccine hacks. The goal is to identify any unusual patterns, such as trends in underlying health conditions, age, sex, the vaccine used, or what type of virus made these people sick.
Scientists are looking for ways to boost the immune response in these at-risk patients. They are looking at whether they need vaccinations at higher doses. Or maybe they need a “booster” later. They may have better protection if their immunosuppressive therapy is suspended during the vaccination.
“This is an area that we need to continue to learn more about,” Schwartz said. “At the moment, we don’t have enough information to make really good judgments.”
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