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A study published Monday in the Annals of Internal Medicine showed that a third dose of the Covid-19 vaccine may boost protection for some people with weakened immune systems.
The study, conducted by researchers at Johns Hopkins University, involved 30 organ transplant recipients, all of whom were vaccinated with two doses of an RNA vaccine, either Pfizer-BioNTech or Moderna. Since organ transplant recipients must take immunosuppressive drugs to make sure their bodies do not reject the transplant, there is a concern that they may not develop strong responses to the vaccines, leaving them susceptible to Covid-19.
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In fact, despite full vaccination, the vast majority of patients in the study – 24 patients – did not have antibodies against the coronavirus, and six patients had only low levels.
So, the researchers gave them a third dose of the vaccine, either Pfizer, Moderna or Johnson & Johnson. After about two weeks, their antibody levels were measured again. In patients who did not initially have antibodies, eight had an increase after the third dose of the vaccine. And in the six patients who started at low levels, they all had an increase in antibodies against the coronavirus.
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Although the study was small, the findings could be important for the millions of Americans who are immunocompromised and still susceptible to Covid-19, even after vaccination. According to the United Network for Organ Sharing, more than 17,000 transplants were performed in the first five months of 2021 alone.
“For me, the main message here for transplant patients and immunocompromised patients is one of hope,” said Dr. Dore Segev, study author and associate vice president for research and professor of surgery at Johns Hopkins University.
This letter was received by transplant recipients like Tamsin Skills, 50, of Charlotte, North Carolina.
Skeels, who was not part of the new study, underwent a liver transplant in September 2019, a few months before the outbreak of the epidemic.
A few months ago, she got the Covid-19 vaccine under the guidance of her doctors.
But they warned her to be careful about avoiding infection. “Don’t change your behavior from quarantine,” Skiles remembers. “Stay home as much as possible. When you go out, stay protected. Stay masked and stay away, even after vaccination.”
Even if vaccines do not provide maximum protection for those with compromised immune systems, they can help indirectly when others get injections.
“The more people vaccinated, the safer people will be taking immunosuppressants,” Skiles said.
Segev and his team found in previous research that only 17 percent of transplant patients had an immune response after a single dose of the Covid-19 vaccine. After a second dose, that number rose to 54 percent, but that left 46 percent unprotected.
“I’m pleasantly surprised,” Segev said, because some patients in the new study who did not respond to two doses were able to get a response after a third dose.
However, as the study indicated, an additional dose may not work for every transplant patient. It is unclear whether the same approach would work for other types of immunocompromised patients, such as those with autoimmune disorders.
“We just need to know how to do it [protect these patients]Segev said. “We need to know if it’s going to be something as simple as a third dose or whether we’re going to need to do something like make changes to the immunosuppression in these patients.” This may mean, for example, identifying and modifying drugs that interfere with the response to a vaccine that are taken after transplantation.
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Segev hopes to launch a larger trial to study how a booster third dose regimen works in transplant patients across the country and hopes to enroll 1,000 patients. For now, his advice to transplant patients is to remain vigilant and practice public health measures such as masking and social distancing when going out in public.
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“The mantra I say to my transplant patients is to vaccinate them and act as if you are not immunized,” he said. “I will only do what the CDC says is safe for unvaccinated people.”
John Wehrey, director of the Immunology Institute at the University of Pennsylvania, called the study “robust” to help understand the immune response of immunocompromised patients.
Although a third of patients who did not respond to only two doses developed antibodies, Wehrey was optimistic about what this means for transplant patients.
“That’s a cup half full versus half empty,” said Wehrey, who was not involved in the research. “One third is not zero, so it does offer some hope for people who are on immunosuppressive drugs.”
Wehrey cautioned that it remains unclear what the results mean for realistic protection of immunosuppressed patients and agreed that transplant patients and other people with compromised immune systems should be careful before returning to normal social activities.
Skeels continues to be vigilant about mask wearing and other ways to reduce the risk of infection.
“I know there are wonderful people working on this, and I have confidence, faith and optimism,” she said. “In the meantime, I’m going as I did.”
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