Immunocompromised Americans May Need a 4th COVID Shot


The US Centers for Disease Control and Prevention (CDC) authorized a third dose for certain immunocompromised people 18 and older in August. It said a third dose, rather than a booster — the CDC makes a distinction between the two — was necessary because the immunocompromised may not have had a complete immune response from the first two doses. The US Food and Drug Administration (FDA) has also authorized booster shots of all three available vaccines for certain people and that would include the immunocompromised.

But people with certain health conditions that make them moderately or severely suppress their immune systems may get a fourth mRNA Covid-19 shot, according to updated guidelines.

HINES, ILLINOIS – SEPTEMBER 24: Lalain Reyeg administers a COVID-19 booster vaccine and an influenza vaccine to Army veteran Gary Nasakaitis at the Edward Hines Jr. VA Hospital on September 24, 2021 in Hines, Illinois. Today, CDC Director Rochelle Walensky endorsed a booster shot of the Pfizer-BioNTech COVID-19 vaccine for people 65 years and older, those with underlying medical conditions or those who work in high-risk situations. (Photo by Scott Olson/Getty Images)

“Moderately to severely immunocompromised” people include those who are in treatment for cancers of the blood or for tumors, certain organ transplant and stem cell recipients, people with advanced or untreated HIV, and those who take high-dose corticosteroids or other drugs that may suppress their immune systems. The CDC estimates about 9 million people who live in the US, or about 2% of the population, fall into this category.

CNN reports that a study from Johns Hopkins University this past summer showed that immunocompromised people who were vaccinated also were still 485 times more likely to end up in the hospital or die from Covid-19 compared to most vaccinated people. In small studies, the CDC said, fully vaccinated immunocompromised people accounted for about 44% of the breakthrough cases that required hospitalization. People who are immunocompromised are also more likely to transmit the virus to people who had close contact with them. Research showed that a booster dose enhanced the antibody response to the vaccine in certain immunocompromised people.

That would make for a fourth shot at least six months after completing the third mRNA vaccine dose. At this time, the CDC does not have a recommendation about the fourth shot. People should talk to their doctors to determine if it is necessary, the CDC says.


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