The CDC estimates that more than half a million U.S. patients have already had two doses of the vaccine, and nearly 50,000 have had three. In order to complete four immunocompromised people’s immune systems in one dose, those patients need to receive a booster dose, but a report from the Centers for Disease Control and Prevention suggests that may be difficult for some people who received a single dose.
In a new report published Monday in the journal JAMA Internal Medicine, the CDC reports that in an analysis of the U.S. population, with patients who received three immunocompromised shots, those who had had two shots had higher rates of failure than those who had received one shot.
This didn’t change based on factors such as age or gender, and the researchers were able to narrow the group to people who had failed to build a strong enough immune response to get enough thimerosal-free vaccines in the first place.
Of 1,153 patients who received two shots of the CDC’s boost-the-Feuerwart booster, or COPV-19, between 2001 and 2016, 103 (11.9 percent) had stopped using the booster, and the failure rate was 21.4 percent for the patients who did not use it.
COPV-19 is a complex series of injections, and it’s often the second booster given after one dose of diphtheria, tetanus and pertussis (Tdap) booster. By 2001, there were 53,005 people receiving vaccinations that included a Tdap booster for those with certain immunocompromised conditions. The CDC recommends everyone under age 65 be vaccinated against all three diseases, as well as other vaccine-preventable diseases such as HPV.
Of the 499 patients who received three immunocompromised vaccines between 2002 and 2016, 128 (20.7 percent) stopped using the booster. Among those who did take a booster, the failure rate was 29.8 percent, a difference between the two groups that the researchers noted was “statistically significant.”
“If the second booster dose is associated with suboptimal immunological responses, then the next booster (COPV-20) should be considered,” the authors of the study wrote.
Because of the CDC report, the CDC has now included four immunocompromised people as a group for which a four-shot booster should be considered for those who have not received one shot. They are patients who received two doses of COPV-19 after the first shot, but who had not received the second booster because they were underserved by the health system.
Dr. James Gesell, professor of health services research at Virginia Commonwealth University, called the findings “highly significant” when the data was broken down by races, education and gender, and estimated that the death rate of people receiving the vaccines was in the “single digits.”
In a commentary accompanying the CDC report, Gesell described the “new consideration of adjuvanted booster for the previously underserved segment of patients as a possible safeguard against some or all future immunocompromised vaccine-inoculated patients.”
So far, Gesell said, the CDC doesn’t appear to have proposed setting up a statewide public health program to ensure patients who require more than one booster dose do so, but he recommended to be on the lookout for this possibility.
JAMA Internal Medicine, JAMA Magazine, JAMA Pediatrics and Health Care.