Thread by @PeterHotez

1/10 Many thanks ⁦@chrislhayes⁩ for hosting me tonight ⁦@allinwithchris⁩ on the very important problem of Covid vaccine immunogenicity and takes on people receiving immunosuppressive Rx or with immune deficiencies.

2/10 it’s now a significant % of US population as much as 3-5% and increasing annually

3/10 includes those with 1) primary immunodeficiency, 2) leukemias lymphomas, 3) solid organ malignancies and chemotherapy, 4) bone marrow transplants, 5) solid organ transplants, 6) B cell mab Rx, 7) corticosteroids Rx, 8) CAR-T Rx, 9) splenectomy, 10) primary immunodeficiency

4) it’s difficult to generalize especially since many of those with these conditions were excluded from the phase 3 mRNA vaccine trials, so we’re trying to understand this post EUA release

5) also renal dialysis patients

6/10 In some studies the response to first dose of mRNA vaccines was quite low, but improved after 2 doses. Potentially down the line a 3rd dose might be warranted

7/10 also the timing is important, such as timing vaccinations before starting immunosuppressive Rx or delaying first or second dose until afterwards and immune system reconstituted

8/10 these are complicated decisions that should be made in consultation with a hematologist-oncologist, rheumatologist, transplant specialist who would know specifics of individual conditions in consultation with infectious diseases specialist

9/10 also in regards to masks, until we get better tests for confirming vaccine immunity, such individuals may still be considered partially vulnerable or at risk of contracting COVID19 even after immunization. Again discussing with your speciality physician critical

10/10 the good news is now research papers are coming and we’re learning a lot even in the last few weeks. Hopefully CDC organizing all this information

Special thanks to Jeff Auletta MD at
@nationwidekids who pointed me to some valuable resources and background articles. There’s also good info on the @ASH_hematology website that Jeff co-authored