Thread by @profshanecrotty

Vaccination of immunocompromised or immunosuppressed people against COVID is a major topic now.
I think this is good simple advice:
"Get vaccinated, but behave as though you're not," Dorlan Kimbrough, a neurologist who treats multiple sclerosis patients at Duke. 🧵

It is early days for understanding and advice on this, but thankfully there are already scientific studies (preprints) being published on COVID vaccine immune responses in such patients. These are two good new news articles on the topic:
advisory.com/en/daily-brief…

and
washingtonpost.com/lifestyle/2021…

Importantly, immunocompromised/immunosuppressed is a diverse range. Many have will make fine immune responses to COVID-19 vaccines. So the specific condition/medical treatments matter. Remicade/infliximab and glucocortocoid treatment result in reduced vaccine antibody responses.

Somewhat surprisingly, B-cell CLL patients had low responses. Organ transplant patients and people on B cell depletion therapies have the most severe reduction of vaccine antibody responses, as expected.

Sadly, no T cell data available from any of these studies. Thus, is unclear if people with weak antibodies are still making T cells (which prob varies depending on patient condition), and whether those T cells provide substantial or partial protection against serious COVID

Thus, as noted at the beginning of the thread, the best advice for now is get vaccinated but then behave as if you haven't been vaccinated. In the near future, it may be determined that some people need another booster immunization

Cases like this will become more common:
Here's an immunocompromised doctor who took 2 doses of RNA vaccine and then 1 dose of J&J. medpagetoday.com/special-report…

h/t @ArthurCaplan MaryMarshall

People are starting vaccine clinical trials like this for immunocompromised/immunosuppressed people.

Related, in the near future, it may be determined that some people who completely fail to respond to the vaccine will need continuous prophylactic monoclonal antibody therapy.

Some of the recent papers on this topic of vaccination of immunosuppressed/immunocompromised:
doi.org/10.1177/175628…
dx.doi.org/10.1101/2021.0…
dx.doi.org/10.1101/2021.0…
medrxiv.org/content/10.110…
jamanetwork.com/journals/jama/…
medrxiv.org/content/10.110…