Life in the islands may seem to be returning to a semblance of normality as COVID-19 vaccines add a layer of protection, but patients with weakened immune systems may face the threat of infection regardless of whether they have received a shot.

That’s because the vaccines currently on the market may not work as well for people who are immunocompromised, whether because of a genetic disorder, a disease, a recent organ transplant or medication, some studies show.

Nearly 7 of 10 patients Dr. Tarquin Collis sees fall into that category. As the chief of infectious diseases at Kaiser Permanente Moanalua Medical Center, he said he has advised them to get the COVID-19 vaccine anyway, even if their ability to produce antibodies against the coronavirus may be hindered.

“It’s still incredibly helpful to be vaccinated,” he said. “If it only provides partial protection it’s certainly going to be better than nothing.”

Registered Nurse Alexis Lagasca from Kalihi Palama Health Center gives COVID-19 vaccinations at St. Elizabeth Church.
Patients with weakened immune systems may face the threat of COVID-19 infection regardless of whether they have received a vaccination against the respiratory disease. Cory Lum/Civil Beat/2021

Dr. Jennifer Mbuthia, an allergist and clinical immunologist with expertise in vaccines and vaccine immunology at The Queen’s Health Systems, agreed. She stressed that those with weakened immune systems should still avoid large crowds and keep taking pandemic precautions even as official restrictions on masks and social distancing are being eased.

“Evidence does demonstrate that there is a dampened response, but the response is not zero,” she said. “The antibody response is only part of the story of how the immune system is creating that new memory and protecting that body.”

Vaccines work by stimulating the body’s immune system to make antibodies against a specific virus. But that work is complicated in patients with immune deficiencies stemming from diseases like arthritis and cancer or those taking immunosuppressive drugs.

That raises fears that their vaccinations might not have worked.

The Centers for Disease Control and Prevention says people with HIV, autoimmune conditions or weakened immune systems due to other illnesses or medicines “may receive a COVID-19 vaccine,” but “should be aware of the limited safety data” and the “potential for reduced immune responses” to shots.

There are many factors to consider, such as how many different medications a patient is using, or the cadence of their therapies. Perhaps there is a certain time between taking immunosuppressants where patients have the best chance of benefitting from a vaccine. People should discuss these issues with their doctors, Mbuthia said.

“A lot of it does come down to that individual clinical situation,” she said.

Checking the level of antibodies after someone gets a COVID-19 shot is popular, says Collis, but at this point, it’s not much help at determining if someone is protected from infection or illness.

Current commercial antibody tests on the market can tell patients if antibodies exist but can’t provide more details about how many are there or their effectiveness, he said.

Dr. Tarquin Collis is the infectious disease chief at Kaiser Permanente Moanalua Medical Center. Courtesy Kaiser Permanente

The accuracy of such antibody tests also varies.

“It’s like trying to predict the weather with a thermometer stuck on your front lawn without barometric pressure, radar and subtle forecasting of wind speeds and tide charts,” Collis said.

“We couldn’t really act on the results and we don’t know how to interpret them. Immunosuppression is this incredibly complex four-dimensional thing.”

Patients have also come to Collis with concerns that their underlying condition could flare up, which he said he has not seen at the Oahu Kaiser Permanente hospital.

“That’s another message I try to get across — don’t avoid the vaccines because you’re worried about your underlying condition,” he said.

It’s still not known how long antibodies that fight SARS-CoV-2, the virus that causes COVID-19, can stay in someone’s system. Researchers are also still trying to determine if fully vaccinated people are less infectious.

A study in Britain that tracked 7,000 people with Crohn’s disease or ulcerative colitis from 90 hospitals found fewer than half of patients who took a medication called Remicade mounted an immune response following a coronavirus infection.

A JAMA journal article found just 17% of more than 400 transplant recipients who received one dose of a COVID-19 vaccine had traceable antibodies three weeks after their shots.

Mbuthia and Collis expect booster shots may play a role in the future to ensure ongoing protection, especially for people with immune deficiencies.

The next best thing to do is to ensure everyone else in the household is vaccinated, they said.

“You can protect your loved ones by also getting vaccinated yourself,” Mbuthia said.

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