The American Heart Association announced its support this week for the CDC and FDA recommendation that immuno-compormised patients should receive a third dose of the Pfizer or Moderna COVID vaccines. Getty Images
August 18, 2021 — The U.S. Centers for Disease Control and Prevention (CDC) recommended Friday a third dose of the Pfizer-BioNTech or Moderna COVID-19 vaccine for people with moderately to severely compromised immune systems. This includes those who have had a heart, stem cell or other organ transplant and are on immunosuppressive treatment, or who have weakened immune systems due to disease or other medical treatment including active cancer therapy.
The American Heart Association (AHA) and the American Stroke Association announced its support for the new recommendation for people who have had a heart transplant or who have moderately to severely weakened immune systems to receive a third mRNA COVID-19 vaccine dose.
"We remain concerned about the significant disparities in COVID-19 vaccination in different populations. Therefore, we continue to urge all adults and children ages 12 and older in the U.S. to receive a COVID-19 vaccine as soon as they can, as recommended by the CDC and authorized for emergency use by the U.S. Food and Drug Administration," the AHA statement said. It was cosigned by AHA President Donald Lloyd-Jones, M.D., Sc.M., FAHA; Immediate Past President Mitchell S.V. Elkind, M.D., M.S., FAHA, FAAN; President-Elect Michelle A. Albert, M.D., M.P.H., FAHA; Chief Science and Medical Officer Mariell Jessup, M.D., FAHA; and Chief Medical Officer for Prevention Eduardo Sanchez, M.D., M.P.H., FAHA, FAAFP.
The CDC’s Advisory Committee on Immunization Practices’ (ACIP) recommended use of an additional dose of COVID-19 vaccine for people with moderately to severely compromised immune systems after an initial two-dose vaccine series. This official CDC recommendation, follows the U.S. Food and Drug Administration (FDA) decision to amend the emergency use authorizations of the vaccines for people who are immune-compromised.
"At a time when the Delta variant is surging, an additional vaccine dose for some people with weakened immune systems could help prevent serious and possibly life-threatening COVID-19 cases within this population," said CDC Director Rochelle P. Walensky, M.D., MPH, in a statement on the new recommended dose.
Who is Eligible for a Third COVID Vaccine Dose?
Eligible individuals may comprise approximately 3% of the U.S. population and also includes people living with HIV, those taking high-dose corticosteroids or immunosuppressive medications for rheumatologic conditions, and those who have genetic conditions that weaken the immune system.
The new CDC guidance does not recommend an additional COVID-19 vaccine for any other population nor for anyone who received the Janssen (Johnson and Johnson) COVID-19 vaccine.
Related to this guidance, the FDA has issued amendments to the emergency use authorizations for the mRNA COVID-19 vaccines manufactured by Pfizer-BioNTech or Moderna to allow certain immunocompromised individuals to receive a third dose of the same mRNA COVID-19 vaccine in addition to the initial 2 doses received.
New Data Show Immuno-compromised Do Not Build Up Sufficient Immunity From First Vaccine Doses
Emerging data suggest some people with moderately to severely compromised immune systems do not always build the same level of immunity compared to people who are not immunocompromised. In addition, in small studies, fully vaccinated immunocompromised people have accounted for a large proportion of hospitalized breakthrough cases (40-44%). Immunocompromised people who are infected with SARS CoV-2 are also more likely to transmit the virus to household contacts.
While people who are immunocompromised make up about 3% of the U.S. adult population, they are especially vulnerable to COVID-19 because they are more at risk of serious, prolonged illness. Included in CDC’s recommendation are people with a range of conditions, such as recipients of organ or stem cell transplants, people with advanced or untreated HIV infection, active recipients of treatment for cancer, people who are taking some medications that weaken the immune system, and others.
The additional dose of an mRNA COVID-19 vaccine should be the same vaccine as the initial series and administered at least four weeks after completing a primary mRNA COVID-19 vaccine series. While vaccination is likely to increase protection in this population, even after vaccination, people who are immunocompromised should continue follow current prevention measures (including wearing a mask, staying 6 feet apart from others they do not live with, and avoiding crowds and poorly ventilated indoor spaces) to protect themselves and those around them against COVID-19 until advised otherwise by their healthcare provider.
CDC does not recommend additional doses or booster shots for any other population at this time.
AHA Strongly Supports Vaccination as Key Defense Against COVID
“As recently amended for emergency use authorization by the U.S. Food and Drug Administration and recommended by the CDC, we urge heart transplant patients and all people in the U.S. who have moderately to severely compromised immune systems to receive a third dose of an mRNA COVID-19 vaccine (the Pfizer-BioNTech or Moderna COVID-19 vaccine)," the AHA leadership said in the statement.
They said research indicates a third COVID-19 vaccine dose will provide people with moderately to severely weakened immune systems more protection against COVID-19 infection and reduce the risk of serious, prolonged illness if an individual contracts COVID-19.
The AHA said patients should consult with a healthcare professional if they have any questions about whether a third COVID-19 vaccine dose is appropriate.
“We continue to recommend that all adults and children ages 12 and older in the U.S. receive a COVID-19 vaccine as soon as they can," the AHA stated. "The data continue to confirm that the COVID-19 vaccines are highly effective at preventing serious COVID-19 infection, hospitalization and death."
COVID Vaccines Are 99% Effective
The AHA noted more than 99% of Americans who have been vaccinated against COVID-19 have not had a breakthrough case of infection. However, more than 95% of the most recent COVID-19 hospitalizations and deaths in the U.S. are among people who are not vaccinated.
“We also support the CDC’s updated safety recommendations due to the recent surge of the Delta variant: mask wearing for all people regardless of vaccination status when indoors in communities with ‘substantial’ or ‘high’ rate of COVID-19 infection, which represents more than 93% of U.S. counties," the AHA said.
Additional important precautions the AHA cited include frequent hand washing and social distancing, combined with mask wearing and vaccinations.
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