Why should a person with a primary immunodeficiency who doesn’t respond to vaccines receive a vaccine for COVID-19? Can the antibody response to the COVID-19 vaccine be effectively measured? Should persons with PI get a booster vaccine?
These queries and so many more continue to pour in from the PI community about COVID-19 and the vaccine. To address those concerns, IDF presented a July education forum, “COVID-19: Your Questions Answered.”
Dr. Kathleen Sullivan, chief of Allergy and Immunology at Children’s Hospital of Philadelphia and member of IDF’s Physician Advisory Committee, imparted her knowledge on the subject during the forum.
A recent study shows, said Dr. Sullivan, that the COVID-19 vaccine does, in fact, induce an immune response in persons with antibody deficiencies. She called the findings “a wonderful and huge surprise.”
“Even if you didn’t respond to the pneumococcal vaccine, there’s a good chance you’re going to respond to the COVID vaccine, and I think this is really important,” said Dr. Sullivan.
“These RNA vaccines are so strong that even people with antibody deficiencies, with the exception of XLA, still have a very good chance of making an antibody response.”
Most persons with CVID, the most common antibody deficiency, will make antibodies to the vaccine, as will those with other common antibody disorders such as hypogammaglobulinemia and IgA deficiency.
Most persons with XLA, another common antibody disorder, didn’t produce an immune response, but that doesn’t mean those with the condition shouldn’t get the vaccine. The vaccine will likely offer some protection through their immune T cells if the person contracts COVID-19.
“We know that even if you don’t make antibodies, you still get some benefit from the vaccine,” said Dr. Sullivan. “Based on this, I recommend the vaccine for almost all of my PI patients, but check with your immunologist to see what is right for you.”
Dr. Sullivan recommended avoiding antibody tests to see if the vaccines are effective. The types of tests vary. Some are plus-minus, which only reveal if you do or don’t have antibodies, and others measure specific antibody levels. The bottom line is that researchers still don’t know what level of antibody is protective. More accurate tests may be available later this year.
“We will have answers, but we just don’t have them at this moment,” said Dr. Sullivan.
If a person opts for an antibody test and the test reveals no antibodies, a booster vaccine may be appropriate. If a person has had two shots of either the Moderna or the Pfizer vaccine, Dr. Sullivan is recommending to her patients to get a third booster shot of the Johnson & Johnson vaccine.
Dr. Sullivan also fielded dozens of questions from participants on topics such as:
- Effects of COVID-19 on persons with PI
- Long-haul COVID-19
- Monoclonal antibody treatments
- Protective antibodies in immunoglobulin
- Breakthrough infections
- Virus variants
- Vaccine availability for children
- Ways to protect against the virus
To listen to the full Q&A, click here.