Additional Vaccine Doses

Health & Wellness, Kidney Transplant, Medication 2 Minutes

I saw a link on Reddit to a CDC presentation regarding additional vaccine doses for immunocompromised people (IP) (PDF). It outlines steps needed to have the CDC recommend additional doses, but we are still very far away from that. It appears that we are still in the reviewing data process, and still required FDA approval under the Emergency Use Authorization for the vaccines.

There were four slides under the section “What do we know now?”

I am #2 on the list, but do not know what portion of the ~2.7% are organ transplant recipients.
Even though IP are ~2.7% of the population, they/we account for 40-44% of hospitalized breakthrough cases. Again, they do not disclose what % of breakthrough cases are from IP. It is likely lower than the 40-44% since infected IP are “more likely to get seriously ill from COVID-19.”
This one is a bit confusing because I think they are combining data from several categories. It does appear that vaccine effectiveness (VE) is lower in IP than in the general population: 75% vs. 90% for infections, 71% vs. 94% for symptomatic cases, and 59% vs. 91% for hospitalization. Some of the non-mRNA vaccines (Sinovac, Sinopharm) are around this level of VE anyway so maybe it’s not that bad?
This is a small sample size (n=63), but it seems that organ transplant recipients have the worse antibody response out of all the IP categories. I was on hemodialysis for several years, and was categorized as a high-risk for infection at the beginning of the pandemic. However, it is probably due to cardiovascular and respiratory issues rather than the immune system. So the response to the vaccine should be fairly normal, but once infected, symptoms will likely be more serious.

Again, since the data is not segregated by type of immunocompromised people, it is hard to estimate the increase in infection risk, even subjectively. My reading is that if there is a response to the vaccine, it is about 2/3 the effectiveness vs. non-IP. However, this may be lower for organ transplant recipients since the anti-rejection medications are specifically designed to mute any immune response.

In my case, I am slightly hopeful since my first vaccine shot was about 18 hours before surgery. I do not know if that is sufficient time for the immune system to develop any protection. Post-surgery, I was on a higher dosage of anti-rejection medications compared to today, but I do not know objectively whether it was a larger then normal dose. The transplant center did start to lower my dosage after about two weeks so there may be a slight chance that the second vaccine shot was somewhat effective, even though I did not experience any response side effects.

I am thinking about this daily because I am invited to my boss’s party next weekend. It is indoors but with a lot of open doors plus patios and balconies. In the past, the room was somewhat crowded. If I go, I am going to wear a KN95 mask, but it will be difficult to maintain a six foot separation from everyone else. It is difficult to manage risk where there is essentially no data. I am bringing my sister as my +1 guest. She is excited to go but she understands if I decide to skip the event.

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