Is a COVID Vaccine Booster Dose Necessary in Those Who Are Immunocompromised?

• The question of whether a booster for the COVID vaccine is necessary has been top of mind for many of our cancer patients and their loved ones. This comes with the recent uptick in news and information related to the effectiveness of the COVID vaccine in immunocompromised groups.

  As we explore the necessity of a booster shot or vaccine in immunocompromised people, the most important thing to remember is, “The data continue to demonstrate remarkable efficacy and safety of the existing COVID-19 vaccines against all variants of the virus,” according to Martin J. Edelman, MD, chair of the Department of Hematology/Oncology at Fox Chase Cancer Center.

  We recommend that all our patients get vaccinated against COVID-19 unless there is an absolute contraindication to doing so. It is also very important that family members and close contacts of patients receive the vaccination. This not only protects the individual vaccinated, but also the patient with cancer. The data are very clear that the major risk of disease is in the unvaccinated population.

  Below, Dr. Edelman shares the answers to some common questions people have on this topic:

  Is the COVID vaccine less effective in cancer patients?

  A reduced immune response is typical of all vaccines (including the COVID-19 vaccine) in patients with a cancer of the blood like leukemia, lymphoma, and multiple myeloma. But, even in these patients, there is still some protection, and it is recommended that they get the COVID-19 vaccination as soon as possible.

  Patients who are receiving active treatment (such as chemotherapy and radiation) for other cancers may also have a slightly to moderately compromised immune system. At this time, we are unsure whether this decreases the effectiveness of the COVID-19 vaccine in these patients. But our advice remains the same: Get the COVID-19 vaccination, as soon as possible, if you have not done so already.

  One of the most important things to remember is that the major potential source of exposure today is from unvaccinated family members and close contacts. It is essential that everyone be vaccinated. Vaccination protects both the individual who is vaccinated as well as the people they contact.

  Should patients with a compromised immune system receive a booster dose of the COVID-19 vaccine?

  While laboratory studies suggest that a third COVID-19 vaccine dose might increase protection of immunocompromised patients, at this time there are not sufficient data to recommend it. More research is being performed on the effect of a booster shot (i.e., vaccination beyond the approved number of doses—two for Pfizer or Moderna; one for Johnson and Johnson) for individuals who are fully vaccinated (at least two weeks after the last dose of the vaccine).

  On July 22, 2021, a CDC advisory committee met to discuss whether an additional shot could significantly boost the chances that a person with a weakened immune system will have a protective response. While there is some evidence that an increase in protective response could be achieved with a third dose of the COVID-19 vaccination, no U.S. professional organization or government agency has recommended this course of action to date.

  Fox Chase Cancer Center physicians will continue to follow the emerging data—as well as the recommendations from the CDC and FDA—and will provide updates for our patients when necessary.

  See a current list of COVID vaccination locations at Temple Health.

  Is it recommended that immunocompromised patients receive antibody testing to see if the vaccine was effective?

  We are not recommending routine antibody testing at this time. There is no clear guidance on what these antibody titers mean.

  What can cancer patients and those who are immunocompromised do to protect themselves from COVID-19?

  Right now, the best thing our patients can do beyond getting vaccinated is to avoid crowds and indoor gatherings with unvaccinated people unless everyone is masked. We also suggest they continue to avoid unnecessary travel, as different areas of the county and world are seeing increased infection rates.

  Creating a circle of protection for ourselves and family, friends, and loved ones by getting the COVID-19 vaccine if you haven’t already done so is crucial. A truly vast amount of data demonstrates that the vaccine is remarkably safe and effective. The number of individuals who have had side effects is extremely small and not different from those who have had other vaccines.