UPMC: Covid vaccine may not be as effective at immune compromise

UPMC experts on Friday shared new data related to the efficacy of the covid-19 vaccines on patients with compromised immune systems – suggesting that the vaccines are less effective for some people in preventing infection.

Researchers searched for antibodies through blood tests of 70 volunteer residents of UPMC Senior Communities, as well as 67 patients with cancer affecting blood, bone marrow and lymph nodes. Samples were taken a few weeks after volunteers were fully vaccinated.

All of the elderly patients developed antibodies against the coronavirus, says Dr. David Nace, chief medical officer of UPMC Senior Communities. But some have developed less than others.

“The levels differed significantly between individuals, but all had antibodies, and I do want to reinforce that,” he said. “I also have to note: because we know there is an antibody response to the vaccine, we do not know how good it is with an antibody response.”

Nace said there were infections within UPMC facilities even after vaccination. But he said these infections were asymptomatic, suggesting that even with fewer antibodies, the vaccine provides some protection to older people.

Among the blood cancer patients, however, the development of antibodies was more nuanced. Dr. Ghady Haidar, a doctor who transplants infectious diseases, said that 54% of the blood of the patients sampled produced detectable antibodies, while 46% did not.

There was a subgroup of patients with a specific type of blood cancer called chronic lymphocytic leukemia (CLL) that was tested: 77% of CLL patients did not produce any antibodies.

Haidar emphasizes that although a large proportion of the patients did not develop the antibodies, more than half did so, which he said was ‘relatively effective’.

“This finding does not mean that the vaccine does not work in these subgroups of patients, because our immune system honestly has more than just antibodies,” he added.

Haidar and Nace said they were not surprised by the results: patients with immune systems, including the elderly, already have fewer reactions to most vaccines, such as the flu vaccine.

“I absolutely expected it,” Haidar said. ‘If you look at the flu literature, for example, there is a lot of data in people with cancer and transplants that show that such people do not respond to vaccines, as well as people with normal immune systems. Our findings were not surprising. ”

The data shared reflects only UPMC patients, although doctors said the findings are consistent with studies in other areas. It also focuses on only two groups with immune compromises, those with blood cancer and the elderly – the researchers did not test those with other cancers, HIV patients, organ recipients or others with an affected immune system.

‘This is not the end of the story; we are continuing to expand this work, ”said Haidar. “We really want to know why these patients did not make antibodies … and we are also interested in other groups of patients with an immune system.”

The UPMC research has not yet been evaluated by other scientists. According to the doctors, the health system is obliged to share the new information as quickly as possible.

“I do not want patients like this to be wary of the wind and not to mask and not take social distance,” Haidar said. “We need to emphasize to patients like this that you may not be fully protected, so please continue to take the usual precautions.”

The results suggest that people should continue to follow public health restrictions, stay alert even after they have been fully vaccinated – especially if they are immune or in someone’s environment, the doctors said.

Nace said the results, specifically the success among long-term caregivers, call for action for long-term care facilities to proceed with the reopening of certain restrictions, such as visits.

“That’s part of why we did this study,” Nace said. ‘It does mean that we have to continue with the reopening. This should not limit us. We must be considerate. We must be careful … But we must really try to reduce the negative effects of social isolation on individuals and to reopen these facilities. ‘

The doctors encouraged individuals who did develop covid-19 even after vaccination to seek monoclonal antibody treatment, a therapy that uses intravenous (IV) infusion of antibodies that search for and block the coronavirus to infect a patient’s cells.

Since the treatment was enthusiastically promoted at a news conference two months ago, quality head Tami Minnier said the demand for the antibody infusion at UPMC facilities has quadrupled. The system has treated more people in the past three weeks than since its approval by the U.S. Food and Drug Administration in December.

UPMC doctors still recommend that all eligible people – including the immune compromises discussed on Friday – be vaccinated for covid-19.

Minnier said UPMC administered more than 364,000 doses systematically, including nearly 233,000 people who were not affiliated with UPMC. 40,000 doses were administered alone last week, she said.

UPMC, with the Pittsburgh Penguins and the Department of Health in Allegheny County, will next week host a transit clinic at the Pittsburgh Mills Mall in Frazer, where they estimate that 12,000 doses of the Johnson & Johnson vaccine will be given.