5 Health Conditions That Can Compromise COVID-19 Vaccine Immunity

Organ recipients should be vaccinated, and so should their household members and caregivers, says a June 2 letter from 24 groups representing professionals in transplant medicine.

A new Johns Hopkins study signals that transplant patients may benefit from so-called “booster dosing,” getting an extra dose of the COVID-19 vaccine. The study of 30 transplant recipients with low antibody levels found that a third dose boosted antibody responses in 14 of the recipients.

2. Cancer

People with cancer can be more susceptible to infections.

"Both the underlying medical condition and immunosuppressive regimens may affect the immune response", says Meghan Baker, M.D., a hospital epidemiologist who works with immunocompromised patients at Dana Farber Cancer Institute and Brigham and Women's Hospital in Boston.

Those with blood cancers may be more at risk of long-term infection and death than those with solid tumors. That's because they frequently have lower levels of immune cells that produce antibodies, says the National Cancer Institute.

Certain cancer treatments can suppress the immune system, including chemotherapy or stem cell or bone marrow transplants.

Most immunocompromised cancer patients will get some protection from the COVID-19 vaccines, but they should take precautions to minimize their exposure to the novel coronavirus, Baker says. Meanwhile, she adds, “There are active studies to determine if and when a booster vaccine may be appropriate."

3. HIV/AIDS

An estimated 1.2 million people in the United States have HIV, or human immunodeficiency virus. If untreated, HIV can advance to AIDS, known as acquired immunodeficiency syndrome. But new infections are down more than two-thirds since the epidemic's harshest years in the mid-1980s. New drugs are stabilizing existing cases.

"Between 50 percent and 70 percent of people with HIV/AIDS are on medications that have made their immune systems intact,” says Carole Treston, executive director of the Association of Nurses in AIDS Care, in Uniontown, Ohio, and Washington, D.C.

Treston supports federal guidelines that all people 12 and older — except those with previous vaccine allergy reactions — be vaccinated. She points to federal guidance that says people with HIV “should receive COVID-19 vaccines, regardless of their CD4 or viral load, because the potential benefits outweigh the potential risks.”

4. Lupus

Lupus is an autoimmune disease, meaning that the body's immune system attacks its own organs and tissue. It affects 1.5 million people in the United States, mostly women of child-bearing age.

It is characterized by mild or no symptoms interrupted by “flares” or flare-ups, periods when symptoms worsen. Lupus can also lead to serious problems such as kidney failure, blood clotting and heart attacks.

The lupus immune system is less capable of fighting infections, says Ashira D. Blazer, M.D., a rheumatologist at NYU Langone Health in New York City. And when a lupus patient has an active flare, the immune system is less effective in combatting such infections, she said.

The medical center recommends that lupus patients get the COVID-19 vaccines, and those who have are not getting more flares than those who have not. But those experiencing moderate to severe flares should confer with their rheumatologists about the vaccines’ risks and benefits, she said.

"Some medications that are required to treat more serious lupus features may decrease the vaccine's efficacy,” Blazer adds.

5. Multiple Sclerosis

Like lupus, Multiple Sclerosis (MS) is an autoimmune disease. A patient's immune system attacks the protective coating on nerve fibers, which can be damaged or even destroyed. Symptoms include muscle spasms, loss of balance and the inability to walk.

Nearly 1 million people in the United States age 18 and over have MS. Some treatments can rein in the immune system's ability to fight infection, says Julie Fiol, associate vice president of health care access for the National MS Society.

For instance, people taking certain medications “will have a reduced and possibly indetectable antibody response to the COVID-19 vaccines,” Fiol says. But even then, other parts of the immune system may kick in and offer protection.

Clinical trials have been launched to probe how those with multiple sclerosis respond to the vaccine.

"These studies are critical for people with MS,” Fiol says, “So they can understand their level of protection and feel comfortable returning to their ‘normal’ as many others already are.”

Deborah Schoch is a contributing writer who covers health and science. A longtime journalist, she has most recently done work for AARP, The New York Times and KNBC-TV Los Angeles.