{"id":2241,"date":"2021-10-10T09:52:01","date_gmt":"2021-10-10T09:52:01","guid":{"rendered":"http:\/\/khoo.com.au\/?p=2241"},"modified":"2021-10-10T09:53:19","modified_gmt":"2021-10-10T09:53:19","slug":"who-should-have-a-covid-19-vaccine-booster-now","status":"publish","type":"post","link":"https:\/\/khoo.com.au\/index.php\/2021\/10\/10\/who-should-have-a-covid-19-vaccine-booster-now\/","title":{"rendered":"Who should have a Covid-19 vaccine booster now?"},"content":{"rendered":"\n<p>10th October 2021, Dr Chee L Khoo<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/character_holding_syringe_400_clr_19089.png\" alt=\"\" class=\"wp-image-2245\" width=\"209\" height=\"198\" srcset=\"https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/character_holding_syringe_400_clr_19089.png 400w, https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/character_holding_syringe_400_clr_19089-300x285.png 300w\" sizes=\"auto, (max-width: 209px) 100vw, 209px\" \/><figcaption>Booster Jab, anyone ?<\/figcaption><\/figure><\/div>\n\n\n\n<p>You would have\ncaught a bit of the announcement that <strong>some people<\/strong> may be due a Covid-19\nvaccine booster. As usual, the announcement is not precise or detailed enough\nand now everyone is confused whether they are the intended target group for the\nbooster. It is not a call to boosters for most vaccinated people. It\u2019s only for\nthose who has a <strong>significant reduction in their immunity<\/strong>. It\u2019s not for\nthose who has \u201ca weakened immune system\u201d or \u201ca bit run down\u201d. The eligibility\ncriteria is detailed below.<\/p>\n\n\n\n<p><strong>The rationale\nfor the booster<\/strong><\/p>\n\n\n\n<p>People with\nimmunocompromising conditions or therapies are at increased risk of severe\noutcomes due to COVID-19. Studies have shown that the immune-compromised\npopulation with COVID-19 have a 1.5-2.0 times higher risk of death than the\ngeneral population (1-3). In addition, immunocompromised individuals can have\nprolonged SARS-CoV-2 infection and viral shedding, which can increase the risk\nof viral evolution during infection, and the subsequent risk of development of\nviral variantsm(4-10)<\/p>\n\n\n\n<p>Unfortunately,\npeople who has immunocompromising conditions or are on therapies that reduce\ntheir immunity, may not develop adequate immunity from the standard double\nvaccinations of the Covid-19 vaccines, whether AZ or Pfizer. The ATAGI has now\nannounced that the following people should be getting their third vaccine:<\/p>\n\n\n\n<p><strong>Who is eligible?<\/strong><\/p>\n\n\n\n<p>Active Cancers<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Active haematological cancers \u2013 e.g leukaemia, lymphoma<\/li><li>Non-haematological cancers <strong>currently on active treatment<\/strong> including chemotherapy, radiotherapy therapy<\/li><\/ul>\n\n\n\n<p>Recipients of\norgan transplants<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Solid organ transplant and still on immunosuppressive therapy<\/li><li>Bone marrow transplant within 2 years of transplantation.<ul><li>Those beyond 2 years from transplant should discuss with their treating specialist about the need for a 3<sup>rd<\/sup>\u00a0dose.<\/li><\/ul><\/li><\/ul>\n\n\n\n<p>The immunosuppressive agents that qualify:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>High dose corticosteroid treatment equivalent to >20mg\/day of prednisone for \u226514 days in a month, or pulse corticosteroid therapy.<\/li><li>Medications used to treat auto-immune arthritis (e.g Rheumatoid arthritis or Ankylosing Spondylitis)<ul><li>mycophenolate, <\/li><li>methotrexate (>0.4 mg\/kg\/week), <\/li><li>leflunomide, <\/li><li>azathioprine (>3mg\/kg\/day), <\/li><li>6-mercaptopurine (>1.5 mg\/kg\/day), <\/li><li>alkylating agents (e.g. cyclophosphamide,       chlorambucil), and systemic calcineurin inhibitors (e.g. cyclosporin,       tacrolimus)<\/li><li>B cell depleting agents (e.g. anti-CD20       monoclonal antibodies, BTK inhibitors, fingolimod), anti-CD52 monoclonal       antibodies (alemtuzumab), anti-complement antibodies (e.g. eculizumab),       anti-thymocyte globulin (ATG) and abatacept<\/li><\/ul><\/li><\/ul>\n\n\n\n<p>See Table 1 &amp; 2<\/p>\n\n\n\n<figure class=\"wp-block-image is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/EligibleArthritis-1024x417.jpg\" alt=\"\" class=\"wp-image-2242\" width=\"781\" height=\"318\" srcset=\"https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/EligibleArthritis-1024x417.jpg 1024w, https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/EligibleArthritis-300x122.jpg 300w, https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/EligibleArthritis-768x313.jpg 768w, https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/EligibleArthritis-465x190.jpg 465w, https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/EligibleArthritis-695x283.jpg 695w, https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/EligibleArthritis.jpg 1175w\" sizes=\"auto, (max-width: 781px) 100vw, 781px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/EligibleOthers-1024x173.jpg\" alt=\"\" class=\"wp-image-2243\" width=\"780\" height=\"131\" srcset=\"https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/EligibleOthers-1024x173.jpg 1024w, https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/EligibleOthers-300x51.jpg 300w, https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/EligibleOthers-768x130.jpg 768w, https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/EligibleOthers-465x79.jpg 465w, https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/EligibleOthers-695x118.jpg 695w, https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/EligibleOthers.jpg 1175w\" sizes=\"auto, (max-width: 780px) 100vw, 780px\" \/><\/figure>\n\n\n\n<p>Agents that don\u2019t qualify:<\/p>\n\n\n\n<p>These agents are also used\nto treat auto-immune conditions but do not significantly affect immunity and\npatients on these agents are not recommended to have a third injection at this\npoint in time. <\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Immune checkpoint inhibitors, <\/li><li>anti-integrins, <\/li><li>anti-TNF-\u03b1, <\/li><li>anti-IL1, anti-IL6, anti-IL17, anti-IL4 and\nanti-IL23 antibodies <\/li><li>hydroxychloroquine (Plaquenil) or sulfasalazine\n(Pyralin) <\/li><\/ul>\n\n\n\n<p>See Table 3 for a summary of agents listed above.<\/p>\n\n\n\n<figure class=\"wp-block-image is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/NotEligible-1024x696.jpg\" alt=\"\" class=\"wp-image-2244\" width=\"846\" height=\"575\" srcset=\"https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/NotEligible-1024x696.jpg 1024w, https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/NotEligible-300x204.jpg 300w, https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/NotEligible-768x522.jpg 768w, https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/NotEligible-465x316.jpg 465w, https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/NotEligible-695x472.jpg 695w, https:\/\/khoo.com.au\/wp-content\/uploads\/2021\/10\/NotEligible.jpg 1587w\" sizes=\"auto, (max-width: 846px) 100vw, 846px\" \/><\/figure>\n\n\n\n<p>While these agents on their own do not significantly reduce immunity, they may do so when used in combination. Patients who are on a combination of these agents should discuss with their GP or specialist.<\/p>\n\n\n\n<p><strong>Diseases that\nresults in immunosuppression<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Primary immunodeficiency including <strong>combined\n     immunodeficiency and syndromes<\/strong>, <strong>major antibody deficiency<\/strong>\n     (e.g., common variable immune deficiency (CVID) or <strong>agammaglobulinemia<\/strong>),\n     defects of innate immunity (including phagocytic cells), defects of immune\n     regulation, complement deficiencies and phenocopies of primary\n     immunodeficiencies.<\/li><li>Advanced or untreated <strong>HIV<\/strong> with CD4 counts\n     &lt;250\/\u03bcL or those with a higher CD4 count unable to be established on\n     effective antiretroviral therapy<ul><li>a 3<sup>rd<\/sup>&nbsp;primary dose is not\n      required for people living with HIV, receiving ART with CD4 counts\n      \u2265250\/\u03bcL<\/li><\/ul><\/li><li>Long term haemodialysis or peritoneal dialysis<\/li><\/ul>\n\n\n\n<p><strong>Which vaccine?<\/strong><\/p>\n\n\n\n<p>An\nmRNA vaccine (Pfizer or Moderna) is preferred to Vaxzevria (AstraZeneca) for\nthis 3rd dose. AstraZeneca can be used for the 3rd dose for individuals who\nhave received AstraZeneca for their first 2 doses if there are no\ncontraindications or precautions for use, or if a significant adverse reaction\nhas occurred after a previous mRNA vaccine dose which contraindicates further\ndoses of mRNA vaccine (e.g., anaphylaxis, myocarditis).<\/p>\n\n\n\n<p><strong>When should you have the booster?<\/strong><\/p>\n\n\n\n<p>The recommended interval for the 3rd dose is <strong>2 to 6 months after the 2nd dose of vaccine.<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>A minimum interval of 4 weeks may be\nconsidered in exceptional circumstances (e.g., anticipated intensification of\nimmunosuppression; outbreaks).<\/li><li>People who have received a 2nd dose more\nthan 6 months ago should receive a 3rd dose as soon as feasible.<\/li><\/ul>\n\n\n\n<p><strong>Who else might be eligible?<\/strong><\/p>\n\n\n\n<p>Anyone with a condition not\nlisted above should only be considered for a 3rd dose where the treating\nphysician has assessed the patient as having a similar level of severe\nimmunocompromise and where the benefits of a 3rd dose of COVID-19 vaccine\noutweigh the risks.<\/p>\n\n\n\n<p>If you are eligible based on the above criteria, call us to make an appointment soon. We have enough vaccine supplies but please don\u2019t delay the booster. <\/p>\n\n\n\n<p><strong>References<\/strong>:<\/p>\n\n\n\n<p>1. Suarez-Garcia I, Perales-Fraile I, Gonzalez-Garcia A, et\nal. In-hospital mortality among immunosuppressed patients with COVID-19:\nAnalysis from a national cohort in Spain. PLoS One 2021;16:e0255524. <\/p>\n\n\n\n<p>2. Vaid N, Ardissino M, Reed TAN, et al. Clinical\ncharacteristics and outcomes of immunosuppressed patients hospitalized with\nCOVID-19: experience from London. J Intern Med 2021;289:385-94. <\/p>\n\n\n\n<p>3. Ward D, Gortz S, Ernst MT, et al. The effect of\nimmunosuppressants on the prognosis of SARS-CoV-2 infection. Eur Respir J 2021.\n<\/p>\n\n\n\n<p>4. Avanzato VA, Matson MJ, Seifert SN, et al. Case Study:\nProlonged Infectious SARS-CoV-2 Shedding from an Asymptomatic Immunocompromised\nIndividual with Cancer. Cell 2020;183:1901- 12 e9. <\/p>\n\n\n\n<p>5. Baang JH, Smith C, Mirabelli C, et al. Prolonged Severe\nAcute Respiratory Syndrome Coronavirus 2 Replication in an Immunocompromised\nPatient. J Infect Dis 2021;223:23-7. <\/p>\n\n\n\n<p>6. Choi B, Choudhary MC, Regan J, et al. Persistence and\nEvolution of SARS-CoV-2 in an Immunocompromised Host. N Engl J Med\n2020;383:2291-3. <\/p>\n\n\n\n<p>7. Helleberg M, Niemann CU, Moestrup KS, et al. Persistent\nCOVID-19 in an Immunocompromised Patient Temporarily Responsive to Two Courses\nof Remdesivir Therapy. J Infect Dis 2020;222:1103-7. <\/p>\n\n\n\n<p>8. Khatamzas E, Rehn A, Muenchhoff M, et al. Emergence of\nmultiple SARS-CoV-2 mutations in an immunocompromised host. medRxiv\n2021:2021.01.10.20248871. <\/p>\n\n\n\n<p>9. Nakajima Y, Ogai A, Furukawa K, et al. Prolonged viral\nshedding of SARS-CoV-2 in an immunocompromised patient. J Infect Chemother\n2021;27:387-9. <\/p>\n\n\n\n<p>10. Truong TT, Ryutov A, Pandey U, et al. Increased viral\nvariants in children and young adults with impaired humoral immunity and\npersistent SARS-CoV-2 infection: A consecutive case series. EBioMedicine\n2021;67 <\/p>\n\n\n\n<p>11. https:\/\/www.health.gov.au\/sites\/default\/files\/documents\/2021\/10\/atagi-recommendations-on-the-use-of-a-third-primary-dose-of-covid-19-vaccine-in-individuals-who-are-severely-immunocompromised_1.pdf<\/p>\n","protected":false},"excerpt":{"rendered":"<p>10th October 2021, Dr Chee L Khoo You would have caught a bit of the announcement that some people may be due a Covid-19 vaccine booster. As usual, the announcement is not precise or detailed enough and now everyone is confused whether they are the intended target group for the<span class=\"more-link\"><a href=\"https:\/\/khoo.com.au\/index.php\/2021\/10\/10\/who-should-have-a-covid-19-vaccine-booster-now\/\">Continue Reading<\/a><\/span><\/p>\n","protected":false},"author":2,"featured_media":2093,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[17],"tags":[],"class_list":["entry","author-chee1404","post-2241","post","type-post","status-publish","format-standard","has-post-thumbnail","category-covid-19"],"_links":{"self":[{"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/posts\/2241","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/comments?post=2241"}],"version-history":[{"count":2,"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/posts\/2241\/revisions"}],"predecessor-version":[{"id":2247,"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/posts\/2241\/revisions\/2247"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/media\/2093"}],"wp:attachment":[{"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/media?parent=2241"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/categories?post=2241"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/tags?post=2241"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}