19 July 2021

Fully vaccinated but still need a mask

Clinical COVID-19 Management

As England lifts covid-19 restrictions today the US Centers for Disease Control and Prevention (CDC) has warned there’s to be no return to normal for immunocompromised people.

In a statement issued last week (16 July) the CDC stated that people who are immunocompromised need to continue following current prevention measures, regardless of covid-19 vaccination. This includes wearing a mask, staying 1.5m apart from people outside their household, and avoiding crowds and poorly ventilated indoor spaces.

This warning applies to a wide range of people including but not limited to “people receiving chemotherapy for cancer, people with hematologic cancers such as chronic lymphocytic leukemia, people receiving stem cells or organ transplants, people receiving hemodialysis.”

Certain drugs are also under the spotlight. Included in the CDC warning are “people using certain medications that might blunt the immune response to vaccination (e.g.  mycophenolate, rituximab, azathioprine, anti-CD20 monoclonal antibodies, Bruton tyrosine kinase inhibitors).”

The CDC recommends that at-risk patients should be counselled to continue prevention measures.

Dr Sam Whittle, who manages the Australian Living Guidelines for rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis, is not surprised by the CDC statement.

“We already know that vaccine immunogenicity is reduced in immunosuppressed people – indeed our recommendation states: ‘Following vaccination, people with AIRD should be aware that the risk of covid-19 infection is reduced but not eliminated and that appropriate physical precautions (e.g. masks, physical distancing, hand hygiene) based on the current community risk should continue to be observed.’”

Allison Dakin, from Darwin, has ankylosing spondylitis and told Rheumatology Republic, “I actually had this conversation with my GP last week.”

Mrs Dakin, 40, was “concerned because I am immune compromised” and “got in early” for the Astra Zeneca vaccination before the federal government applied age limitations.

She was vaccinated at a local Darwin GP and had “very few side effects at all.”

“But the advice I got was ‘we don’t know the effectiveness of this for people with ankylosing spondylitis’,” she said.

She is willing to get a third vaccination if it could possibly make a difference. “If that is what I have to do, that’s what I will do,” she said.

Dr Whittle can only speculate if Australia would take that approach. 

“I haven’t heard anything official to say that is going to happen but I suspect that once we have more data we may well be looking at a program of booster doses that may be different for people who are immunocompromised or who have not mounted an adequate response to the first two doses,” he said.

Mrs Dakin was also advised by her GP that her “lack of her vaccination side-effects meant that its efficacy might be lower than for other people”. Although this is contrary to current data it did spark the conversation with her GP about taking extra shielding precautions.

Mrs Dakin said the top priority in being immunocompromised “is to make my life as normal as possible.”