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Moderate to severe immunocompromising conditions that may result in suboptimal COVID-19 vaccine response[1,2]

Moderate to severe immunocompromising conditions that may result in suboptimal COVID-19 vaccine response[1,2]
Active treatment for solid tumor and hematologic malignancies
Receipt of solid-organ transplant and taking immunosuppressive therapy
Receipt of CAR-T-cell therapy or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppressive therapy)*
Moderate or severe primary immunodeficiency (eg, DiGeorge, Wiskott-Aldrich syndromes)
Advanced or untreated HIV infection (CD4 cell count <200 cells/microL, history of AIDS-defining illness without immune reconstitution, clinical manifestations of symptomatic HIV)
Active treatment with:
  • High-dose corticosteroids (ie, ≥20 mg prednisone or equivalent per day for ≥2 weeks)
  • Alkylating agents
  • Antimetabolites
  • Transplant-related immunosuppressive drugs
  • Cancer chemotherapeutic agents classified as severely immunosuppressive
  • TNF blockers
  • Other biologic agents that are immunosuppressive or immunomodulatory

In the United States, the Centers for Disease Control and Prevention lists the above conditions as examples of immunocompromising conditions that warrant additional primary COVID-19 vaccine series doses (eg, a three-dose primary mRNA vaccine series rather than a two-dose primary mRNA vaccine series) and an accelerated booster dose interval. This list is not exhaustive; other immunocompromising conditions, such as impaired splenic function, may also warrant the same vaccine adjustments. Refer to other UpToDate content for specifics of vaccine doses and intervals.

People with the above conditions may also meet criteria for pre-exposure prophylaxis with specific monoclonal antibody regimens in the United States. Refer to UpToDate content on pre-exposure prophylaxis for more details.
CAR: chimeric antigen receptor; TNF: tumor necrosis factor; ACIP: Advisory Committee on Immunization Practices.
* For those who received COVID-19 vaccination prior to hematopoietic stem cell transplant or CAR-T-cell therapy, repeat vaccination with a full primary series is recommended at least 3 months after the transplant or therapy.
Reference:
  1. Centers for Disease Control and Prevention. Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States. Available at: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html (Accessed on February 18, 2022).
  2. US Food and Drug Administration. Fact Sheet for Healthcare Providers: Emergency Use Authorization for Evusheld (tixagevimab co-packaged with cilgavimab). Available at: https://www.fda.gov/media/154701/download (Accessed on December 10, 2021).
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