Study points at low uptake of COVID-19 vaccine boosters by immunocompromised people in the US

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In a recent study published in JAMA network openResearchers enrolled between December 14, 2020, and August 6, 2022 in the Kaiser Permanente Southern California (KPSC), an integrative health system in the United States of America (USA), in immunocompromised patients. , conducted a retrospective cohort study.

study: Analysis of COVID-19 Vaccine mRNA Uptake in Immunocompromised Patients in the Large US Healthcare SystemImage credit: chatuphot/Shutterstock

Researchers decided to take the messenger ribonucleic acid (mRNA) coronavirus disease 2019 (COVID-19) vaccine in these patients. In addition, we investigated factors associated with receiving at least four booster doses.


The US Centers for Disease Control and Prevention (CDC) recommends boosting the COVID-19 vaccine for immunocompromised people. In October 2021, the CDC shortened the interval between her first two-dose vaccination regimen and the first booster dose by at least five months to better protect immunocompromised people.

Again, in February 2022, CDC shortened this gap to at least three months. In May 2022, CDC revised all previous recommendations. They declared that immunocompromised patients could receive a fifth dose (second booster) of the mRNA COVID-19 vaccine.

Rapidly changing CDC guidelines are confusing and many immunocompromised patients fail to adhere to them. Non-adherence in this high-risk subpopulation has resulted in severe COVID-19 cases with public health implications.

About research

In this study, researchers used the KPSC electronic health record (EHR) system to obtain data for all immunocompromised patients aged 18 years and older. However, only individuals who had an immunodeficiency disease in the year before the study began or who were on immunosuppressive medications when the study began were included. This meant that one of these two inclusion criteria had to be met until December 14, 2021.

Researchers used pre-validated algorithms to identify immunodeficiency states and drugs. International Statistical Classification of Diseases, Tenth Revision (ICD-10) code.

Additionally, the team limited its study analysis to immunocompromised patients who received only the mRNA COVID-19 vaccine. They censored participants upon death or unenrollment from the KPSC system.


Researchers screened 44,529 of 3,133,341 KPSC members aged 18 or older with KPSC membership of 1 year or longer in December 2020 for this study. However, he was only 42,697 in the final cohort. Of those, 18,789 (44%) were over the age of 65. In 2006 1 (47%) were female and the remaining 53% were male. The study cohort consisted of Asian or Pacific Islanders, Black Americans, Hispanics, and Caucasians in proportions of 10.1%, 12.1%, 33.5%, and 41.9%.

36,606 received a single dose of the mRNA vaccine (BNT162b2 or mRNA-1273), whereas 1588 received a combination of these two vaccines. Some of the individuals included had also received her 4th and her 5th doses as recommended by the CDC.

By the end of the study period, more than 61% of immunocompromised patients had received no more than 3 doses of mRNA vaccine, and 37.5% had received 4 doses. Interestingly, he was the only 0.9% of patients who received five doses as recommended by the CDC. And by April 2022, six months after the CDC recommendation, only 14% of eligible immunocompromised patients had received her fourth dose. [i.e., their first booster]). In fact, in this high-risk population, uptake of the first and his second boosters was slow and failed to meet CDC recommendations.

Moreover, these results did not change after considering booster dose eligibility. Thus, of the 13,054 recipients who received his 4th dose at least 4 months before the culmination of the study, 391, or 3%, received her 5th dose. I received (second booster).

Cox proportional hazards regression analysis revealed that adults aged 65 years and older were more likely to receive 4 doses than those aged 18-44 and 45-64. Similarly, this likelihood was higher in white immunocompromised individuals compared with black and Hispanic individuals. less likely to receive


Results from the current study highlight substantial gaps in adherence to CDC recommendations for boosting immunocompromised individuals. the highest. However, by August 2022, despite CDC recommendations, only 0.9% of immunocompromised patients enrolled at KPSC had received her five doses of mRNA COVID-19 vaccine. Also, only 41% received four monovalent mRNA doses, ie one booster.

Reluctance to vaccines by immunocompromised individuals may have arisen from safety concerns. They may have misinterpreted the change in CDC guidelines as a lack of vaccine efficacy, particularly for immunodeficiency. But the most likely reason is confusion among medical practitioners. Amid changes in CDC guidelines, they remained confused about how and how often immunocompromised people should receive their fourth and fifth doses of the vaccine.

The emergence of Omicron and pandemic fatigue may also have contributed to the reduced intake of booster doses in this high-risk population. Given the serious consequences of COVID-19 and the importance of boosters to prevent the vulnerability of this population, physicians and public health officials are making recommendations for COVID-19 booster doses as immunocompromised individuals continue to evolve. A targeted effort should be made to keep matters up to date.

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