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COVID-19, omicron and the immunocompromised: Get your booster shot!

The CDC recommends booster shots for people with weakened immune systems.

People looking puzzled (illustration) Illustration: Getty Images

Updated March 2, 2021, to address the most current variant, omicron.

By Esther Benenson

The omicron variant is more contagious than previous forms of the virus that causes COVID-19. Most COVID-19 hospitalizations in this country are due to the omicron variant. 

Although vaccination is highly effective at preventing hospitalizations and death, people who are immunocompromised may not respond to the COVID-19 vaccine. That’s why the Centers for Disease Control and Prevention (CDC) recommends booster shots for people with moderate to severe immunocompromising diseases.

Here, VCU Health answers questions on the safety and effectiveness of the COVID-19 vaccine for people who are immunocompromised — including information on booster shots.

What is the immune system?

The immune system refers to your body’s means of attacking invading pathogens, like viruses and bacteria, after they enter your body. Your immune system attacks these pathogens to prevent them from harming your organs and tissues. Some of these invading pathogens are merely annoying, like a cold. Others, like the virus that causes COVID-19, can be deadly.

What does it mean to be immunocompromised?

Being immunocompromised means your body’s immune system is unable to keep you safe from invading agents, like viruses and bacteria.

What diseases, conditions and treatments can weaken your immune system and cause you to be immunocompromised?

More than 200 diseases cause immune system issues. These include:

  • Cancers that affect the bone marrow, such as leukemia and lymphoma
  • Insufficiently controlled diabetes (type 1 and type 2)
  • Advanced human immunodeficiency virus (HIV) infection — particularly in patients not on treatment with low CD4 counts

Sometimes it’s the treatment for a medical condition that can weaken your immune system. These include but are not limited to:

What does the immune system have to do with COVID-19?

When your immune system doesn’t work well, viruses, such as the virus that causes COVID-19, can enter your body undetected and are given free reign. During a pandemic, viruses pass from one person to another quickly and easily. People with a healthy immune system have a greater chance at fighting the infection than those whose immune system is weak.

The virus that causes COVID-19 is highly lethal. More than 950,000 people in the United States have died from COVID-19. Even people with a healthy immune system are succumbing to infection, severe symptoms and death. People without a properly functioning immune system have an even harder time fighting the infection.

Vaccines work by teaching your body how to produce antibodies to fight an infection before the infection actually takes place. That way your body is primed to fight off the invading pathogens as soon as they appear. 

People with weakened immune systems are at a disadvantage for two reasons:

  1. Their immune system may not be strong enough to fight off infection on its own.
  2. Their immune system may not be sufficiently strengthened by a vaccine to fight off infection.

Nonetheless, it is possible that someone who is immunocompromised may respond sufficiently to vaccination, so vaccination is critical to help prevent infection to the maximum extent possible.

Is it safe for people with weakened immune systems to get the vaccine?

Yes. All of the currently available COVID-19 vaccines in the United States are safe for people who are immunocompromised. They do not contain live coronavirus. No one can get COVID-19 from the vaccine. Without it, you are completely open to infection and the severe results of COVID-19, including death. 

Data show that people who are immunocompromised do not respond to the current vaccines as robustly as people who are not immunocompromised. That said, a significant proportion will respond, and any potential protection is better than no protection. Booster shots may help fill in the gap.

Can people who are immunocompromised get a booster shot?

The CDC recommends that people who are moderately to severely immunocompromised get a booster shot.  You can get the booster as soon as 28 days after your primary vaccination, no matter which vaccine you originally received. You do not need to get the same vaccine for your booster. The CDC has approved boosters for all three vaccines -- Pfizer, Moderna and Johnson & Johnson (J&J). 

What else can people with weakened immune systems do to lower their risk of COVID-19?

Follow the same practices the CDC and FDA have been advising all along for unvaccinated people, but with even greater diligence:

  • Wear a face mask, especially when indoors
  • Maintain a distance of at least six feet from others
  • Minimize time spent in indoors around crowds
  • Wash your hands frequently or use alcohol hand sanitizer

Talk to your doctor about any additional concerns you may have.

This article was previously updated October 22, 2021, under the headline, "COVID-19, delta and the immunocompromised: Get your booster shot!". It was originally published August 13, 2021. 

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