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COVID-19 vaccines and transplant patients: What’s all this talk about a third dose?

Yes. You should get the vaccine. But no, we’re not offering a third dose — yet. Here's why.

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Please note that this content is accurate as of the publication date.

As a transplant patient, the medicines you take to prevent organ rejection weaken your ability to fight infections. You’re extra cautious in your daily life. You wash your hands often and stay away from crowds. This is true in times of pandemic or not.

We know you still have questions about the COVID vaccines. Is the vaccine effective? Should I still get it? And what’s all this talk about a third dose for transplant patients? Here, Dr. Megan Morales, director of Transplant Infectious Diseases at VCU Hume-Lee Transplant Center, answers your questions and provides the latest information regarding the safety of the COVID-19 vaccines for transplant patients.

Megan Morales

Is the vaccine still safe for transplant patients?

Yes. The vaccine is safe. Transplant patients should receive the COVID-19 vaccine. None of the vaccines authorized by the FDA contain live coronavirus nor do they contain a weakened or dead version of the coronavirus. The vaccines have no coronavirus to pass on to you. You will not be exposed to this virus in any way.

I’m still worried. Is the vaccine worth the risk? I don’t want to take any chances on getting COVID-19.

Again, the vaccine does not contain the virus that causes COVID-19, so you can’t get the disease from the vaccine. It’s definitely worth getting vaccinated.

It is recommended that transplant recipients receive whatever vaccine may be available to them. Even as research studies indicate that the vaccine may not be as effective for transplant patients, we know from other vaccines that it can also reduce the severity of the illness, if a patient were to get COVID-19.

To be clear, any degree of protection from this deadly disease is better than no protection. Transplant patients may be more likely to have severe disease and require hospitalization or care in the ICU, so please remember that the benefits of vaccination outweigh the risks, which are often mild side effects.

What are the side effects of the vaccine?

In available safety data of transplant patients who have received the vaccine so far, reactions were generally mild and similar to those of non-transplant patients. Side effects included mild, temporary soreness, redness or swelling at the injection site, headache and fever.

What’s all this talk about a third vaccine dose?

Observational studies — that’s when researchers did not administer a vaccine but studied patients who had received the shot — have found some people make measurable antibodies against COVID following a third dose when they did not after the first two doses. Additional research is now being done in this area to determine if a third dose is safe and effective for transplant patients, what type of third dose is ideal, and at what timing interval. VCU Health is also working to pursue research in this area, as well.

It’s important to highlight that the B cells commonly associated with vaccine protection only provide part of a patient’s immunity picture. Across the United States, this antibody response is not commonly checked in vaccinated transplant patients. There are also T cells at play that may help fight against COVID-19 infection. Currently, the body’s T cell response cannot be easily measured. This means that a person may not show B cell antibodies, but may still have some virus protection. It is also unknown for transplant patients what level of any antibody response protects them from COVID-19.

You should continue to observe safe practices. This includes wearing your mask, practicing frequent hand hygiene, physical distancing from others and avoiding unnecessary outings. Do not stop until you’re told to.

Is VCU Health offering a third vaccine dose to transplant patients?

No, VCU Health is not offering a third vaccine dose to transplant patients at this time. This adheres to the FDA’s emergency use authorization (EUA), which authorized up to two doses of the COVID-19 vaccines. This also follows guidance from the American Society of Transplantation, American Society of Transplant Surgeons and International Society for Heart and Lung Transplantation.

There is still research needed to better understand a third vaccine dose’s efficacy and safety for transplant patients.

If I have the option, should I get a third dose?

We recommend that you discuss this directly with your transplant coordinator. Right now, receiving a third dose is only advised in the context of a clinical research trial. Such studies are being established in the U.S. VCU Health may participate in this research, as well. For now, research studies are the best way to safely receive a third dose, should you wish to participate.

When can I get the vaccine?

The vaccine is now available for all transplant patients age 12 and up. You can follow the VCU Health COVID vaccine page, the Virginia Department of Health website or contact your transplant coordinator for additional information.

Your household members should also get vaccinated if they can. Having vaccinated people around you will make you safer, as well.

What if I’ve already had COVID-19?

You should get vaccinated even if you've had COVID-19. You may have some degree of protective antibodies for a period of time, but the vaccine may give you additional protection against reinfection. You should wait until you have fully recovered from COVID-19. We encourage you to discuss the timing of your vaccination with your transplant team to make the best decision for you.

If you received monoclonal antibody treatment or convalescent plasma, it is recommended to delay vaccination by 90 days after treatment.

Should patients waiting for transplant be vaccinated?

Yes, you should get your vaccination before your transplant if possible. Many transplant candidates have other health conditions such as diabetes, high blood pressure or advanced kidney disease, which may put them at increased risk of severe COVID-19. Ideally, you would be vaccinated at least two weeks before transplant to give your immune system time to respond effectively. However, we will not delay your transplant because of a more recent vaccine.

When should I get the vaccine posttransplant?

New transplant recipients should delay receiving a COVID-19 vaccine:

• Kidney transplant patients should wait three months after transplant

• All other organ recipients should wait one month after their transplant surgery.

Additional patients may also need to adhere to the three-month window. Those patients will be informed directly by our care team.

This delay in vaccination is necessary to give your immune system enough time after transplant to recover to a level where the vaccine is more likely to be effective.

After I get the vaccine, am I safe right away? Do I have to wear a face mask or practice social distancing?

Now is not the time to let up on the safety precautions you have been observing.

The CDC recently changed recommendations for mask wearing. However, this does not apply to people at high risk of COVID infection, which includes transplant patients and those on immune-suppressing medications. You should continue to observe safe practices. This includes wearing your mask, practicing frequent hand hygiene, physical distancing from others and avoiding unnecessary outings. Do not stop until you’re told to.

We’re here for you

Please know that all of us at Hume-Lee are here to guide you through the vaccination process. Our team is closely monitoring vaccine developments and recommendations for transplant patients.

We are on this journey together. Should you have any questions, you may call us at (804) 828-4104. For additional transplant-specific information, visit the American Society of Transplantation COVID-19 resource page

For more information

For a variety of news and information on COVID-19 and how VCU Health is keeping patients safe, please visit our COVID-19 News Center

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