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COVID-19 vaccines and transplant patients: Third dose recommended

The FDA and CDC recommend a third dose. Here’s why you should get it.

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Updated August 25, 2021, to include information on the third dose. Please note that this content is accurate as of the update 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 is the latest information on a third dose? 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.

Dr. Megan MoralesShould transplant patients get a third dose?

Yes. Transplant recipients should get a third dose of the vaccine. This new guidance follows FDA authorization that extends the emergency use authorizations (EUA) for transplant recipients and other similarly immunocompromised individuals. This applies to the Pfizer and Moderna vaccines. The amended guidance was updated following clinical research showing lower effectiveness of the first two doses for transplant patients. The third dose has been shown to offer increased protection against COVID-19 for some patients.

When and how should patients receive a third dose?

Patients are urged to receive the same vaccine (either Pfizer or Moderna) as their initial vaccination. They also need to have completed the two shots at least 28 days earlier. With this in mind, patients may receive a vaccine in the community. If you receive a third dose of vaccine in the community, please contact your transplant coordinator so your medical records can be updated appropriately. VCU Health is offering third dose vaccinations for transplant patients. For questions and scheduling, patients should contact their transplant coordinator.

What if I received the single-shot Johnson & Johnson vaccine?

There is no updated guidance on that at this time. However, the CDC and FDA are closely examining this issue and will update about possible additional vaccine doses when able. 

What if I’ve been exposed to someone with COVID-19 infection?

The FDA recently approved the use of monoclonal antibodies for preventing infection (prophylaxis) in high-risk patients before they become sick. For example, if a transplant patient had a known COVID-19 exposure, they could receive monoclonal antibody infusion before showing symptoms. This permits transplant teams to help patients sooner, with the intention of avoiding serious negative outcomes from COVID-19. To be clear, the use of this treatment is not a substitute for vaccination against COVID-19.

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 or approved 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.

Even as research studies indicate that the vaccine may have varying effectiveness 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 potentially 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.

At what age can transplant patients get the vaccine?

The COVID-19 vaccine is available for all transplant patients age 12 and up for Pfizer and age 18 and up for Moderna. You can follow the VCU Health COVID vaccine page, the Virginia Department of Health website or contact your transplant coordinator for additional information.

Any eligible household member should also be vaccinated. 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, you may delay vaccination by 90 days after treatment. However, vaccine given earlier in that 90-day window does not need to be repeated.

Should patients waiting for transplant be vaccinated?

Yes, you should get your vaccination before your transplant if possible. Vaccination is likely to be more effective when given before transplant.  Also, 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.

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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