So to keep you in the loop, my spies have intercepted a communication by Prof Van-Tam, OK…it was sent to the Doctors. COVID-19 causes a variety of symptoms, Dr Angry says symptoms of COVID include loss of taste and you can see this symptom is on the increase all around London.
Get ready for a Booster in Autumn 2021
Anyway back to the Medical Van th Man..He wrote:
As you will be aware, shielding was paused on the 1st April, and since then individuals have been able to follow the same guidance as the rest of the population. This will remain the case when restrictions are lifted, although the Government continues to advise the most vulnerable to think about extra steps they may wish to take to protect themselves. This will be particularly important for those individuals who are immunosuppressed. Although the vast majority of the population will be well protected by the vaccine, including the clinically extremely vulnerable, no vaccine is 100% effective and there is emerging evidence to suggest that some immunocompromised and immunosuppressed individuals may not respond as well to the COVID-19 vaccine as others.
Such patients will have been at long-term risk of infectious disease and, prepandemic, and should in most cases be familiar with making individual risk assessments to deal with possible encounters with a wide variety of infections, not least influenza and other respiratory viruses. Consider the risks of close contact with others:
• in crowded spaces, where there are more people who might be infectious
• in enclosed indoor spaces where there is limited fresh air
• when COVID-19 disease levels are high in the general community
Take steps to reduce the risk of catching or spreading COVID-19. For example, they could:
• meet outside if possible – the particles containing the virus that causes
COVID-19 are quickly blown away which makes it less likely that they will be
breathed in by another person
• make sure the space is well ventilated if you meet inside; open windows and
doors or take other action to let in plenty of fresh air
• consider whether you and those you are meeting have been vaccinated – you
might want to wait until 14 days after everyone’s second dose of a COVID-19
vaccine before being in close contact with others
• wash your hands regularly and avoid touching your face
• consider continuing to practice social distancing if that feels right for you and
• asking friends and family to take a lateral flow test before visiting you
• ask home visitors to wear face coverings
This advice will be particularly appropriate to those who are immunosuppressed.
Public Health England data shows for those who are immunosuppressed, vaccine effectiveness against symptomatic infection is 4% after a first dose. However, this rises to 74% after a second dose, which amounts to broadly similar protection levels to those who are not in a risk group.
Time out here, this is all well and dandy and says this is good news but we know that not every one you is immunosuppressed makes a response. So if you lumped everyone with MS together it would be like this, but there are people on specific treatments that don’t do well. To be fair he says
It should be noted however that these figures are based on very small numbers of events in a subgroup which covers a broad definition of immunocompromise. The analysis also only looked at symptomatic disease. Further work is therefore needed to evaluate vaccine efficacy in specific groups, and to evaluate vaccine efficacy against severe outcomes. It is also important to note that these are aggregated data for immunocompromised patients as a whole. Within this group there will be substantial variation in the degree of immunosuppression: in some individuals, any vaccine hypo-responsiveness might have been transient related to ongoing or recent chemotherapy that is time limited, suggesting that they might respond to a booster at a later time point. In other cases where immunosuppression is more intrinsic to the underlying condition, such as those with haematological malignancies, any reduced ability to respond to vaccines might persist. Measurement of antibody levels post-vaccination appears to correlate
in general with the likelihood of vaccine protection against infection, but unless T-cell responses are also measured, likely clinical protection against severe disease cannot be fully assessed.
The OCTAVE-DUO study is seeking answers to these issues by evaluating boosters for the immunosuppressed and should be able to report to JCVI by late August or early September.
All clinically extremely vulnerable individuals, not just those who are immunosuppressed, have always been and remain a high priority group of individuals for COVID-19 vaccination (Cohorts 4 and 6).
Interim advice from the JCVI, indicates that in the Autumn a programme of booster vaccinations may be offered to individuals over the age of 16 who are immunosuppressed and to adult household contacts.
Full vaccination should be encouraged, and implemented in such a way as to promote optimal immune response. More information can be found here.
However the problem with the OCTAVE study is there will not be many people with MS on the trial.
Data is surfacing
Comparison of immunogenicity between BNT162b2 and ChAdOx1 SARS-CoV-2 vaccines in a
large haemodialysis population Clarke et al. MedRXiv https://doi.org/10.1101/2021.07.09.21260089. This study compares the immunogenicity of BNT162b2 (n=523) against the adenovirus vector vaccine, ChAdOx1 (n=498), in 1021 haemodialysis patients. In infection-naïve patients, overall seroconversion rates were comparable, however, spike protein antibody concentrations were significantly higher following BNT162b2. No difference in T cell responses was seen, however, all naïve patients had weaker responses compared with healthy controls. Equivalent attenuated cellular responses to both vaccines, with greater humoral responses toBNT162b2, suggests BNT162b2 has superior immunogenicity in this patient population, with data on clinical efficacy required.
Here you can seee most people gave a response Anti-S was detected in 936 (91.2%) of patients post-vaccination. We have seen in anti-CD20 MSers anti-S may becommonly found but the receptor binding domain response is lower. There was no difference in seroconversion rates between infection-naïve patients who received BNT162b2 (pfizer), 248/281 (88.3%) compared with ChAdOx1, 227/272 (83.5%)..Only 73 (38.2%) of patients had detectable T-cell responses post-vaccination, with no proportional difference between infection-naïve patients who received BNT162b2, 2/19 (10.5%), versus ChAdOx1, 15/75 (20.0%), p=0.34. Use of immunosuppression, OR 0.15 (0.09-0.26), p<0.0001 was associated with non-seroconversion.
However this is another example that the antibody response induced with pfizer is higher than AZ. (Also note this is a log scale so the response is distorted the pfizer response is about 5 or 6 times higher.
This was also seen in another OCTAVE study.
Prendeckimetmal. Comparison of humoral and cellular responses in kidney transplant recipients receiving
BNT162b2 and ChAdOx1 SARS-CoV-2 vaccines https://doi.org/10.1101/2021.07.09.21260192.
Anti-S was detected in 569 (61.8%) patients. Only 28/106 (26.4%) of patients had detectable T-cell responses.
(5.1%), p=0.15. However if you are optimizing, hopefully even the JCVI can see this one.
COI: None relevant
Disclaimer: Please note that the opinions expressed here are those of the author and do not reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust or Queen Mary Univeristy of London.