Immunocompromised patients determine next steps in wake of new CDC guidance for fully vaccinated

Posted at 5:20 AM, May 18, 2021

HILLSBOROUGH COUNTY, Fla. — May marks one year since Patrick Nielsen received a life-changing kidney transplant.

His wife, Patsy Nielsen, made decals looking for a donor, which led to a Good Samaritan finding out he was a living donor match for Patrick.

“Amazing, amazing, so great not having dialysis and feeling horrible all the time,” said Patrick.

Now enjoying things they couldn’t before, like camping and vacation, the couple said they’re still taking extra precautions even though they’re fully vaccinated against COVID-19.

“I know a lot of places don’t require them or are going by the honor system so until we feel comfortable taking them down we’re still going to be wearing them,” said Patrick.

“If we are in a spot where a lot of people aren’t wearing masks and it’s a little overcrowded we choose not to partake in that event or go grocery shopping or whatever,” said Patsy.

They explained they’re not sure how well Patrick is protected due to the immune suppressant drugs he must take post-transplant.

While the CDC has loosened guidance for those who are fully vaccinated, the agency also notes in its guidance that if someone has a condition or takes medication that weakens their immune system, they may not be fully protected even if fully vaccinated and may need to continue taking precautions. The agency recommends talking to your doctor.

“The physician will know the individualized risk. if you’re going to talk to your physician ask your physician whether or not you should get a test to see if you’ve responded to the vaccine. It’s really important some people that we might have assumed would not respond well to the vaccine apparently do respond to the vaccine so this is actually a really interesting scientific question,” said Michael Teng, Ph.D., an associate professor of medicine at USF Health.

Teng also noted that if someone doesn’t have a high immune response he would treat every situation like a potential exposure risk.

While people with immune disorders were generally not included in COVID-19 vaccine trials, researchers are now turning their attention to them.

The National Institutes of Healthstarted enrolling participants in a study last month looking at how people with immune system deficiencies respond to COVID-19 vaccines.

A recent study of solid organ transplant recipients by Johns Hopkins Medicine researchers led them to recommend strict safety precautions after vaccination for organ transplant recipients and immunocompromised patients. They found 46% of participants had no detectable antibody after two doses of an mRNA vaccine.

“I think that’s an area we need more research, more understanding in this area because we simply don’t know and these people are very, very fragile when it comes to infection,” said Dr. Hani Wadei, a nephrologist at the Mayo Clinic Transplant Center in Jacksonville.

He and other researchers had a letter published in the American Journal of Transplantation with cancers about the immune response for solid organ transplant recipients after mRNA COVID-19 vaccines.

The letter explains seven solid organ transplant recipients diagnosed with COVID-19 at Mayo Clinic in Florida after receiving vaccines. Two patients had one dose, and five had both doses. Dr. Wadei said when checking six of them for antibodies, all except for one had no detectable response to the vaccine.

“The message is to the transplant patients continue to be vaccinated we need the vaccine, don’t refrain from vaccination but at the same time don’t lift your guard,” Dr. Wadei said.

In the meantime, the Nielsens are carrying on.

“You not only have to protect yourself but you have to protect others because you don’t know you could be standing in the line at the grocery store with somebody like Patrick,” said Patsy. “Or like our friends who have had transplants or people who have other autoimmune disorders where it’s not only up to them, but it’s up to everybody else to kind of take a step back and look at that.”

“You can protect many people by wearing the mask, like we try ourselves, but I also understand people that don’t wanna wear them., It’s their choice if they don’t have to,” said Patrick.