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Is covid vaccine helpful for a covid patient?

Is covid vaccine helpful for a covid patient?


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I am not a biology student and this question came in my mind out of nowhere.

I read somewhere that the vaccines contain some denatured or almost dead corona viruses and when these are injected in our body , our immune system remembers them and if the actual (killer) corona virus enters our body , our body recognises it and quickly attacks it.

But if we have a corona patient his body has already identified the corona virus and so if the vaccine is given the body will not have much changes to do and simply refuses it .

So is it okay to give the covid vaccines to a covid patient ? Can it make the infection even worse ?


In short, no. It's not harmful but it won't do anything to prevent or mitigate the current infection.

How vaccines work in general is that they train the immune system to respond to an infection so that they are prepared for it. Generally protein component of the virus or an inactivated form of the pathogen is used as a vaccine. The immune system recognises the proteins as 'foreign' and develops anti-bodies to fight them. Then you are immunised to the virus without having to suffer the symptoms of infection. Vaccines work before you are infected as a preventative measure. Then when you are infected, the immune system is prepared and can fight of the virus with the antibodies already developed since the virus has the same "antigen" proteins as you immune cells have already been exposed to from the vaccine.

So what happens when you are vaccinated when you are already infected? Basically nothing.

The benefit of a vaccine is a head-start to train your immune system how to fight it to prepare for the early stages of infection. If you are vaccinated, your immune system will destroy the virus before the it multiplies or gives you symptoms. If you've already been infected then the active virus has already infected many of your cells and multiplied into many copies. Adding inactivated viral particles or spike protein antigen won't help your immune system, it's already been exposed to them by the ongoing infection. Your immune cells are just playing catch up to the infection that's already taken hold. The virus has already stormed the beaches and the immune cells were not prepared. Vaccination now is arguably pointless. They will eventually produce antibodies against the virus already in your system even if you weren't vaccinated.

Lasting immunity after recovering from infection is not guaranteed and a vaccine could give immunity to other strains. For these reasons, it could still be recommended by medical professionals if you've already been infected. However, you need to be vaccinated before exposure to the virus for it to be effective. A vaccine is not a treatment.

Note: the currently available AstraZeneca, Pfizer, Moderna, and Johnson & Johnson vaccines for SARS-CoV-2 do not contain live or inactivated coronavirus. They trick the host system into producing the spike protein from instructions carried by the vaccine.

Citation for clinical application: Jenner, E (1798) An Inquiry into the Causes and Effects of the Variolae Vaccinae.


Study finds COVID-19 vaccines safe for IBD patients

Patients with inflammatory bowel diseases (IBD) do not appear to have increased risk of side effects from the Pfizer or Moderna COVID-19 vaccines, according to a recent Cedars-Sinai study published online and upcoming in print in the American Journal of Gastroenterology. In fact, those being treated with advanced immune-modifying therapies may experience them less often than the general population.

IBDs, including Crohn's disease and ulcerative colitis, are chronic conditions that occur when the intestinal immune system becomes overreactive, causing chronic diarrhea and other digestive symptoms. In a published survey at the beginning of COVID-19 vaccine distribution, 70% of IBD patients reported concern about side effects from the vaccines.

"What we've learned is that if you have IBD, the side effects you're likely to experience after a vaccine are no different than they would be for anyone else," said Gil Melmed, MD, corresponding author of the study and director of Inflammatory Bowel Disease Clinical Research at Cedars-Sinai. "If you're being treated with advanced therapies such as biologics, these side effects might even be milder. So, don't let that be a reason that you're not getting vaccinated.

Evaluating Post-Vaccine Side Effects

Patients with IBD and other immune-related conditions on biologic therapies were excluded from COVID-19 vaccine trials, so Melmed and fellow researchers evaluated post-vaccination side effects in 246 adult IBD patients in a nationwide COVID-19 vaccine registry used by investigators at Cedars-Sinai.

These patients, like those in the general population, most often reported pain and swelling at the injection site, followed by fatigue, headache and dizziness, fever and chills, and gastrointestinal symptoms. Most side effects were mild and lasted only a few days.

Very few IBD patients reported severe side effects -- most commonly fatigue, fever and headache. And just two of the 246 patients studied reported severe gastrointestinal symptoms.

Many IBD patients expressed concern that vaccination would cause a "flare" or worsening of their condition. Research into whether post-vaccination GI symptoms were from flares or simply reactions to the vaccine is ongoing. However, Melmed emphasized that the vast majority of reported gastrointestinal symptoms were short-lived and resolved on their own.

Around 80% of patients in the study were being treated with advanced therapies that inhibit the body's immune response in a targeted way, including various biologic and Janus kinase inhibitor therapies. Melmed said this inhibition of the immune system might partially explain the slightly lower number of side effects these patients reported.

"A lot of these adverse events might actually be due to the immune system reacting to the vaccine," said Melmed. "So, it's possible that you're not going to have as strong of a reaction to a vaccine if you're on medications that modulate parts of your immune system."

Patients with other types of immune-related conditions receiving these therapies would also likely experience fewer side-effects.

"We believe that our results will be applicable to patients with other immune-mediated inflammatory diseases as these drugs are widely used in dermatology, neurology, rheumatology and other disciplines," said Dermot McGovern, MD, PhD, study co-author and director of Translational Research in the Inflammatory Bowel and Immunobiology Research Institute and Joshua L. and Lisa Z. Greer Chair in Inflammatory Bowel Disease Genetics at Cedars-Sinai. "We will be working with our colleagues in oncology to understand effects of the vaccine on people receiving therapy for cancer and also with our partners in the health care workers study to understand if there are differences of outcomes from the vaccine that may be influenced by having an autoimmune disease."

Study Expansion

Meanwhile, the current study of IBD patients is being extended for 5 years to help researchers determine whether -- because their immune systems are being modulated by IBD treatment -- they are receiving less protection from COVID-19 vaccines.

"What we do not yet know is whether these vaccines build lasting immunity to COVID-19 in patients with immune-mediated disease," said study co-author Susan Cheng, MD, director of Public Health Research and Erika J. Glazer Chair in Women's Cardiovascular Health and Population Science at Cedars-Sinai. "Gathering this critically important information is the next step for our research team."

Funding: This study was supported by The Leona M. and Harry B. Helmsley Charitable Trust, the Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, and the National Institute of Diabetes and Digestive and Kidney Disease Grants P01DK046763 and U01DK062413. This study has been additionally supported in part by the Cedars-Sinai Precision Health Initiative, the Erika J. Glazer Family Foundation, and through the Serological Sciences Network, grant NCI U54-CA260591.

Financial disclosures: Dermot McGovern and Gil Melmed are consultants for Pfizer Inc. related to IBD therapeutics Melmed has received research funding from Pfizer for an unrelated investigator-initiated study.

Read more on the Cedars-Sinai Blog: What IBD Patients Should Know About COVID-19


WHO lists additional COVID-19 vaccine for emergency use and issues interim policy recommendations

WHO today listed the Sinopharm COVID-19 vaccine for emergency use, giving the green light for this vaccine to be rolled out globally. The Sinopharm vaccine is produced by Beijing Bio-Institute of Biological Products Co Ltd, subsidiary of China National Biotec Group (CNBG).

&ldquoThe addition of this vaccine has the potential to rapidly accelerate COVID-19 vaccine access for countries seeking to protect health workers and populations at risk,&rdquo said Dr Mariângela Simão, WHO Assistant-Director General for Access to Health Products. &ldquoWe urge the manufacturer to participate in the COVAX Facility and contribute to the goal of more equitable vaccine distribution.&rdquo

WHO&rsquos Emergency Use Listing (EUL) is a prerequisite for COVAX Facility vaccine supply. It also allows countries to expedite their own regulatory approval to import and administer COVID-19 vaccines.

The EUL assesses the quality, safety and efficacy of COVID-19 vaccines, as well as risk management plans and programmatic suitability, such as cold chain requirements. The assessment is performed by the product evaluation group, composed by regulatory experts from around the world and a Technical Advisory Group (TAG), in charge of performing the risk-benefit assessment for an independent recommendation on whether a vaccine can be listed for emergency use and, if so, under which conditions.

In the case of the Sinopharm vaccine, the WHO assessment included on-site inspections of the production facility.

The Sinopharm product is an inactivated vaccine called SARS-CoV-2 Vaccine (Vero Cell). Its easy storage requirements make it highly suitable for low-resource settings. It is the also first vaccine that will carry a vaccine vial monitor, a small sticker on the vaccine vials that change color as the vaccine is exposed to heat, letting health workers know whether the vaccine can be safely used.

WHO&rsquos Strategic Advisory Group of Experts on Immunization (SAGE) has also completed its review of the vaccine. On the basis of all available evidence, WHO recommends the vaccine for adults 18 years and older, in a two-dose schedule with a spacing of three to four weeks. Vaccine efficacy for symptomatic and hospitalized disease was estimated to be 79%, all age groups combined.

Few older adults (over 60 years) were enrolled in clinical trials, so efficacy could not be estimated in this age group. Nevertheless, WHO is not recommending an upper age limit for the vaccine because preliminary data and supportive immunogenicity data suggest the vaccine is likely to have a protective effect in older persons. There is no theoretical reason to believe that the vaccine has a different safety profile in older and younger populations. WHO therefore recommends that countries using the vaccine in older age groups conduct safety and effectiveness monitoring to make the recommendation more robust.

WHO emergency use listing

The emergency use listing (EUL) procedure assesses the suitability of novel health products during public health emergencies. The objective is to make medicines, vaccines and diagnostics available as rapidly as possible to address the emergency, while adhering to stringent criteria of safety, efficacy and quality. The assessment weighs the threat posed by the emergency as well as the benefit that would accrue from the use of the product against any potential risks.

The EUL pathway involves a rigorous assessment of late phase II and phase III clinical trial data as well as substantial additional data on safety, efficacy, quality and a risk management plan. These data are reviewed by independent experts and WHO teams who consider the current body of evidence on the vaccine under consideration, the plans for monitoring its use, and plans for further studies.

As part of the EUL process, the company producing the vaccine must commit to continue to generate data to enable full licensure and WHO prequalification of the vaccine. The WHO prequalification process will assess additional clinical data generated from vaccine trials and deployment on a rolling basis to ensure the vaccine meets the necessary standards of quality, safety and efficacy for broader availability.

WHO also listed the Pfizer/BioNTech vaccine for emergency use on 31 December 2020 two AstraZeneca/Oxford COVID-19 vaccines on 15 February 2021, produced by AstraZeneca-SKBio (Republic of Korea) and the Serum Institute of India and COVID-19 vaccine Ad26.COV2.S developed by Janssen (Johnson & Johnson) on 12 March 2021.

SAGE is the principal advisory group to WHO for vaccines and immunization. It is charged with advising WHO on overall global policies and strategies, ranging from vaccines and technology, research and development, to delivery of immunization and its linkages with other health interventions. SAGE is concerned not just with childhood vaccines and immunization, but all vaccine-preventable diseases.

SAGE has issued recommendations on Pfizer (8 January 2021), Moderna (25 January 2021), AstraZeneca (21 April 2021), and Janssen COVID (17 March 2021) vaccines, as well as issued a framework for access and population prioritization roadmap.

SAGE and EUL are complementary but independent processes. The EUL process is centered on determining if a manufactured product is quality-assured, safe and effective. SAGE is policy oriented. Policy recommendations for a vaccine are only of value to a vaccination campaign when the product has been listed or authorized for use.

In the context of COVID-19 and due the pressing need for vaccines, the Secretariat of SAGE and the EUL team have been working in parallel to allow WHO EUL and policy recommendations, based on the available evidence, to be issued in a synchronized manner.


Study Reveals Recipe for Even More Powerful COVID-19 Vaccines

NEIDL, Broad scientists say next-generation vaccines could stimulate another arm of the immune system, imparting better protection against coronavirus variants

A new study looking at the way human cells activate the immune system in response to SARS-CoV-2 infection could open the door to even more effective and powerful vaccines against the coronavirus and its rapidly emerging variants keeping the global pandemic smoldering.

Researchers from Boston University’s National Emerging Infectious Diseases Laboratories (NEIDL) and the Broad Institute of MIT and Harvard say it’s the first real look at exactly what types of “red flags” the human body uses to enlist the help of T cells—killers sent out by the immune system to destroy infected cells. Until now, COVID vaccines have been focused on activating a different type of immune cell, B cells, which are responsible for creating antibodies. Developing vaccines to activate the other arm of the immune system—the T cells—could dramatically increase immunity against coronavirus, and importantly, its variants.

In their findings, published in Cell, the researchers say current vaccines might lack some important bits of viral material capable of triggering a holistic immune response in the human body. Based on the new information, “companies should reevaluate their vaccine designs,” says Mohsan Saeed, a NEIDL virologist and the co–corresponding author of the paper.

Saeed, a BU School of Medicine assistant professor of biochemistry, performed experiments on human cells infected with coronavirus. He isolated and identified those missing pieces of SARS-CoV-2 proteins inside one of the NEIDL’s Biosafety Level 3 (BSL-3) labs. “This was a big undertaking because many research techniques are difficult to adapt for high containment levels [such as BSL-3],” Saeed says. “The overall coronavirus research pipeline we’ve created at the NEIDL, and the support of our entire NEIDL team, has helped us along the way.”

Mohsan Saeed, BU NEIDL virologist, says the new findings could be a game changer for coronavirus vaccine design. Photo courtesy of Mohsan Saeed

Saeed got involved after he was contacted by genetic sequencing experts at the Broad Institute, computational geneticists Pardis Sabeti and Shira Weingarten-Gabbay. They hoped to identify fragments of SARS-CoV-2 that activate the immune system’s T cells.

“The emergence of viral variants, an active area of research in my lab, is a major concern for vaccine development,” says Sabeti, a leader in the Broad Institute’s Infectious Disease and Microbiome Program. She is also a Harvard University professor of systems biology, organismic and evolutionary biology, and immunology and infectious disease, as well as a Howard Hughes Medical Institute investigator.

“We swung into full action right away because my laboratory had [already] generated human cell lines that could be readily infected with SARS-CoV-2,” Saeed says. The group’s efforts were spearheaded by two members of the Saeed lab: Da-Yuan Chen, a postdoctoral associate, and Hasahn Conway, a lab technician.

From the outset of the COVID pandemic in early 2020, scientists around the world knew the identity of 29 proteins produced by SARS-CoV-2 virus in infected cells—viral fragments that now make up the spike protein in some coronavirus vaccines, such as the Moderna, Pfizer-BioNTech, and Johnson & Johnson vaccines. Later, scientists discovered another 23 proteins hidden inside the virus’ genetic sequence however, the function of these additional proteins was a mystery until now. The new findings of Saeed and his collaborators reveal—unexpectedly and critically—that 25 percent of the viral protein fragments that trigger the human immune system to attack a virus come from these hidden viral proteins.

How exactly does the immune system detect these fragments? Human cells contain molecular “scissors”—called proteases—that, when the cells are invaded, hack off bits of viral proteins produced during infection. Those bits, containing internal proteins exposed by the chopping-up process—like the way the core of an apple is exposed when the fruit is segmented—are then transported to the cell membrane and pushed through special doorways. There, they stick outside the cell, acting almost like a hitchhiker, waving down the help of passing T cells. Once T cells notice these viral flags poking through infected cells, they launch an attack and try to eliminate those cells from the body. And this T cell response isn’t insignificant—Saeed says there are links between the strength of this response and whether or not people infected with coronavirus go on to develop serious disease.

“It’s quite remarkable that such a strong immune signature of the virus is coming from regions [of the virus’ genetic sequence] that we were blind to,” says Weingarten-Gabbay, the paper’s lead author and a postdoctoral fellow in the Sabeti lab. “This is a striking reminder that curiosity-driven research stands at the basis of discoveries that can transform the development of vaccines and therapies.”

“Our discovery…can assist in the development of new vaccines that will mimic more accurately the response of our immune system to the virus,” Sabeti says.

T cells not only destroy infected cells, but also memorize the virus’ flags so that they can launch an attack, stronger and faster, the next time the same or a different variant of the virus appears. That’s a crucial advantage, because Saeed and his collaborators say the coronavirus appears to delay the cell’s ability to call in immune help.

“This virus wants to go undetected by the immune system for as long as possible,” Saeed says. “Once it’s noticed by the immune system, it’s going to be eliminated, and it doesn’t want that.”

Based on their findings, Saeed says, a new vaccine recipe, incorporating some of the newly discovered internal proteins making up the SARS-CoV-2 virus, would be effective in stimulating an immune response capable of tackling a wide swath of newly emerging coronavirus variants. And given the speed with which these variants continue to appear around the world, a vaccine that can provide protection against all of them would be a game changer.

This research was supported by the National Institutes of Health, the National Institute of Allergy and Infectious Diseases, the National Cancer Institute Clinical Proteomic Tumor Analysis Consortium, a Human Frontier Science Program Fellowship, a Gruss-Lipper Postdoctoral Fellowship, a Zuckerman STEM Leadership Program Fellowship, a Rothschild Postdoctoral Fellowship, the Cancer Research Institute/Hearst Foundations, a National Science Foundation Graduate Research Fellowship, EMBO Long- Term Fellowships, a Cancer Research Institute/Bristol-Myers Squibb Fellowship, the Parker Institute for Cancer Immunotherapy, the Emerson Collective, the G. Harold and Leila Y. Mathers Charitable Foundation, the Bawd Foundation, Boston University start-up funds, the Mark and Lisa Schwartz Foundation, the Massachusetts Consortium for Pathogen Readiness, the Ragon Institute of MGH, MIT and Harvard, and the Frederick National Laboratory for Cancer Research.


COVID Vaccines Work in IBD Patients on Biologics

by Kate Kneisel, Contributing Writer, MedPage Today April 23, 2021

All inflammatory bowel disease (IBD) patients taking biologic treatment who received both doses of Pfizer-BioNTech or Moderna COVID-19 vaccines had a positive antibody response, a small prospective study showed.

Of 48 IBD patients vaccinated in the study, all 41 who were on a biologic when they were vaccinated achieved seropositivity, Serre-Yu Wong, MD, PhD, of Icahn School of Medicine at Mount Sinai in New York City, and colleagues reported in Gastroenterology.

Additionally, all 26 patients who completed the full two-dose vaccine schedule had a positive antibody response, while 84.6% of those achieved index levels that would qualify them for convalescent plasma donation.

"This is an extremely promising finding for patients taking biologic medications for IBD," Wong noted in a press release. "To put it in context, we believe this is reassuring in light of two recent publications -- one in JAMA showing inhibited responses in transplant patients receiving immunosuppression after just one dose, and one in Gut showing attenuated antibody responses to SARS-CoV-2 infection (which are different from responses to vaccination) in IBD patients receiving infliximab [Remicade]."

Specifically, the Gut study of IBD treatments showed that, compared with TNF monotherapy, use of thiopurine monotherapy and TNF antagonists plus thiopurine were both associated with significantly increased risk of severe COVID-19. An expert consensus panel recommended that IBD patients be vaccinated against SARS-CoV-2.

While "very little is known about these patients and how they will respond to the various vaccines. It is very important to note that the risk of COVID-19 infection, and complications associated with COVID-19, is much higher than any risks associated with the vaccines available today," noted study co-author Jean-Frederic Colombel, MD, PhD, of Mount Sinai, speaking in a recent Facebook Live interview.

Their assessment of serological responses to COVID vaccination in IBD patients &ndash part of an ongoing study known as ICARUS -- included assay of sera for total immunoglobulins (Igs) and IgG to the receptor binding domain (RBD) of the SARS-CoV-2 S protein and for antibodies to nucleocapsid protein.

Investigators compared those responses to COVID-19 vaccination among 48 IBD patients (23 Crohn's disease and 25 ulcerative colitis patients, mean age 49, 52% female) with those of 43 healthy, vaccinated controls. Those controls included 14 healthcare workers (mean age 35.2, 50% female) and 29 previously-vaccinated volunteers (mean age 31.5, 37.9% female). Except for three of the latter group, all controls had completed two doses. The study also included antibody testing results from 21 study patients infected with SARS-CoV-2 to show relation to naturally-generated antibodies.

Of the 41 patients receiving a biologic when they were vaccinated, 33.3% were on TNF antagonist monotherapy, 35.4% vedolizumab (Entyvio) monotherapy, 6.3% vedolizumab combination therapy with thiopurine, 8.3% ustekinumab (Stelara), and one patient (2.1%) on guselkumab (Tremfya) for psoriasis. Of those not on biologics, 6.3% of patients were taking oral steroids, and 10.4% were not taking any medications.

Compared with the two control groups, the fully vaccinated IBD patients had similar levels of antibody response at all timepoints. Two previously infected IBD patients achieved high index values after a single vaccine dose, well above values achieved from natural SARS-CoV-2 infection, the authors observed.

Treatments being received by the 26 patients who completed both COVID-19 vaccine doses included TNF antagonist monotherapy (eight), vedolizumab monotherapy (12), and ustekinumab (two) four were not taking medications.

Compared with healthcare worker controls, serological responses were lower among patients on tumor necrosis factor (TNF) inhibitors (anti-RBD total Ig, P=0.0299), and lower in patients on vedolizumab monotherapy (anti-RBD total Ig, P=0.0069 anti-RBD IgG, P=0.045 anti-S IgG, P=0.0043).

"Despite achieving antibody levels consistent with presumed protection, we also found an association of lower antibody levels in patients with vedolizumab for all antibodies tested and with anti-TNFs for anti-RBD total Ig only. This finding warrants further investigation, as results could have been affected by timing, vaccine, or clinical characteristics such as age," authors wrote.

Regarding IBD patients' questions about choice and timing of COVID-19 vaccination, "the best vaccine is really the one you can get soonest. It is not wise to wait or put vaccinations on hold and IBD patients should absolutely continue on their biologics without interruption," Colombel emphasized.

Limitations acknowledged by authors included small sample size, single center experience, and differences in time to blood collections.

Nevertheless, this study brings a reassuring message to IBD patients and healthcare practitioners, the group concluded: "Larger studies with more detailed measurements including cell-mediated responses, particularly between dose 1 and 2, will be required to assess immune responses and the effects of medications. In the meantime, our results support the consensus recommendation for IBD patients to receive COVID-19 vaccines when available."

Kate Kneisel is a freelance medical journalist based Belleville, Ontario.


Study: COVID-19 vaccine booster dose safe, needed for transplant patients

June 14 (UPI) -- People who have received an organ transplant may need a booster dose of the COVID-19 vaccine, a small study published Monday by the journal Annals of Internal Medicine found.

The 30 organ transplant recipients in the study had a reduced immune system response after their second dose of the two-shot vaccines compared with the average response of adults in the general population, the data showed.

This is likely due to the fact that, following the procedure, transplant patients are treated with drugs called immunomodulators, which are designed to tamp down the immune system so that it accepts the new organ.

All 30 achieved an adequate antibody response for protection against the virus after being given a booster dose of one of the two vaccines, from either Pfizer-BioNTech or Moderna, with no serious side effects, researchers said.

Because they take immune-modifying drugs, transplant patients need booster doses of vaccines against hepatitis A and B, among others.

Other people on these type of medications, including people with multiple sclerosis and rheumatoid arthritis, may also need extra shots, they said.

"Third doses . will no doubt be part of the approach to improving vaccine response in immuno-suppressed individuals," study co-author Dr. Dorry Segev told UPI in an email.

"[Our] results are encouraging and give us hope that transplant patients might ultimately be able to achieve a reasonable amount of protection through vaccination," said Segev, director of epidemiology research in organ transplantation at Johns Hopkins University in Baltimore.

Antibodies are cells produced by the human immune system to help fight off a virus. The COVID-19 vaccines, meanwhile, are designed to prime the immune system to create antibodies against the coronavirus, according to the Centers for Disease Control and Prevention.

With these antibodies, the immune system is essentially prepared to fight off the virus, preventing serious infection and illness, the agency says.

Public health officials have suggested recently that booster doses of the COVID-19 vaccine may be needed for full protection, depending on the course of the pandemic, particularly as new variants emerge.

However, it is too soon to tell whether annual shots, as with the flu vaccine, will be needed, experts say.

For this study, Segev and his colleagues studied immune response following vaccination in 30 patients who had received a transplant organ.

After receiving their second dose of the COVID-19 vaccine, 10 participants still had negative antibody levels and all had lower levels than those typically found in the general population, the data showed.

However, after receiving a third or booster dose, their antibody levels rose to levels commonly seen in the general population.

None of the 30 participants given a booster dose experienced serious side effects, with only redness, swelling and soreness at the injection site as well as fever, chills, headache and diarrhea reported.

One of the 30 participants suffered from a "mild" organ rejection, which was resolved with treatment and may or may not have been linked with the vaccine, they said.

While the researchers said the booster dose appears safe for organ transplant patients, they note that more research is needed to establish both the efficacy and safety of a third vaccine dose.

"[Our research] sets the stage for larger studies, where we can better understand which patients will respond well to this approach and who might need a different approach," Segev said.

"In general, we have found the vaccines to be safe in transplant patients, and the safety in our small third dose study also seems acceptable, although larger numbers are needed to be able to say that with more confidence," he said.


COVID-19 vaccines may give protection for years, studies show

COVID-19 vaccines may provide protection for at least a year, and possibly even a lifetime, to people who were previously exposed to the virus, two new studies suggest.

Both studies looked at people who had been exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) about a year earlier, The New York Times reported. Cells that remember the virus persist in the bone marrow and may produce antibodies whenever needed, according to a study published in the journal Nature. The other study, posted online at the biology research site BioRxiv, showed that these memory B cells continue maturing and strengthening for at least 12 months after initial infection with the coronavirus.

Together, the findings suggest that most people who have recovered from SARS-CoV-2 infection and were later vaccinated will not require booster shots, The Times said. But it is likely that vaccinated people who were never infected will still need booster shots, as will some people who were infected but did not produce a strong immune response against the virus.


Herd immunity conversations not helpful to vaccine efforts, Dr. Besser says

Since there’s no safety issue, there's no downside to getting the vaccine, Offit said: “It's certainly worth a try.”

Even though blood cancer patients may not respond fully to the vaccine, this does not mean vaccination is futile, the Leukemia & Lymphoma Society noted.

People with a fragile immune system are at risk for severe COVID-19, so getting even some protection from the vaccine is better than having none at all, the American Cancer Society noted.

Offit recommended people with compromised immune systems have their antibodies measured after they get the COVID-19 vaccine to gauge the amount of response.

Patients may want to ask their doctor whether it’s worth suspending their immune-suppressing medication or treatment for a while and then get vaccinated. Offit recently talked with a person with multiple sclerosis who was considering that step at the risk of having the disease flare up.


COVID-19 Vaccines Recommended for Autoimmune Patients

By Myriam Masihy &bull Published March 17, 2021 &bull Updated on March 17, 2021 at 7:42 pm

Millions of Americans suffer from chronic autoimmune diseases, which could make them more vulnerable to the coronavirus. While antibodies protect healthy people when they get infected, their bodies do the opposite.

“It attacks our own bodies, like our organs, our heart, the lungs, the brain, the skin. It kind of goes backwards instead of protecting us,” said Ana Sofia Membreno-Stuart, who was diagnosed with Lupus.

While the data is limited, the American College of Rheumatology (ACR) found these patients appear to have a higher risk of a serious coronavirus infection.

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“Many patients with rheumatic disease do require hospitalization and have a more severe presentation,” Dr. Iris Navarro-Millan said.

She is an ACR member and a rheumatologist from Weill Cornell Medicine.

The ACR recently released recommendations for patients with autoimmune diseases such as Lupus, Rheumatoid Arthritis, Sjogren, among others, who want to get the COVID-19 vaccine but worry about their bodies’ reaction.

“It’s a very common question and one that is important to hear from their doctor,” Dr. Navarro-Millan said. “We know that happens with patients with the Flu vaccine, the Shingles vaccine, that they tend to feel a little bit not so well, fatigue, and in some instances people do develop a flare.”

But the American College of Rheumatology recommends these patients get the COVID-19 vaccine saying the benefit “outweighs the potential risk” of “flare or the disease worsening.”

“So bottom line is the risk of the flare, even if it’s a bad one that makes you feel bad, it’s still not as bad as getting a serious COVID-19 infection that can put you in the hospital,” Dr. Navarro-Millan said.

For patients who are under immunosuppressant treatments, such as Methotrexate, Tofacitinib and Baricitinib, the ACR recommends suspending the medications for one week after each dose of their vaccination. But they empathize it’s important to consult with their doctor before making any decision.

“The majority of medications used to treat rheumatic diseases do not change on the doses or the frequency of the doses, except for a few,” Dr. Navarro-Millan said.

Experts tell us these changes will help the vaccines be more effective. For more information about these new guidelines and recommendations on medications, you can click here.


Q: We’ve known for a long time that many infections—not just COVID-19—can cause enduring and disabling symptoms, like crushing fatigue and brain fog, in some people. Is Long COVID just another example of this?

Michael Sneller: Maybe it’s new, maybe it’s not. There are precedents for this kind of postinfectious, noncritical illness, such as posttreatment Lyme disease. And there are people with chronic fatigue syndrome, some of whom pinpoint the onset of their symptoms to a viral infection. During polio outbreaks in the 1950s, there was another syndrome that developed in people: fatigue, concentration difficulties, aches and pains. I thought early on that given tens of millions of people who were likely going to get infected with COVID, that we would be seeing this.

Emilia Liana Falcone: In terms of fatigue, some of the neurological complications, brain fog, lack of concentration, is common for sure after other infections. That being said, I think there are certain features that are not quite as common that we’re seeing now—the loss of smell and taste I’ve seen in the clinic at least 6 months out. There’s also this new onset of some endocrinopathies, such as thyroid problems. Maybe this happens in the context of other viral infections and we’re not looking for it. But it might be something more distinctive of COVID.

Q: How did you get interested in Long COVID?

E.L.F.: I spent almost 9 years at the National Institutes of Health, where I was looking at long-term inflammatory complications in patients with inborn errors of immunity. It seemed to me highly plausible that given the intense inflammatory processes in the acute phase of COVID-19, there would be long-term effects.

M.S.: About 6 years ago, I was asked to help lead a study of Ebola survivors in West Africa. In the 2014 outbreak, it infected hundreds of thousands of people. Of those who survived, there emerged persistent symptoms such as headaches and joint pain. We enrolled approximately 1000 Ebola survivors and about 2300 Ebola-negative people in Liberia—it was an NIAID-Liberia collaboration. I knew we needed to have a control group, in order to really determine whether any of the things we were seeing were related to Ebola per se, or just life in Africa, which can be hard. I learned a lot that I was able to apply to studying post-COVID syndrome.

Q: Why don’t we yet have a clear definition of Long COVID?

M.S.: A year ago, this didn’t exist. So that’s why.

E.L.F.: A lot of the first studies were based on questionnaires and chart reviews, especially in hospitalized patients. There’s been a lot of describing symptoms. There’s a lack of mechanistic data.

Q: How is your study set up to dig into the biology?

M.S.: We have a COVID group, at least 6 weeks out from the onset of symptoms, of 18 years and older. We’ve enrolled about 150 survivors, and about 55% have no post-COVID symptoms. As was the case with the Ebola study, we knew it was important to have a control group. We ask participants to identify people that they had contact with who didn’t get COVID, and we ask them to join the study. We try to match them for age, and if you do that, you get pretty good matching for other comorbidities, including hypertension, diabetes, obesity, and so forth. We’ve got just about 100 controls now enrolled.

Both groups undergo basically the same evaluations, which include lung function, exercise testing, and heart MRIs. Cortisol and thyroid functions are measured to work out reasons for various things like fatigue. We have an extensive mental health evaluation with neurocognitive testing, psychiatric interviews. And then we have a whole laboratory component, looking at aspects of the immune response, evidence of persistent virus, persistent inflammation. It’s a longitudinal study for 3 years. We see people every 6 months, sometimes sooner.

E.L.F.: This is very similar to our study. We also begin with a slew of questionnaires that include information on diet, well-being, etc. There’s neuropsychiatric or neuropsychological testing by a separate team. We look at every organ system. And then there’s collection and analysis of blood and tissue samples—we have laboratories right upstairs. We also have a team of specialists that we refer to for deeper workups of anyone with an actual organ dysfunction.

Q: You both include control groups of people who have not had COVID-19. Why is that important?

E.L.F.: You need to control for the background noise. We’re in a pandemic, and that is creating anxiety, stress, insomnia, depression. We have to include people who are living that to be able to tease out what is really related to the infection.

M.S.: With the Ebola study, by having a control group, we showed that a lot of symptoms that were thought to be post–Ebola syndrome symptoms actually occurred at the same frequency in the control group.

I can give you two examples from our current study. There are published reports about tinnitus being a post-COVID problem. About 12% of our COVID group complains of tinnitus, and about 14% of the control group has tinnitus. It’s the same thing with finding a mild abnormality in a lung test that measures how well lungs transfer oxygen to the bloodstream. About 50% or 60% of the COVID group has that, with a median age of 50. Had I not had a control group, I’d say, “This is from COVID.” Well, exactly the same percentage of the age-matched, comorbidity-matched control group have the defect. You need a control group to really attribute any abnormality to the viral infection. Without a control group, that’s difficult, if not impossible.

E.L.F.: Exactly.

Q: Might your findings help explain who is susceptible to Long COVID?

M.S.: Potentially. It might give some clues to what might be causing these symptoms. If you had detailed biospecimens from the acute illness phase from the same patients, that would be ideal, but that’s very hard to do. In my cohort, 90% rode COVID-19 out at home. So they’ve got no biospecimens.

E.L.F.: Developing predictive models is very attractive, and people have been interested in that. But the issue is with those patients who are not hospitalized, you just don’t have any samples from before or during the illness to compare to the present.

Q: It’s going to take time for your studies and others to tease this out. Are there ways to help people with Long COVID right now?

E.L.F.: There isn’t a clear treatment pathway. You can treat the obvious reversible issues—someone who’s anemic, someone who’s vitamin D deficient. A lot revolves around rehabilitation, depending on the patient.

Q: What does rehabilitation involve?

E.L.F.: If it’s pulmonary, there are exercises you can do to improve shortness of breath, some of which are related to the exercises opera singers do. We’ve been approached by the Opera House of Montreal to develop a rehab program for patients, because a lot of these exercises work on improving lung function.

M.S.: I find in talking to patients, they’re afraid to exercise because they think they have heart damage or lung damage. I tell them that we’re doing a lot of testing. If we don’t find any evidence of serious damage in the lungs, I encourage them to start gradual exercise. There are a lot of mental health issues, and in the control group, too. There is a lot of room for better mental health evaluation in the community, and treatment.

E.L.F.: The only thing I would add is if you think that the patient has chronic fatigue syndrome, then it’s more of a conservational approach in terms of their energy, rather than forcing an exercise progression.

Q: Do you think that some of these cases are chronic fatigue syndrome?

E.L.F.: I think there’s a subgroup of post-COVID patients where maybe they will fall into that category, but there might be others that have something else.

Q: There have been anecdotal reports about people with Long COVID getting better after vaccination. What do you think of this?

E.L.F.: It’s very provocative it’s intriguing. With the control group, you have to take a careful look. It could just be patients’ natural rate of healing.

M.S.: We asked people to let us know when they are getting vaccine. On a subset, we’re trying to draw blood at certain time points to study B cell and antibody response in both groups after vaccination.

E.L.F.: We, too, are sampling patients after the first dose and the second dose, although here in Quebec, if they’ve had COVID, they only get one dose.

M.S.: As far as symptoms go, the majority of people in my protocol who got vaccinated haven’t said one thing or the other. We’ll just see what happens.

Q: Long COVID is in the news constantly. What do you think about how it’s being described to the general public?

M.S.: There’s a lot of misinformation out there that does not give context. There will be a headline saying psychosis is a new symptom of Long COVID, and it turns out the story is about just one person. My patients, some of them tell me they spend 6, 8 hours a day on social media pages related to Long COVID. I think that’s not always a good thing.

Q: But they might be doing that because they’re not getting the support they need from the health system, right?


HRSA Uninsured Program

Join the collective fight to defeat this pandemic and volunteer to participate in Health Resources & Services Administration (HRSA) Uninsured Program. The HRSA Uninsured Program provides claims reimbursement to health care providers generally at Medicare rates for:

  • Testing uninsured individuals for COVID-19
  • Treating uninsured individuals with a COVID-19 primary diagnosis
  • COVID-19 vaccine administration to the uninsured
  • Delivering the services listed above to uninsured, undocumented immigrants

What services are covered for reimbursement?

  • Specimen collection, diagnostic and antibody testing.
  • Testing-related visits including in the following settings: office, urgent care or emergency room or telehealth.
  • Treatment: office visit (including telehealth), emergency room, inpatient, outpatient/observation, skilled nursing facility, long-term acute care (LTAC), rehabilitation care, home health, durable medical equipment (e.g., oxygen, ventilator), emergency ambulance transportation, non-emergent patient transfers via ambulance, and FDA-licensed, authorized, or approved treatments as they become available for COVID-19 treatment.
  • Administration fees related to FDA-licensed or authorized vaccines.

Services not covered by traditional Medicare will also not be covered under this program. In addition, the following services are excluded: