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3% Of Americans Take Drugs That May Affect COVID-19 Vaccine Response

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About 3% of adults are immunosuppressed from medications.

Key Takeaways

  • Nearly 3% of Americans under 65 take medications that suppress their immune system.
  • Immunosuppression may impact the COVID-19 vaccine's response in your body.
  • Experts say it's still important to get vaccinated against COVID-19, even if you're immunocompromised.

A new study finds that nearly 3% of American adults under 65 take medications that weaken their immune system. Health officials warn that being immunocompromised may lower the effectiveness of the COVID-19 vaccine.

The May study, which was published in JAMA Network Open, analyzed patient data from more than 3 million people with private insurance. The researchers specifically looked for immunosuppressive medications, including chemotherapy medications and steroids like prednisone.

The data shows that nearly 90,000 people took medications that made them immunosuppressed. Two-thirds of those patients took an oral steroid medication at least once, and more than 40% took steroids for more than 30 days in a year. These medications can potentially decrease vaccine effectiveness while increasing an individual's risk for severe COVID-19.

Lead study author Beth Wallace, MD, a rheumatologist at Michigan Medicine, tells Verywell that she and her colleagues started their research during the second wave of the pandemic “when researchers were just beginning to realize that people taking certain immunosuppressive medications might be at higher risk of severe illness from COVID.”

“Our team realized that there was very little data out there about exactly who was taking these medications, and what they were taking them for,” she says. Wallace says her team noted as they were writing the study that people taking immunosuppressive medications may also have a “slower, weaker response” to the COVID-19 vaccine.

“This wasn’t on our radar yet when we wrote the manuscript because at that time the COVID vaccines were not available to the public yet,” she says. “But now, this question of how many people are on immunosuppressive drugs has new relevance, because we’re learning more and more about how those drugs might affect vaccine response in this population.”

Official Health Guidance

People who are immunocompromised are at higher risk of severe complications from COVID-19. That includes people with certain health conditions, like cancer and diabetes, along with those who use corticosteroids or other immune-weakening medicines.

Researchers have also found that SARS-CoV-2, the virus that causes COVID-19, can even survive longer in people who are immunosuppressed because their immune systems generate a weaker response to the virus.

The Centers for Disease Control and Prevention (CDC) specifically recommends that people who are immunocompromised get vaccinated against COVID-19. However, the CDC also says that they may not be fully protected from COVID-19, even if they are fully vaccinated. As a result, the organization recommends that people who are immunocompromised continue to take extra precautions, like masking even after vaccination.

What This Means For You

If you're considered immunocompromised because of a health condition or medication you take, you should still get vaccinated. But even after being fully vaccinated experts recommend you keep taking some COVID-19 safety precautions. Some experts recommend you continue to wear a mask around others in public.

COVID Vaccine Less Effective In Immunocompromised People

Most research on the effectiveness of the COVID-19 vaccine on people who are immunosuppressed focuses on organ transplant patients.

One study analyzed data from 658 organ transplant patients who received two doses of a COVID-19 mRNA vaccine. The researchers found that only 15% of the patients developed antibodies to the virus after the first vaccine. After the second dose of the vaccine, 54% of the patients had antibodies.

“Immunosuppressive drugs work by reducing the ability of your immune system to recognize and fight off things that it perceives to be threats,” Wallace says. “This is why these drugs work to treat conditions like rheumatoid arthritis, which happen because the immune system mistakenly perceives parts of the patient’s body, like the joints, to be a threat.”

But immunosuppression “also reduces the immune system’s ability to mount a response to things you want it to respond to, like infections and vaccines,” Wallace says. They aren't all equal, though. “Some immunosuppressive drugs have a bigger effect on vaccine response than others do, but most of them seem to affect this response to some degree,” she says.

However, there is still a lot to be learned about the effectiveness of the COVID-19 vaccine on people who are immunosuppressed.

“When people discuss immunosuppression and response to vaccines, it is really critical that it be integrated with clinical data,” infectious disease expert Amesh A. Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security, tells Verywell. “While immune response might be blunted to a vaccine, it has to be assessed whether that translates into an increased risk for breakthrough infection or a more rapid waning of protection from symptomatic disease.”

Research so far has focused on antibody response, which is only one part of the body’s immune response, Adalja says.

Wallace points out that there is no official set of recommendations on which precautions immunosuppressed people should take to protect themselves from COVID-19. “Researchers are working to understand how different immunosuppressive drugs affect a person’s response to the COVID vaccine, and how to make sure this cohort gets the most protection possible from the shot,” she says.

That may include a booster vaccine at some point, Adalja says. However, more research needs to be done.

“For now, everyone agrees that people taking immunosuppressive drugs should get the COVID vaccine,” Wallace says. “But until we have more data, people on these medications should make an individual decision with their doctor about what precautions to take afterward."

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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  1. Wallace BI, Kenney B, Malani PN, Clauw DJ, Nallamothu BK, Waljee AK. Prevalence of immunosuppressive drug use among commercially insured US adults, 2018-2019JAMA Netw Open. 2021 May 3;4(5):e214920. doi:10.1001/jamanetworkopen.2021.4920

  2. Centers for Disease Control and Prevention. People with certain medical conditions. Updated May 13, 2021.

  3. Abbasi J. Researchers tie severe immunosuppression to chronic covid-19 and virus variantsJAMA. 2021;325(20):2033-2035. doi:10.1001/jama.2021.7212.

  4. Centers for Disease Control and Prevention. When you’ve been fully vaccinated. Updated May 16, 2021.

  5. Boyarsky BJ, Werbel WA, Avery RK, et al. Antibody response to 2-dose SARS-CoV-2 mRNA vaccine series in solid organ transplant recipientsJAMA. Published online May 5, 2021. doi:10.1001/jama.2021.7489