Can Immunocompromised People Safely Receive the COVID-19 Vaccine?

Immunocompromised people are at higher risk of severe COVID-19, including hospitalization and death.

The CDC currently recommends COVID-19 vaccines for immunocompromised people. In the United States, available vaccines include the mRNA vaccines made by Pfizer-BioNTech and Moderna and the Johnson & Johnson viral vector vaccine.

There has been significant research into the effectiveness of COVID-19 vaccines in immunocompromised people. Although the immune response in an immunocompromised patient may not be as robust as in someone who is not immunocompromised, the available vaccines still offer protection.

This article looks at the effectiveness of COVID-19 vaccines for immunocompromised people, and the CDC's current recommendations for this group.

Are You Immunocompromised?

People who are immunocompromised have weakened immune systems. According to the Centers for Disease Control and Prevention (CDC), this includes:

• People living with HIV/AIDs
• Transplant recipients
• People who are being treated for cancer
• People who have diseases that affect their immune system
  

People who have weakened immune systems may not respond as well to the COVID-19 vaccine.

Vaccine Type Matters

There are different types of vaccine available for different diseases. Immunocompromised people generally need to be careful about which type they receive.

Peter Gulick, MD is an associate professor of medicine at Michigan State University. He tells Verywell that most vaccines are either inactivated or attenuated.

An inactivated vaccine uses the killed version of the germ that causes a disease. Examples of inactivated vaccines include hepatitis A, flu, polio, and rabies. Because the immune response triggered by an inactivated vaccine isn't usually as strong as those triggered by attenuated vaccines, they are usually administered in doses.

The COVID-19 Pfizer and Moderna vaccines are neither attenuated or inactivated. They are mRNA vaccines. These vaccines teach your cells to make a protein or piece of a protein that triggers an immune response and results in the production of antibodies. The antibodies help protect you from COVID-19.

“A vaccine that’s not live is usually a component that triggers your body to create a memory for that specific virus and then create antibodies, versus a live vaccine which has a low concentration of the actual virus itself” Navya Mysore, MDCM, CCFP tells Verywell. Mysore is a New York-based family physician and medical director for the Tribeca office of One Medical. 

“These COVID vaccines are not live vaccines," Gulik says. "And so, a patient that is immunocompromised—no matter what degree of compromise—could take the vaccine."

The Johnson & Johnson COVID-19 vaccine is a viral vector vaccine. It uses an inactivated common cold virus called an adenovirus as a vector or delivery method. The Johnson & Johnson vaccine is also a recombinant vaccine. This means it uses a small piece of the virus's genetic material to trigger an immune response. These vaccines are usually safe for immunocompromised people.

COVID-19 Vaccine Recommendations For the Immunocompromised

The CDC currently recommends three primary doses of an mRNA vaccine for immunocompromised people ages 12 and up, followed by a booster shot given at least three months after the third dose. Immunocompromised children between the ages of 5 and 11 should also receive three primary doses of the vaccine. Boosters aren't recommended in this group at this time.

Adults aged 18 and up can get either the Pfizer vaccine or the Moderna vaccine. The Pfizer vaccine is the only one currently approved for use in children.

At this time, the CDC doesn't recommend the Johnson & Johnson vaccine except in certain circumstances. This is because there is a higher risk of adverse reactions with this vaccine. The Johnson & Johnson vaccine may be a better choice if:

• If you've had a severe reaction to one of the mRNA vaccines
• If you're allergic to any ingredient in the mRNA vaccines
• If you do not have access to an mRNA vaccine
• If you understand the risks but have a personal preference for the Johnson & Johnson vaccine

If you received the Johnson & Johnson vaccine as your primary COVID-19 vaccine, you can choose to get an mRNA vaccine as a booster.

Weaker Immune Response

Studies have shown that COVID-19 vaccine effectiveness tends to be lower in immunocompromised people than it is in the general population. However, vaccination does still provide good protection. A 2022 review found that vaccines in immunocompromised people were still 63% to 100% effective at preventing hospitalization, compared to 81% to 92% in the general population.

It is important to note, though, that vaccine effectiveness may vary depending on how immunosuppressed the recipient is. 

Research shows that people with HIV who have lower T-cell counts don't respond as well to the vaccine as people with higher T-cell counts. For these patients, the timing of the vaccine can optimize its efficacy.

“I want to not delay it, but try to optimize their immune systems so they can get a good response,” Gulick says. Gulick waits for his patients who are HIV positive to have a T-cell count above 200 before recommending they get the vaccine. “With my HIV patients, I try to get their T-cells up to at least above 200 and as high as I can before I give them any vaccines,” Gulick says. “If their T-cells are low, they may not get the response I want them to get.” 

This is one of the reasons social distancing and mask-wearing are still important, especially in areas that have medium to high levels of COVID-19. These "community levels" are based on variables like hospital admissions and the number of new cases in the area.

If you are immunocompromised and your community level is medium, talk to your healthcare provider about masking and social distancing. In areas where the community level is high, extra precautions are warranted for immunocompromised people regardless of vaccination status.

“Because such patients have the potential for reduced immune responses, they must continue to follow all current guidance to protect themselves against COVID-19, even after vaccination,” Sri Banerjee, MD, PhD, MPH, tells Verywell. Banerjee is an epidemiologist and core faculty in Walden University’s School of Health Sciences. 

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.