What to Know About Immunodeficiency and COVID-19 Risk

People who live with primary or secondary immunodeficiency may be concerned about their risks during the pandemic. This includes risks of contracting the coronavirus (SARS-CoV-2) from another person and having a more severe course of COVID-19 (the disease it causes).

If you have one of the more than 400 types of primary immunodeficiency, you may be more likely to have infections than healthy people. Those with secondary immunodeficiency, when the immune system is compromised because of an outside factor, such as a disease or a medication, may also be at increased risk of infections.

Immunodeficiency and COVID-19 Risk

The global community has come together to try to better understand how COVID-19 may affect people who live with immunodeficiency. The risk of complications may be different depending on the type of immunodeficiency.

Primary Immunodeficiency

There are many forms of primary immunodeficiency, and they have different types and degrees of immune suppression. Broadly speaking, the information collected so far has shown that people with these conditions are not at a greater risk of experiencing severe COVID-19.

While it’s not thought that having a primary immunodeficiency is a risk factor for either contracting or having a worse course of COVID-19, it’s important to find out your individual risk. For instance, those who also live with the conditions that are known risk factors for severe COVID-19 may be at a greater risk.

There is some concern that children who are immunocompromised may be at greater risk for infection and disease. The concern is that these patients might not have the same antibody response and be able to fight off the infection as well as adults or healthy people.

However, the International Patient Organisation for Primary Immunodeficiencies acknowledges that more data is needed to understand COVID-19 in people with primary immune deficiency. To understand personal risk, patients are encouraged to speak to their healthcare providers. 

Secondary Immunodeficiency

There are many reasons people may have secondary immunodeficiency. This can include the use of certain medications, cancer (lymphomas and leukemias), treatment with radiation or chemotherapy, malnutrition, alcohol use disorder, and being older.

Those who live with certain types of secondary immune deficiencies may have an increased risk of complications. One study, for instance, showed that people with leukemia or lymphoma might have a worse outcome from COVID-19.

The Centers for Disease Control and Prevention (CDC), however, has defined which conditions put people at an increased risk of severe illness from COVID-19. Included is being in an immunocompromised state (having a weakened immune system) from having had a solid organ transplant.

COVID-19 is a new disease, data is still being collected, and other conditions not listed may also be associated with an increased risk.

The CDC has also listed the conditions for which there “might” be an increased risk for severe illness from COVID-19. These include being in an immunocompromised state (having a weakened immune system) from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune-weakening medications.

In people who are receiving biologic medications that alter the immune system, for the most part there has not been a connection with a severe course of COVID-19. An important factor in limiting risk is keeping underlying conditions well controlled (such as avoiding flare-ups). Speak to your healthcare provider about your individual risk.

Having a fever may be a recurring sign of certain forms of primary or secondary immunodeficiency. For that reason, some people may want to get tested for COVID-19 if they experience a fever or any other signs or symptoms. A negative test result may help in avoiding unnecessary isolation or quarantine for a suspected infection.

Patients should ask their healthcare providers to determine if their disease or condition, or the medication they take to manage a disease, suppresses the immune system.

One small study showed that people with primary immunodeficiency and those with secondary immune deficiency who were having symptoms might fare worse with COVID-19. However, more data is needed, and the risk will depend greatly on the reason for the immune deficiency.

Immunodeficiency Treatments and COVID-19

It’s recommended that patients who live with primary and secondary immunodeficiency continue taking their regular treatments unless their healthcare providers give instructions to make a change. This includes those patients who:

• Are being treated for cancer
• Are receiving immunosuppressive or immunomodulatory therapy
• Have complications involving their heart or lungs
• Have received a solid organ transplant
• Have organ damage
• Have received stem cell or gene therapy

Patients may be concerned about certain treatments for primary immunodeficiency. Immunoglobulin (Ig) replacement therapy does not give any protection against COVID-19.

Plasma-derived medicinal products (PDMPs), including intravenous immunoglobulin (IVIG) or subcutaneous immunoglobulin (SCIG), are considered safe, and patients should continue their treatments unless their healthcare provider says to make a change.

If you are thought to be at higher risk from COVID-19 because you have other risk factors, your healthcare providers might give special instructions. This could mean changing medications or dosages. It could also include being more strict with physical distancing and other ways of preventing infection, such as hand hygiene and mask wearing. 

Frequently Asked Questions

Should people with primary and secondary immunodeficiency get a COVID-19 vaccine?

The Centers for Disease Control and Prevention (CDC) currently recommends COVID-19 vaccination for everyone 6 months and older, including those with weakened immune systems.

In fact, it's recommended that moderately to severely immunocompromised persons receive additional doses of the COVID-19 vaccine as part of their primary series. A second booster shot may also be recommended.

People that have any reason to think that they may have an allergic reaction to a COVID-19 vaccine should talk to their allergist or immunologist. It may be recommended that some people get vaccinated at a healthcare provider’s office or hospital to be cautious.

Which people with immune deficiency might be more at risk of a severe case of COVID-19?

People with a primary immune deficiency should talk to their healthcare provider about their own risk. Who might be more likely to get infected with COVID-19 or have severe disease isn’t yet understood.

The CDC has included an immunocompromised state (having a weakened immune system) from solid organ transplant as being at risk of more severe disease from COVID-19.

Conditions that may be associated with increased risk for severe illness from COVID-19 include being in an immunocompromised state from blood or bone marrow transplant, immune deficiencies, HIV, and use of corticosteroids or other immune-weakening medicines.

There is a concern that those who have lung or respiratory complications may be at higher risk. People who have those or other complications that are known to be at greater risk should be cautious to avoid infection.

Should treatments be spaced out from getting a COVID-19 vaccine?

For most treatments, it’s not thought that there is a reason to space them out either before or after vaccination. People should talk to their healthcare providers about their specific medications.

In most cases, the best course of action is to get vaccinated when eligible with the vaccine that is available. However, those who have other risk factors or who have concerns about vaccination should ask their healthcare provider and/or receive the vaccine in a medical setting (such as a hospital or clinic).

Is it safe for people with immune deficiencies to get any type of vaccine?

The four vaccines approved or authorized for emergency use in the United States (manufactured by Pfizer, Moderna, Johnson & Johnson, and Novavax) are not live vaccines and are considered safe for use in those who are immunocompromised.

Currently, the Pfizer, Moderna, or Novavax COVID-19 are recommended over the J&J COVID-19 vaccine. The CDC recommends the J&J COVID-19 vaccine only be considered in some situations. Live vaccines may be contraindicated in people with immune suppression.

How to Stay Safe

Some people who live with immunodeficiency already take many precautions to avoid infections. The general advice given for avoiding COVID-19 is helpful, along with a few additions:

• Avoid close contact with people who don’t live in the same household.
• Avoid contact with others (handshakes, kisses, hugs).
• If impossible to avoid a person who may have a respiratory infection, ask them to cover their coughs and sneezes and wash their hands frequently.
• Use alcohol-based hand sanitizer if soap/water is not available.
• Wash hands frequently (every hour if needed).
• Wear a mask that covers the nose and mouth.

A Word From Verywell

The COVID-19 pandemic has been stressful for people who are immunocompromised. While there is much more information still needed, experts can make suggestions based on what’s now known. For most people, continuing to treat their condition with their regular medications during the pandemic is recommended.

People who live with complex medical conditions should continue to be cautious about avoiding infection and stay updated about the risk in their local area. If there is an infection, contact healthcare providers right away to get instructions and care.

The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit our coronavirus news page.