Individuals who are immunocompromised demonstrated low adherence to the Centers for Disease Control and Prevention’s (CDC’s) recommendations for continued COVID-19 booster doses, according to study findings published in JAMA Network Open.
The risk for severe COVID-19 is higher among immunocompromised individuals compared with the general population. Furthermore, immunocompromised patients tent to have a weaker immune response to vaccines and even experience a higher rate of vaccine failure compared with healthy individuals. The US Centers for Disease Control and Prevention currently recommends immunocompromised individuals to receive additional doses of the COVID-19 vaccine, specifically, a a fifth dose or a second booster of the vaccine.
To assess mRNA COVID-19 vaccine uptake and factors associated with this uptake among immunocompromised individuals aged 18 years or older, researchers in the United States conducted a regional cohort study within a large integrated health care system, Kaiser Permanente Southern California (KPSC), from December 14, 2020 to August 6, 2022.
They identified 42,697 immunocompromised individuals who fit the eligibility criteria for the study (47% women; 44% aged 65 years or older; 41.9% White, 33.5% Hispanic, 12.1, Black, 10.1% Asian/Pacific Islander). By the end of the follow-up period and after adjusting for disenrollment from KPSC health plans and death of study participants, approximately 78% of immunocompromised participants had received 3 doses of mRNA vaccines, 41% 4 doses, and only 0.9% 5 doses.
Immunocompromised individuals aged 65 years or older were more likely to have received 4 doses of mRNA vaccines (hazard ratio [HR], 3.95; 95% CI, 3.70-4.22) compared with individuals aged 18-64 years (HR, 2.52; 95% CI, 2.36-2.69).
The researchers found that those less likely to receive at least 4 doses of mRNA COVID vaccines included:
- Individuals who were Hispanic (HR, 0.77; 95% CI, 0.74-0.80) and Black (HR, 0.82; 95% CI, 0.78-0.87) compared with those who were White.
- Individuals receiving high-dose corticosteroids (HR, 0.88; 95% CI, 0.81-0.95) compared with those who were not.
- Individuals previously infected with COVID-19 (HR, 0.71; 95% CI, 0.62-0.81) compared with those who were uninfected.
The researchers’ findings highlight the gap that exists regarding adherence to CDC recommendations for mRNA monovalent COVID-19 booster doses among the immunocompromised population.
They concluded, “Given the vulnerability of this population to develop severe COVID-19, a renewed focus on targeted and tailored efforts to ensure that immunocompromised individuals remain up to date with continuously evolving COVID-19 booster dose recommendations are warranted at this stage of the pandemic.”
Study limitations included possible misclassification or misdiagnosis of immunocompromised individuals, limitations within electronic medical records in documenting vaccine uptake and factors influencing uptake, and lack of a sufficient sample sizes to conduct analyses based of type of immunocompromising condition.
Disclosures: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see original source for full list of disclosures.
Tartof SY, Slezak JM, Puzniak L, et al. Analysis of mRNA COVID-19 vaccine uptake among immunocompromised individuals in a large US health system. JAMA Netw Open. Published online January 20, 2023. doi:10.1001/jamanetworkopen.2022.51833