As he was walking, he ran into his GP, who quickly put an end to his enthusiasm.

To treat inflamed blood vessels in his lungs, Tatelman, 73, takes a drug that suppresses his immune system. His doctor had read recent medical studies that suggested that the vaccine might not work well for some people taking drugs like yours.

The doctor asked him to take a blood test to see if the vaccine had worked, that is, if he had antibodies against the virus.

He was tested and had no detectable antibodies against covid-19.

“It was a total shock,” he said.

Tatelman was now full of questions for her doctor. Did her low antibody levels mean the vaccine hadn’t worked? Should I get a third dose of the vaccine? Should you reduce the medications that suppress your immune system so that the vaccine would have a better chance of working? Was there anything else you could try to make the COVID-19 vaccine work for you?

There is very little data to help Tatelman and his doctor answer these questions. Tens of millions of other Americans are also taking immunosuppressant drugs that could weaken the effect of the COVID-19 vaccine, and they are in uncharted territory, scared – rightly so – by the possibility that their vaccines may not have worked.

If their vaccines didn’t work, they depend on the rest of the population getting vaccinated.

This should inspire unvaccinated people to roll up their sleeves, Dr. Francis Collins, director of the National Institutes of Health, told Citizen Free Press on Thursday.

“Even if you think you don’t need it, think of this as a donation of your own goodwill to those who are most vulnerable,” Collins said. “It is the best hope they have.”

Vaccines are never tested in people with immunodeficiencies

Although there is no clear figure for how many Americans take drugs that could challenge the COVID-19 vaccine, a new study may help to reach an estimate. In an article published last month, Dr. Beth Wallace, a rheumatologist, and her team at the University of Michigan recorded in a database of more than 3 million Americans how many were taking immunosuppressive drugs.

Based on these data, Wallace estimates that about 60 million Americans take immunosuppressants that could interfere with the vaccine.

She mentions that this is a conservative figure, since her database did not include people with Medicare and who might be more likely to take those drugs. His estimate also does not include people taking oral corticosteroids, which could, in large doses and for long periods of time, be a problem for the vaccine.

They test mixed vaccination against covid-19

When pharmaceutical companies tested COVID-19 vaccines in clinical trials last year, they specifically excluded people taking immunosuppressive drugs.

That left those patients “in a bind,” not knowing if vaccines would work for them, said Dr. Kathryn Stephenson, an infectious disease specialist and associate professor at Harvard Medical School.

After the vaccine was made public, researchers began to test whether or not it worked in immunosuppressed people.

Some of the news has been good

A small study conducted at the Icahn Mount Sinai School of Medicine in New York showed that patients taking certain medications to treat ulcerative colitis and Crohn’s disease had ‘robust’ antibody responses to the covid-19 vaccine. 19 from Pfizer and Moderna. The study has been published on a server where drafts of scientific articles are shared before their final publication.

A study by researchers at Johns Hopkins University School of Medicine showed that organ transplant patients did not fare as well. In the study of more than 650 organ recipients, who take drugs to suppress their immune systems to prevent rejection of their new organs, 46% had no antibody response after two doses of Pfizer or Moderna.

In another study, the University of Washington School of Medicine examined patients with conditions such as lupus, psoriasis, and inflammatory bowel disease and found that two types of drugs they took, glucocorticoids and B-cell-lowering agents, lowered “substantially »The ability of the Pfizer and Moderna vaccines to elicit an immune response.

“No one really expected responses to vaccines to be that bad,” said Stephenson, director of the clinical trials unit at the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center, of the studies taken together.

The doctor says that every day, immunosuppressed patients flood her practice with calls and emails asking what to do.

“It has become such a frequently asked question, a topic of anxiety for patients, that last week we had three different meetings and conferences and seminars where it was discussed and tried to come up with strategies on what to say to them,” Stephenson said.

For now, she and her colleagues tell patients that it is not worth checking their antibodies after vaccination, because at this time it is difficult to know exactly what level of antibodies would amount to having protection against COVID-19.

The US Food and Drug Administration (FDA) and the US Centers for Disease Control and Prevention (CDC) also advise against checking levels. of antibodies. Various medical societies, such as the American College of Rheumatology, the American Transplant Society, and the International Organization for the Study of Inflammatory Bowel Disease, essentially say that antibody tests will not fully answer patients’ questions about whether their vaccines have worked.

“For those patients who do not have antibodies or do not produce such a robust antibody response, we do not yet know if they will be protected,” according to a statement from the Leukemia and Lymphoma Society. ‘There are other types of immunity that can provide protection. Immune cells known as T cells may play a role in our immune system’s ability to protect us against COVID-19. ”

The CDC advises against giving additional doses of the vaccine to immunosuppressed people.

But some patients are not listening.

Patients receiving additional doses on their own

Dr. Robert Montgomery is one of them.

Montgomery is director of the NYU Langone Transplant Institute, where he himself received a heart transplant in 2018.

After a test showed that he had had “virtually no response” to two doses of Pfizer’s Covid-19 vaccine, Montgomery said he was “profoundly disappointed” and obtained a dose of Johnson & Johnson’s vaccine.

The doctor claims that receiving a third dose is “uncharted territory,” but he did so because he is exposed to COVID-19 patients, and has seen how immunosuppressed transplant patients like him often become seriously ill when they contract the virus.

He says it worked: After receiving the third dose of the vaccine, his antibodies rose.

Things didn’t turn out so well for Tatelman, the Boston grandmother.

Like Montgomery, he received one dose of the J&J vaccine to supplement his two doses from Pfizer.

A few days ago, she learned that even with that third dose, she still had no detectable antibodies to COVID-19.

“My doctor sent me a note saying, ‘I’m sure you’re disappointed,’ and I told him that ‘disappointed’ doesn’t even come close to how I feel, ‘” Tatelman said. “It was incredibly depressing.”

Looking at the future

The National Institutes of Health (NIH) set out to determine which approaches may work best if the vaccine fails in immunosuppressed people.

«[Vamos a] we have to figure out what we have to do if we want to adequately protect these people, “Dr. Anthony Fauci, director of the NIH’s National Institute of Allergy and Infectious Diseases (NIAID), told Citizen Free Press.

This summer, researchers hope to begin recruiting about 200 vaccinated kidney transplant patients to participate in a study, according to Dr. Daniel Rotrosen, director of the NIAID Division of Allergy, Immunology and Transplantation.

If tests show that the COVID-19 vaccine has not worked as expected, that study participant will be offered an additional dose of the vaccine to see if it helps, Rotrosen added.

Some doctors are skeptical and hope that immunosuppressed patients are given regular doses of an antibody drug currently used to treat COVID-19.

Regeneron, a biotech company that makes the monoclonal antibody against COVID-19, is studying research proposals to prophylactically test its drug in immunosuppressed patients, according to a company spokeswoman.

“We are convinced that this group of patients could benefit from REGEN-COV,” Alexandra Bowie wrote in an email to Citizen Free Press, referring to the company’s drug.

As these studies go into effect, Tatelman feels like he’s never been vaccinated, and has to rely on other people whose vaccines have worked.

You know not to hug your younger grandchildren who are not vaccinated. She has not returned to her work as a volunteer with foster children. Wednesday was her husband’s 75th birthday, and they didn’t go out to a restaurant to celebrate.

Even my closest friends don’t understand why I don’t go to a restaurant with them. They tell me, ‘Of course you can go to a restaurant,’ and I tell them ‘of course not,’ “he said. Where am I safe? Where am I not sure? There are so many things that I don’t know.

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