Immunocompromise

Many people take medication that suppresses their immune system, including for the treatment of cancer, severe asthma, auto immune diseases, or following organ transplantation. Others have medical conditions that can affect the immune system, such as HIV infection, kidney failure, those with pre-existing heart conditions including (non-acute) rheumatic heart disease, congenital heart disease or a history of Kawasaki disease. People with nervous system disabilities (like cerebral palsy) and diabetes (type 1 or type 2) are also recommended to have their COVID-19vaccinations.

These conditions put people at increased risk from COVID-19,and although they may not respond as strongly to the vaccine as someone with a fully functioning immune system, it is safe for them to receive the COVID-19 vaccine and it will provide some protection against COVID-19, particularly against severe, life-threatening infection.

It is important and safe for those receiving active treatment with immunosuppressive medications to have the COVID-19 vaccine. It is important that the optimal timing for vaccination is discussed with specialist before the vaccine appointment. Ideally, vaccination should be conducted prior to any planned immunosuppression.

For information about cancer care and COVID-19 vaccine see Te Aho o Te Kahu (Cancer Control Agency) information here.

For information about COVID-19 vaccination and treatments for autoimmune disease from Arthritis New Zealand, see video here.

This video features Blues rugby player Matt Johnson sharing his story about rheumatic fever and his choice to be vaccinated against COVID-19.

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Three-dose primary course in immunocompromise

Comirnaty 30mcg XBB.1.5 is a single dose primary course. Two additional doses are recommended for those with severe immunocompromise, at eight-week intervals. A prescription is required for any Comirnaty 30mcg XBB.1.5 dose given with less than three months spacing between a previous one.

For those aged 5-11 years who were severely immunocompromised in proximity to their first or second primary doses, a third dose of Comirnaty is recommended as part of their primary course eight weeks after their second dose. For this age group, a prescription and written consent are needed for the third primary dose. For further details, see the Immunisation Handbook 2020 Chapter 5 (section 5.5.8)‍

Preferably, the third dose should be administered at least eight weeks after the second dose. However, the timing also needs to consider current or planned immunosuppressive therapies.

If there are current or planned immunosuppressive therapies, aim to delay the third dose of vaccine until two weeks after the period of immunosuppression, in addition to the time period for clearance of the therapeutic agent.

The eligibility criteria to get a third primary dose is complex. It only applies to people who are severely immunocompromised. See Table 5.3 of the Immunisation Handbook 2020. This list is not exhaustive but provides guidance on scenarios where three primary doses are recommended. There is variation between individuals in response to immunosuppressive or immunomodulating therapy. Clinicians may use their judgement for conditions or medications that are not listed here that are associated with severe immunocompromise.

If an alternative to Comirnaty is required or requested, the second line COVID-19 vaccine Nuvaxovid can be given as a third primary dose to those aged 18 years or older. This also requires a prescription and written consent.

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Evusheld

Evusheld is a pre-exposure prophylaxis (PrEP) therapeutic treatment containing two long-acting monoclonal antibodies (tixagevimab and cilgavimab). It was indicated for protection of highly immunocompromised people but is now not recommended as it does not provide adequate protection against most of the currently circulating SARS-CoV-2 variants.

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