Tag: immune

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Research Particulars How Delta Variant Dodges Immune System

Study Details How Delta Variant Dodges Immune System

The delta variant of the coronavirus can evade antibodies that target specific parts of the virus, according to a new study published in Nature on Thursday. The results provide an explanation for the reduced effectiveness of the vaccines against Delta compared to other variants.

The variant first identified in India is believed to be about 60 percent more contagious than Alpha, the version of the virus that hit Britain and much of Europe earlier this year, and perhaps twice as contagious as the original coronavirus. The delta variant is now causing outbreaks among unvaccinated populations in countries like Malaysia, Portugal, Indonesia and Australia.

Delta is now also the dominant variant in the USA. Infections in the country have been at their lowest level since the pandemic began, although the numbers may rise. Still, hospital admissions and deaths related to the virus remain steep. That’s partly because of the relatively high vaccination rates: 48 percent of Americans are fully vaccinated and 55 percent have received at least one dose.

But the new study found that Delta was barely sensitive to a dose of the vaccine, confirming previous research suggesting the variant can partially bypass the immune system – albeit to a lesser extent than Beta, the variant first identified in South Africa.

French researchers tested how well antibodies produced by natural infections and by coronavirus vaccines neutralize the alpha, beta and delta variants, as well as a reference variant that is similar to the original version of the virus.

The researchers examined blood samples from 103 people infected with the coronavirus. Delta was much less sensitive than Alpha to samples from unvaccinated individuals in this group, the study found.

One dose of vaccine increased sensitivity significantly, suggesting that people who have recovered from Covid-19 may still need to be vaccinated to fight off some variants.

The team also analyzed samples from 59 people after receiving the first and second doses of the AstraZeneca or Pfizer-BioNTech vaccines.

Blood samples from just 10 percent of those immunized with a dose of the AstraZeneca or Pfizer-BioNTech vaccines were able to neutralize the Delta and Beta variants in laboratory tests. But a second dose increased that number to 95 percent. There was not much difference in the levels of antibodies produced by the two vaccines.

“A single dose of Pfizer or AstraZeneca was either poorly effective or not effective at all against beta and delta variants,” the researchers concluded. Data from Israel and the UK broadly support this finding, although these studies suggest that one dose of vaccine is still enough to prevent hospitalization or death from the virus.

According to the new study, the Delta variant also did not react to Bamlanivimab, the monoclonal antibody from Eli Lilly. Fortunately, three other monoclonal antibodies tested in the study retained their effectiveness against the variant.

In April, the US Food and Drug Administration revoked the emergency approval for the treatment of Covid-19 patients as a single treatment, citing the increase in variants resistant to bamlanivimab.

Separately, Pfizer announced Thursday that it is developing a version of its vaccine that targets the Delta variant and is expected to begin clinical trials in August.

The company also reported promising results from studies of people who received a third dose of the original vaccine. A booster given six months after the second dose increases the effectiveness of the antibodies against the original virus and beta variant by five to ten times, the company said in a press release.

Antibody levels could drop six months after immunization, Pfizer said, and booster doses may be needed to fight off variants. But antibodies aren’t the only part of the body’s immune response, and other studies have shown that the immunity induced by full vaccination is likely to remain robust against variants for years to come.

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Ought to Folks With Immune Issues Get Third Vaccine Doses?

Should People With Immune Problems Get Third Vaccine Doses?

When it came to coronavirus vaccination, the third time was the charm for Esther Jones, a dialysis nurse in rural Oregon. After two doses of the Pfizer-BioNTech vaccine failed to jolt her immune system into producing antibodies, she sought out a third, this time the Moderna shot.

It worked. Blood tests revealed a reasonable antibody response, although lower than what would be detected in healthy people. She received a fourth dose last month in hopes of boosting the levels even more.

Ms. Jones, 45, had a kidney transplant in 2010. To prevent rejection of the organ, she has taken drugs that suppress the immune response ever since. She expected to have trouble responding to a coronavirus vaccine, and enrolled in one of the few studies so far to test the utility of a third dose in people with weak immune systems.

Since April, health care providers in France have routinely given a third dose of a two-dose vaccine to people with certain immune conditions. The number of organ transplant recipients who had antibodies increased to 68 percent four weeks after the third dose from 40 percent after the second dose, one team of French researchers recently reported.

The study in which Ms. Jones enrolled has turned up similar results in 30 organ transplant recipients who procured third doses on their own.

Being vulnerable to infection even after inoculation is “very scary and frustrating” for immunocompromised people, said Dr. Dorry Segev, a transplant surgeon at Johns Hopkins University who led the study. “They have to continue to act unvaccinated until we figure out a way to give them better immunity.”

But in the United States, there is no concerted effort by federal agencies or vaccine manufacturers to test this approach, leaving people with low immunity with more questions than answers. The Centers for Disease Control and Prevention, the Food and Drug Administration and the National Institutes of Health in fact recommend even against testing to find out who is protected. And academic scientists are stymied by the rules that limit access to the vaccines.

“There should be already a national study looking at post-transplant patients getting booster shots,” said Dr. Balazs Halmos, an oncologist at the Montefiore Medical Center in the Bronx, who led a study showing that some cancer patients did not respond to the vaccines. “It shouldn’t be our little team here in the Bronx trying to figure this out.”

An estimated 5 percent of the population is considered to be immunocompromised. The list of causes is long: some cancers, organ transplants, chronic liver disease, kidney failure and dialysis, and drugs like Rituxan, steroids and methotrexate, which are taken by roughly 5 million people for disorders from rheumatoid arthritis and psoriasis to some forms of cancer.

“These are the people being left behind,” said Dr. Jose U. Scher, a rheumatologist at NYU Langone Health who led a study of methotrexate’s effect on the vaccines.

Not everyone who has one of these risk factors is affected. But without more research, it’s impossible to know who might need extra doses of the vaccines, and how many. Besides the risk of Covid-19, there is also evidence that low immunity may allow the virus to continue to replicate in the body for long periods, potentially leading to new variants.

An infusion of monoclonal antibodies may help some people who don’t produce antibodies on their own — but again, the idea is not being thoroughly explored, said John Moore, a virologist at Weill Cornell Medicine in New York.

Use of monoclonal antibodies “makes great sense for this group of people, so I would like to see the companies be more active in this area,” he said. “Government support or pressure would also help.”

Updated 

July 4, 2021, 4:20 p.m. ET

The third-dose approach has widespread support among researchers because there is clear precedent. Immunocompromised people are given booster doses of vaccines for hepatitis B and influenza, for example. And discontinuing methotrexate after getting a flu vaccine is known to improve the vaccine’s potency — evidence that compelled the American College of Rheumatology to recommend pausing methotrexate use for one week before being immunized against the coronavirus.

Several studies have indicated that a third coronavirus vaccine dose might succeed in patients who did not have detectable antibodies after the first or second dose. But research has lagged.

Moderna is gearing up to test a third dose in 120 organ transplant recipients, and Pfizer — which produces some immunosuppressant medications — is planning a study of 180 adults and 180 children with an immune condition.

The companies turned down at least two independent teams who hoped to study the effects of a third dose.

The N.I.H. is recruiting 400 immunocompromised people for a trial that would track their levels of antibodies and immune cells for up to 24 months — but has no trials looking at a third dose.

“It takes time, unfortunately, especially as a government agency,” said Emily Ricotta, an epidemiologist at the National Institute of Allergy and Infectious Diseases. “We have to go through a lot of regulatory and approval processes to do these sorts of projects.”

But that explanation does not satisfy some researchers. Many medical centers already have groups of patients who did not respond to the vaccines, so federal agencies could organize a clinical trial without too much difficulty, Dr. Scher noted. “It’s a very simple study,” he said. “There’s no rocket science here.”

Earlier studies suggested that many people with cancer would not respond to the vaccines, but those analyses were done after the patients had received a single dose. A new study published this month by Dr. Halmos of Montefiore Medical Center and his colleagues laid some of those fears to rest. The vaccines seem to work well in patients with a wide range of solid and liquid tumors, according to the large analysis.

But 15 percent of those who had blood cancers and 30 percent of those who took drugs that suppress the immune system had no detectable antibodies after the second dose. Dr. Halmos said he and his colleagues were eager to test whether a third dose could benefit those individuals, but have not yet been able to gain access to the vaccines.

Dr. Segev’s team found in an earlier study that less than half of 658 organ transplant recipients had measurable antibodies after both doses of an mRNA vaccine made by Pfizer-BioNTech or Moderna. But to follow up on the finding, they had to resort to recruiting volunteers like Ms. Jones who had obtained third doses on their own.

The scientists found that a third dose amped up antibody levels in all 30 organ transplant recipients who had low or undetectable levels of antibodies.

Ms. Jones said many people like her felt they had been abandoned by the federal government — especially with the threat of more contagious variants circulating in the United States.

Some members of a Facebook group for immunocompromised people desperate for protection have gotten a third dose at mass vaccination sites where providers don’t check records, or have even crossed state lines, she said. Even so, most continue to wear masks to protect themselves — and have sometimes had to endure harassment as a result.

“It really saddens me that so many people in this world have made masking like, this super political thing when it should never have been,” she said. “It makes it so it’s harder for us to take care of ourselves.”

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Moderna says vaccine generates promising immune response in opposition to variants

Moderna says vaccine generates promising immune response against variants

A doctor draws a syringe of Moderna’s vaccine.

Oliver Berg | Image Alliance | Getty Images

A booster of Moderna’s Covid-19 vaccine triggered a promising immune response against variants B.1.351 and P.1, which were first identified in South Africa and Brazil, respectively, the company announced on Wednesday, citing early data from an ongoing clinical study.

In the study, Moderna is testing a 50 microgram dose of its vaccine in previously vaccinated people. The booster dose was found to increase neutralizing antibody responses against the original virus, as well as against B.1.351 and P.1, two variants that have since spread to other countries, including the United States

The company also said that a booster shot of its other vaccine, which it calls mRNA-1273.351, produced an even better immune response over its current vaccine against the B.1.351 variant from South Africa. The new vaccine is a variant-specific booster shot that targets B.1.351.

The preliminary results, which Moderna says will be published online, have not yet been peer-reviewed.

“As we seek to defeat the ongoing pandemic, we continue to seek to be proactive as the virus evolves,” said Stephane Bancel, CEO of Moderna, in a press release. “We are encouraged by this new data, which increases our confidence that our booster strategy should protect against these newly discovered variants.”

According to Moderna, the side effects were similar to those seen after the second dose of the vaccine in the previously reported studies. Side effects included injection site pain, fatigue and headache, and muscle and joint pain.

The new data comes as drug makers and scientists now say people will likely need a booster shot of Covid-19 vaccines and possibly additional shots each year, just like they did with seasonal flu.

Moderna’s vaccine requires two doses four weeks apart. As with Pfizer and Johnson & Johnson, the shot against Covid is very effective, although company executives and officials now say they expect this strong protection to wear off over time. Pfizer’s vaccine is also a two-dose therapy, while the J&J immunization is just one burst.

The Chief Medical Officer of the White House, Dr. Anthony Fauci, previously said that Americans may need booster vaccinations to better protect themselves from variants.

Earlier Wednesday, US health officials said highly contagious variants are still a “wild card” in their nationwide campaign to vaccinate most American adults by July 4th.

A report by the Centers for Disease Control and Prevention published on Wednesday predicted that Covid-19 cases will increase until May due to the highly contagious variant B.1.1.7 first identified in the UK, before declining sharply by July, because vaccinations reduce infections. Still, variants threaten to reverse the nation’s progress, officials said,

“We are seeing that our current vaccines protect against the pollutants circulating in the country. Put simply, the sooner more people are vaccinated, the sooner we will all get back to normal,” said CDC Director Dr. Rochelle Walensky during a Covid press conference at the White House.

Moderna is evaluating three approaches to increasing immunity. The first approach would use variant-specific booster vaccinations such as mRNA-1273.351, but at a lower dose than the original vaccine. The second would combine the original vaccine with a variant-specific vaccine into a single shot at 50 micrograms or less, Moderna said. The third would test a third shot of the original vaccine at a lower dose.

Bancel told CNBC last month that the company is hoping to have a booster shot for its two-dose vaccine in the fall.

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Vaccines Received’t Defend Thousands and thousands of Sufferers With Weakened Immune Programs

Vaccines Won’t Protect Millions of Patients With Crippled Immune Systems

Dr. Andrew Wollowitz has been at the monastery for the most part at his Mamaroneck, NY home for more than a year

As medical director for emergency medicine at Montefiore Medical Center in the Bronx, 63-year-old Dr. Wollowitz eager to treat patients when the coronavirus raged in town last spring. However, cancer treatment in 2019 had wiped out his immune cells, leaving him defenseless against the virus. Instead, he arranged for his employees to be managed through Zoom.

A year later, people return to Dr. Wollowitz’s life returned to a semblance of normalcy. His wife, dancer and choreographer, is preparing to work for the Austrian National Ballet Company. His vaccinated friends meet, but he only sees them when the weather is nice enough to sit in his back yard. “I spend very little time in public areas,” he said.

Like his friends, Dr. Wollowitz vaccinated in January. But he wasn’t producing antibodies in response – and he hadn’t expected it either. He is one of millions of Americans with weakened immune systems whose bodies cannot learn to use immune fighters against the virus.

Some immunocompromised people were born with missing or faulty immune systems, while others, like Dr. Wollowitz, have illnesses or have received therapies that wipe out their immune defenses. Many of them make little to no antibodies in response to a vaccine or infection, which makes them susceptible to the virus. If infected, they can suffer from prolonged illness, with a death rate of up to 55 percent.

Most people who have lived with immunodeficiency for a long time are probably aware of their vulnerability. However, others have no idea that drugs could put them at risk.

“They’ll be walking around outside thinking they’re protected – but maybe not,” said Dr. Lee Greenberger, scientific director of the Leukemia Lymphoma Society, which funds research into blood cancer.

The only recourse for these patients – other than housing until the virus is withdrawn – may be to regularly infuse monoclonal antibodies, which are mass-produced copies of antibodies obtained from people who have contracted Covid-19 have recovered. The Food and Drug Administration has approved several monoclonal antibody treatments for Covid-19, but some are now also being tested to prevent infection.

Convalescent plasma or gamma globulin – antibodies distilled from the blood of healthy donors – can also help immunocompromised people, although a version of the latter that contains antibodies to the coronavirus is still months away from being available.

“It is a clear area where the need cannot be met,” said Hala Mirza, a spokeswoman for Regeneron, who made their monoclonal antibody cocktail available to a handful of immunocompromised patients through a compassionate application program. (Regeneron released experimental results this week showing the cocktail reduced symptomatic infections by 81 percent in people with normal immune systems.)

It is unclear how many immunocompromised people do not respond to coronavirus vaccines. But the list seems to include at least blood cancer survivors, organ transplant recipients, and anyone taking the widely available drug Rituxan or the cancer drugs Gazyva or Imbruvica – all of which kill or block B cells, the immune cells that develop antibodies – or Remicade, a popular one Drug used to treat inflammatory bowel disease. It can also include some people over the age of 80 whose immune responses have stalled with age.

“We are extremely concerned and interested in finding out how we can help these particular patients,” said Dr. Elad Sharon, an immunotherapy expert at the National Cancer Institute.

As the pandemic spread, doctors who specialized in treating blood cancer or caring for immunocompromised people expected at least some of their patients to encounter difficulties. Dr. Charlotte Cunningham-Rundles, an immunologist at the Icahn School of Medicine on Mount Sinai in New York, has about 600 patients who rely almost exclusively on regular doses of gamma globulin to protect against pathogens.

Nevertheless, 44 of their patients became infected with the coronavirus; four died and another four or five had long-term illnesses. (Chronic infections can give the virus the opportunity to develop into dangerous variants.)

Steven Lotito, 56, one of Dr. Cunningham-Rundles, was diagnosed with a condition known as common variable immunodeficiency when he was 13 years old. Before the pandemic, he had an active lifestyle, exercised, and ate well. “I’ve always known that I take special care of my body,” he said. This included infusions of gamma globulin every three weeks.

Despite careful precautionary measures, Mr Lotito caught the virus from his daughter in mid-October. He had a fever for almost a month and spent a week in the hospital. Convalescent plasma and remdesivir, an antiviral drug, provided relief for a few weeks, but his fever returned. After another infusion of gamma globulin that sweated through four shirts, he finally felt better.

Updated

April 18, 2021, 11:00 p.m. ET

Nevertheless, after almost seven weeks of illness, Mr. Lotito no longer had any antibodies to show. “I still have to take the same precautions that I took a year ago,” he said. “It’s a little daunting.”

People like Lotito-san rely on those around them to get vaccinated to keep the virus at bay, said Dr. Cunningham-Rundles.

“They hope that all of your family members and all of your close co-workers will go out and get a shot, and they will protect you with herd immunity,” she said. “You have to start with that.”

Dr. Cunningham-Rundles has tested their patients for antibodies and has registered some for Regeneron’s monoclonal antibody cocktail. However, many other people with these conditions are unaware of their risks or treatment options.

The Leukemia Lymphoma Society has set up a registry to provide information and antibody tests to people with blood cancer. Several studies are looking at the response to coronavirus vaccines in people with cancer, autoimmune diseases like lupus or rheumatoid arthritis, or in patients taking drugs that suppress the immune response.

What You Need To Know About The Johnson & Johnson Vaccine Break In The United States

    • On April 13, 2021, U.S. health officials called for an immediate halt to use of Johnson & Johnson’s single-dose Covid-19 vaccine after six recipients in the U.S. developed a rare blood clot disorder within one to three weeks of being vaccinated.
    • All 50 states, Washington, DC, and Puerto Rico have temporarily stopped using the vaccine or recommended providers are suspending use of the vaccine. The U.S. military, government-run vaccination centers, and a variety of private companies, including CVS, Walgreens, Rite Aid, Walmart, and Publix, also paused the injections.
    • Fewer than one in a million Johnson & Johnson vaccinations are currently being studied. If there is indeed a risk of blood clots from the vaccine – which has yet to be determined – the risk is extremely small. The risk of contracting Covid-19 in the United States is much higher.
    • The hiatus could complicate the country’s vaccination efforts at a time when many states are facing spikes in new cases and are trying to address vaccine hesitation.
    • Johnson & Johnson has also decided to delay the launch of its vaccine in Europe amid concerns about rare blood clots, which is taking another blow to the vaccine surge in Europe. South Africa, devastated by a contagious variant of the virus found there, also stopped using the vaccine. Australia announced that it would not buy cans.

In one such study, British researchers tracked nearly 7,000 people with Crohn’s disease or ulcerative colitis from 90 hospitals across the country. They found that less than half of the patients who took Remicade had an immune response after contracting coronavirus infection.

In a follow-up, the scientists found that 34 percent of people who took the drug were protected after a single dose of the Pfizer vaccine and only 27 percent after a single dose of the AstraZeneca vaccine. (In the UK, the current practice is to delay second doses to increase vaccine availability.)

Likewise, another study published last month showed that fewer than 15 percent of patients with blood or immune cancer and fewer than 40 percent of patients with solid tumors produced antibodies after receiving a single dose of the Pfizer BioNTech vaccine.

And a study published last month in the journal JAMA reported that only 17 percent of the 436 transplant recipients who received a dose of the Pfizer BioNTech or Moderna vaccine had detectable antibodies three weeks later.

Despite the small likelihood, immunocompromised people should receive the vaccines because they may produce some immune cells that protect, even antibodies in a subset of patients.

“These patients should likely be prioritized for optimally balanced two doses,” said Dr. Tariq Ahmad, gastroenterologist with the Royal Devon and Exeter NHS Foundation Trust who was involved in the infliximab studies.

He suggested that doctors routinely measure antibody responses in immunocompromised people even after two doses of vaccine to identify those who may also need monoclonal antibodies to prevent infection or a third dose of the vaccines.

Wendy Halperin, 54, was diagnosed with a condition known as common variable immunodeficiency when she was 28 years old. She was hospitalized with Covid-19 in January and stayed there for 15 days. However, the coronavirus caused unusual symptoms.

“I had trouble walking,” she recalled. “I just lost control of my limbs like I couldn’t walk down the street.”

Since she was being treated for convalescence plasma for Covid-19, Ms. Halperin had to wait three months for the immunization and has made an appointment for April 26th. However, despite her condition, her body managed to produce some antibodies against the initial infection.

“The takeaway message is that everyone should try to get the vaccine,” said Dr. Amit Verma, oncologist at Montefiore Medical Center.

Gambling has settled in Dr. Wollowitz’s case not paid off. With no antibodies in his system to protect him, he still works from home – a privilege he is grateful for. He was an avid mountain biker and advanced skier both at risk of injury, but he is playing it safe with the coronavirus.

In anticipation of a return to his normal lifestyle, Dr. Wollowitz his bicycles. But he said he had foreseen he would live like this until enough other people are vaccinated and the number of infections in the city drops.

“I’m not exactly sure what that date is,” he said. “I’m really waiting to get out again.”

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Oxford to launch human problem trial to review immune response

Oxford to launch human challenge trial to study immune response

Caroline Nicolls will receive an injection of the Moderna Covid-19 vaccine administered by Nurse Amy Nash at Madejski Stadium in Reading, west of London, on April 13, 2021.

STEVE PARSONS | AFP | Getty Images

LONDON – Oxford University researchers announced the start of a Human Challenge study on Monday to better understand what happens when people who have already contracted the coronavirus become infected for the second time.

The researchers will investigate what kind of immune response can prevent people from becoming infected with Covid-19 again and examine how the immune system reacts to the virus a second time.

Little is currently known about what happens to people who had the virus the second time they were infected.

The experiment is carried out in two phases with different participants in each phase. The first phase is slated to begin this month and the second phase is slated to begin in summer.

In medical research, Human Challenge studies are controlled studies in which participants are intentionally exposed to a pathogen or beetle to study the effects.

“Challenge studies tell us things that other studies cannot because, unlike natural infections, they are tightly controlled,” said Helen McShane, chief investigator for the study and professor of vaccinology in the Department of Pediatrics at Oxford University.

“If we re-infect these participants, we will know exactly how their immune systems responded to the first COVID infection, when exactly the second infection occurs, and how much virus they have,” said McShane.

It is hoped that the study will help improve scientists’ basic understanding of the virus and develop tests that can reliably predict whether people will be protected.

What happens in each phase?

In the first phase, up to 64 volunteers between the ages of 18 and 30 who were previously infected naturally will be re-exposed to the virus under controlled conditions.

Researchers will oversee attendees’ care while they perform CT scans of the lungs and MRI scans of the heart while isolating in a specially designed suite for at least 17 days.

All participants must be fit, healthy and have fully recovered from their initial infection with Covid to minimize the risk.

Study participants will only be released from the quarantine unit if they are no longer infected and there is a risk of the disease spreading.

A view of the City of London on a clear day.

Vuk Valcic | SOPA pictures | LightRocket via Getty Images

In the second phase of the experiment, two different areas are examined.

“First we will very carefully define the basic immune response of the volunteers before we infect them. We will then infect them with the dose of virus selected from the first study and measure how much virus we can detect after infection. We will then.” to be able to understand what kind of immune responses protect against re-infection, “said McShane.

“Second, we will measure the immune response several times after infection so we can understand what immune response is being generated by the virus,” she added.

The entire study period is 12 months, including at least eight follow-up appointments after discharge.

“This study has the potential to change our understanding by providing high-quality data on how our immune systems react to a second infection with this virus,” said Shobana Balasingam, senior research advisor on vaccines at Wellcome, a nonprofit that funded the study.

“The results could have important implications for the future management of COVID-19, influencing not only vaccine development but research into the range of effective treatments that are also badly needed,” Balasingam said.

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Vaccines Gained’t Shield Hundreds of thousands of Sufferers With Crippled Immune Methods

Vaccines Won’t Protect Millions of Patients With Crippled Immune Systems

Dr. Howard Wollowitz has been at the monastery for the most part at his Mamaroneck, NY home for more than a year

As chief of emergency medicine at Montefiore Medical Center in the Bronx, 63-year-old Dr. Wollowitz eager to treat patients when the coronavirus raged in town last spring. However, cancer treatment in 2019 had wiped out his immune cells, leaving him defenseless against the virus. Instead, he arranged for his employees to be managed through Zoom.

A year later, people return to Dr. Wollowitz’s life returned to a semblance of normalcy. His wife, dancer and choreographer, is preparing to work for the Austrian National Ballet Company. His vaccinated friends meet, but he only sees them when the weather is nice enough to sit in his back yard. “I spend very little time in public areas,” he said.

Dr. Wollowitz, like his friends, was vaccinated in January. But he wasn’t producing antibodies in response – and he hadn’t expected it either. He is one of millions of Americans with weakened immune systems whose bodies cannot learn to use immune fighters against the virus.

Some immunocompromised people were born with missing or faulty immune systems, while others, like Dr. Wollowitz, have illnesses or have received therapies that wipe out their immune defenses. Many of them make little to no antibodies in response to a vaccine or infection, which makes them susceptible to the virus. If infected, they can suffer from prolonged illness, with a death rate of up to 55 percent.

Most people who have lived with immunodeficiency for a long time are probably aware of their vulnerability. However, others have no idea that drugs could put them at risk.

“They’ll be walking around outside thinking they’re protected – but maybe not,” said Dr. Lee Greenberger, scientific director of the Leukemia Lymphoma Society, which funds research into blood cancer.

The only recourse for these patients – other than housing until the virus is withdrawn – may be to regularly infuse monoclonal antibodies, which are mass-produced copies of antibodies obtained from people who have contracted Covid-19 have recovered. The Food and Drug Administration has approved several monoclonal antibody treatments for Covid-19, but some are now also being tested to prevent infection.

Convalescent plasma or gamma globulin – antibodies distilled from the blood of healthy donors – can also help immunocompromised people, although a version of the latter that contains antibodies to the coronavirus is still months away from being available.

“It is a clear area where the need cannot be met,” said Hala Mirza, a spokeswoman for Regeneron, who made their monoclonal antibody cocktail available to a handful of immunocompromised patients through a compassionate application program. (Regeneron released experimental results this week showing the cocktail reduced symptomatic infections by 81 percent in people with normal immune systems.)

It is unclear how many immunocompromised people do not respond to coronavirus vaccines. But the list seems to include at least blood cancer survivors, organ transplant recipients, and anyone taking the widely available drug Rituxan or the cancer drugs Gazyva or Imbruvica – all of which kill or block B cells, the immune cells that develop antibodies – or Remicade, a popular one Drug used to treat irritable bowel disease. It can also include some people over the age of 80 whose immune responses have stalled with age.

“We are extremely concerned and interested in finding out how we can help these particular patients,” said Dr. Elad Sharon, an immunotherapy expert at the National Cancer Institute.

As the pandemic spread, doctors who specialized in treating blood cancer or caring for immunocompromised people expected at least some of their patients to encounter difficulties. Dr. Charlotte Cunningham-Rundles, an immunologist at the Icahn School of Medicine on Mount Sinai in New York, has about 600 patients who rely almost exclusively on regular doses of gamma globulin to protect against pathogens.

Nevertheless, 44 of their patients became infected with the coronavirus; four died and another four or five had long-term illnesses. (Chronic infections can give the virus the opportunity to develop into dangerous variants.)

Steven Lotito, 56, one of Dr. Cunningham-Rundles, was diagnosed with a condition known as common variable immunodeficiency when he was 13 years old. Before the pandemic, he had an active lifestyle, exercised, and ate well. “I’ve always known that I take special care of my body,” he said. This included infusions of gamma globulin every three weeks.

Despite careful precautionary measures, Mr Lotito caught the virus from his daughter in mid-October. He had a fever for almost a month and spent a week in the hospital. Convalescent plasma and remdesivir, an antiviral drug, provided relief for a few weeks, but his fever returned. After another infusion of gamma globulin that sweated through four shirts, he finally felt better.

Updated

April 15, 2021, 2:02 p.m. ET

Nevertheless, after almost seven weeks of illness, Mr. Lotito no longer had any antibodies to show. “I still have to take the same precautions that I took a year ago,” he said. “It’s a little daunting.”

People like Lotito-san rely on those around them to get vaccinated to keep the virus at bay, said Dr. Cunningham-Rundles.

“They hope that all of your family members and all of your close co-workers will go out and get a shot, and they will protect you with herd immunity,” she said. “You have to start with that.”

Dr. Cunningham-Rundles has tested their patients for antibodies and has registered some for Regeneron’s monoclonal antibody cocktail. However, many other people with these conditions are unaware of their risks or treatment options.

The Leukemia Lymphoma Society has set up a registry to provide information and antibody tests to people with blood cancer. Several studies are looking at the response to coronavirus vaccines in people with cancer, autoimmune diseases like lupus or rheumatoid arthritis, or in patients taking drugs that suppress the immune response.

What You Need To Know About The Johnson & Johnson Vaccine Break In The United States

    • On April 13, 2021, U.S. health officials called for an immediate halt to use of Johnson & Johnson’s single-dose Covid-19 vaccine after six recipients in the U.S. developed a rare blood clot disorder within one to three weeks of vaccination.
    • All 50 states, Washington, DC, and Puerto Rico have temporarily suspended use of the vaccine or suspended from recommended vendors. The U.S. military, government-run vaccination centers, and a variety of private companies, including CVS, Walgreens, Rite Aid, Walmart, and Publix, also paused the injections.
    • Fewer than one in a million Johnson & Johnson vaccinations are currently being studied. If there is indeed a risk of blood clots from the vaccine – which has yet to be determined – the risk is extremely small. The risk of contracting Covid-19 in the United States is much higher.
    • The hiatus could complicate the country’s vaccination efforts at a time when many states are facing spikes in new cases and are trying to address vaccine hesitation.
    • Johnson & Johnson has also decided to delay the launch of its vaccine in Europe amid concerns about rare blood clots, which is taking another blow to the vaccine surge in Europe. South Africa, devastated by a contagious variant of the virus found there, also stopped using the vaccine. Australia announced that it would not buy cans.

In one such study, British researchers tracked nearly 7,000 people with Crohn’s disease or ulcerative colitis from 90 hospitals across the country. They found that less than half of the patients who took Remicade had an immune response after contracting coronavirus infection.

In a follow-up, the scientists found that 34 percent of people who took the drug were protected after a single dose of the Pfizer vaccine and only 27 percent after a single dose of the AstraZeneca vaccine. (In the UK, the current practice is to delay second doses to increase vaccine availability.)

Likewise, another study published last month showed that fewer than 15 percent of patients with blood or immune cancer and fewer than 40 percent of patients with solid tumors produced antibodies after receiving a single dose of the Pfizer BioNTech vaccine.

And a study published last month in the journal JAMA reported that only 17 percent of the 436 transplant recipients who received a dose of the Pfizer BioNTech or Moderna vaccine had detectable antibodies three weeks later.

Despite the small likelihood, immunocompromised people should receive the vaccines because they may produce some immune cells that protect, even antibodies in a subset of patients.

“These patients should likely be prioritized for optimally balanced two doses,” said Dr. Tariq Ahmad, gastroenterologist with the Royal Devon and Exeter NHS Foundation Trust who was involved in the infliximab studies.

He suggested that doctors routinely measure antibody responses in immunocompromised people even after two doses of vaccine to identify those who may also need monoclonal antibodies to prevent infection or a third dose of the vaccines.

Wendy Halperin, 54, was diagnosed with a condition known as common variable immunodeficiency when she was 28 years old. She was hospitalized with Covid-19 in January and stayed there for 15 days. However, the coronavirus caused unusual symptoms.

“I had trouble walking,” she recalled. “I just lost control of my limbs like I couldn’t walk down the street.”

Since she was being treated for convalescence plasma for Covid-19, Ms. Halperin had to wait three months for the immunization and has made an appointment for April 26th. However, despite her condition, her body managed to produce some antibodies against the initial infection.

“The takeaway message is that everyone should try to get the vaccine,” said Dr. Amit Verma, oncologist at Montefiore Medical Center.

Gambling has settled in Dr. Wollowitz’s case not paid off. With no antibodies in his system to protect him, he still works from home – a privilege he is grateful for. He was an avid mountain biker and advanced skier, both of which were at risk of injury, but he is playing it safe with the coronavirus.

In anticipation of a return to his normal lifestyle, Dr. Wollowitz his bicycles. But he said he had foreseen he would live like this until enough other people are vaccinated and the number of infections in the city drops.

“I’m not exactly sure what that date is,” he said. “I’m really waiting to get out again.”

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Health

Research exhibits promising immune response towards variants

Study shows promising immune response against variants

Scientists at the Mirimus Laboratory prepare to test COVID-19 samples from recovered patients on April 8, 2020 in Brooklyn, New York.

Mischa Friedman | Getty Images

One type of T cell responsible for destroying cells infected with viruses was able to detect three variants of Covid-19 in a small US study, a promising sign that vaccines should continue to protect against new, emerging strains researchers at the National Institute of Allergy and Infectious Diseases said Tuesday.

Researchers led by NIAID researcher Andrew Redd investigated whether T cells were found in blood samples from patients recovering from the original strain of virus that recognized B.1.1.7, the variant B.1.351 originally detected in the UK was originally found in South Africa and P.1, first seen in Brazil. The NIAID is part of the National Institutes of Health, which published the study.

Each of the three variants the scientists examined contained mutations in what is known as the spike protein, which the virus uses to enter human cells. Mutations in this spike protein region could make it less noticeable to T cells and neutralizing antibodies, another important part of the immune response, after infection or vaccination, the researchers said.

In the study, which used blood samples from 30 recovered Covid-19 patients, T-cell responses “remained largely intact and were able to detect virtually all mutations in the variants studied,” they said, adding that even larger studies are required.

“The researchers note that their results suggest that the T-cell response in convalescents, and most likely in vaccines, is largely unaffected by the mutations found in these three variants and should provide protection against emerging variants,” the US wrote Authority a press release.

The results of the study could give hope to public health officials as they attempt to vaccinate the US and other parts of the world. New variants have been a problem for health officials as studies have shown that variants can reduce the effectiveness of current vaccines. The Chief Medical Officer of the White House, Dr. Anthony Fauci, urged Americans to get vaccinated as soon as possible before potentially more dangerous variants emerge.

On Monday, the head of the Centers for Disease Control and Prevention, Dr. Rochelle Walensky, the reporter. She said she was concerned the nation was facing “impending doom” as variants spread and daily Covid-19 cases rise again, threatening to send more people to the hospital.

Scientists say strong responses from both antibodies and T cells are likely required for an effective immune response against the virus. Further studies to examine immune responses are still needed, the researchers stressed, including whether a booster shot would be effective against emerging variants.

“New variants continue to be identified around the world and it will be important to continuously monitor them for possible accumulation of T cell escape mutations,” the researchers wrote.

The researchers also noted that the study had limitations, including the relatively small size of the population studied and that all participants were from North America.