Preventing SARS-CoV-2 infection in immunocompromised people hasn’t gotten any easier as the pandemic trundles on into its fifth year.
The monoclonal antibody tixagevimab-cilgavimab (Evusheld) has long gone by the wayside for pre-exposure prophylaxis and no replacements are on the horizon. Other prevention strategies among the general population, such as mask-wearing, have all but disappeared.
Vaccination against SARS-CoV-2 is now the key prevention strategy for this vulnerable population, and people who are immunocompromised should still get COVID boosters — but, given that they are less likely to generate an adequate immune response to the vaccines, the question is: how often?
“We really have a very confusing, complex black box of problems,” Catherine Diefenbach, MD, a hematologist-oncologist at NYU Langone Health in New York City, told MedPage Today. “Different people are immunocompromised in different ways. You have people with autoimmune disease who are compromised. You have people with organ transplants who are compromised. You have the elderly who are immunocompromised, and you have malignancy patients who are immune compromised.”
The most vulnerable among the immunosuppressed are people receiving treatment for cancer, especially with B-cell-depleting therapies, those who have received organ transplants who must remain on immunosuppressive medications indefinitely, and people living with HIV. People who must take medications like steroids or methotrexate to manage autoimmune conditions are also at risk for more severe disease from SARS-CoV-2 infection.