COVID-19 vaccine for CVID patient
Are there any recommendations about whether patients with common variable immunodeficiency on IVIG replacement should receive the COVID-19 vaccine?
To our knowledge, immunodeficient patients were not included in the phase 3 trials but will know more once those data are released. The two mRNA vaccines (Moderna and Pfizer) are anticipated to be approved a released very soon. They should be safe for patients with CVID, though their efficacy in this patient population remains unknown. Immune deficient people can get mRNA and DNA vaccines. mRNA and DNA vaccines are not alive. Even though they contain genes, they are not going to cause disease.
I recommend giving the same advice as flu-vaccine. if it gives even an attenuated benefit from T-cell responses to reduce either the risk of infection or to make the illness less severe, then antibody deficient patients should consider having it. We should also acknowledge that some people with e.g. specific antibody deficiency may make a good response to COVID-19 vaccines, just as they might to tetanus but not to e.g. pneumococcus.
Contrarily, there are attenuated virus and live virus vector vaccines involved in Phase 1 and Phase 2 trials. I recommend caution with these vaccines, especially in patients with known or suspected T cell involvement.
As and additional resource; Dr. Kate Sullivan has been providing fantastic COVID-19 related updates on the Immune Deficiency Foundation website. Here is a link to her most recent video update regarding vaccination.
I hope you find this helpful.
Jeffrey G Demain, MD