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Ask the Doctor: If the immunocompromised who are fully vaccinated are at a HIGHER risk of the stated problems including death, WHY is the booster only “highly recommended?” I am not understanding what appears to be a very dangerous contradiction. Can you clarify this for me?

This content was current as of the date it was released. In science and medicine, information is constantly changing and may become out-of-date as new data emerge.

Question:

I am not understanding this information:

The fully vaccinated immune-compromised are at much higher risk for breakthrough infections and are at especially higher risk for hospitalization and death compared to the general population who have been vaccinated.

If the immunocompromised who are fully vaccinated are at a HIGHER risk of the stated problems including death, WHY is the booster only “highly recommended?” I am not understanding what appears to be a very dangerous contradiction. Can you clarify this for me?

Answer: Multiple studies are showing that patients with certain conditions, including blood cancers, make lower levels of antibodies from COVID vaccines as compared to people without these conditions. Additionally, certain therapies used to treat blood cancers also hinder the immune response to vaccination. Early studies have shown that a third dose of a COVID vaccine in patients with organ transplant increases the immune response and lead to higher levels of antibodies against COVID. This information likely applies to blood cancers like CLL as well. Even in patients who did not make an adequate antibody response to the first two doses of the COVID vaccine, the third dose may lead to higher antibody levels, and hopefully increased protection against COVID.

Many factors go into determining a CLL patient’s immune response to the COVID-19 vaccination, including the Stage of the underlying disease. Patients with early or well‑controlled CLL are likely to respond better to vaccination, as compared to patients with advanced CLL. Additionally, patients on certain therapies (such as ibrutinib and rituximab) may have an impaired immune response. Given the difficulty in predicting a person’s immune response, all patients with CLL are advised to receive a third dose of the COVID vaccine, since the risk of significant side-effects is very low, with the upside of increased protection from significant COVID-19 infection.

Simply put, fully vaccinated individuals with any immunocompromised conditions may not have responded to the first two vaccines as robustly as healthy individuals. Early studies are showing that the third “booster” shot gives your immune system the added instructions it needs to react and form more antibodies.