What does immunocompromised mean?

The immune system in our bodies is what helps us fight infections and protects us from disease. There are some medical situations that weaken the immune system. We then refer to these patients as having a compromised immune system or being immunocompromised. A weakened immune system can make it more likely for you to catch an infection or experience a worse outcome from an infection.

What causes a compromised immune system?

Causes of a compromised immune system include: 

  • Undergoing chemotherapy for cancer.
  • Having a blood cancer (such as chronic lymphocytic leukemia).
  • Having an organ transplant that requires you to take medications to reduce your chance of rejecting the organ. 

In addition to cancer or organ transplantation, there are some conditions that cause your body to attack its own immune system. The following are known as autoimmune conditions: 

  • rheumatoid arthritis
  • lupus
  • inflammatory bowel disease (Crohn’s or ulcerative colitis)

Such autoimmune diseases require taking medications that treat the condition by suppressing the immune system. Medications known as corticosteroids, such as prednisone, taken for a long time, are an example of a medication that causes immunosuppression.

Why is COVID-19 especially dangerous for immunocompromised individuals?

Individuals who have a compromised immune system have worse outcomes with COVID-19 infections and are at increased risk of hospitalization or death. Other conditions such as obesity, heart disease, kidney or liver disease have also been shown to worsen COVID-19 illness, even though we don’t think of these conditions as causing immunocompromise.

How to protect the immunocompromised in the age of COVID-19

We have two main interventions to protect individuals whose immune systems have been compromised. 

The first is the preventative COVID-19 vaccines. For individuals who are immunocompromised, more doses are recommended than for the healthy population.

The second is a COVID-19 specific monoclonal antibody, infused under the skin. This infusion targets the SARS-CoV-2 virus, preventing it from spreading in the body and causing illness. The beneficial preventive effect of this one-time infusion of monoclonal antibody lasts for several months.

COVID-19 vaccine and booster recommendations for the immunocompromised 

Immunocompromised individuals are recommended to get an initial three-dose series (Pfizer or Moderna) over a three-month period. A first booster is recommended three months later, followed by a second booster four months after the first. Individuals over the age of 50 should also consider receiving a second booster, even without a compromised immune system. The recommendation for children ages 5 to 11 who are immunocompromised is to get three doses of the Pfizer vaccine.

Are there certain individuals who should not receive vaccines?

There are very few reasons to NOT receive a vaccine: if you had a serious reaction to a previous dose or a known severe allergic reaction to a component of the vaccine.

How to protect the immunocompromised from COVID-19

Immunocompromised individuals should continue to take additional steps proven to help prevent COVID-19:

  • Continue to wear masks in public, preferably high-quality masks such as KN95 or N95.
  • Social distance whenever possible.
  • Practice meticulous handwashing and use hand sanitizer.
  • Stay up to date with all other vaccinations in addition to COVID-19, including annual flu vaccine.
  • Ensure your close contacts are also fully vaccinated against COVID-19.
  • Use self-test kits if you have symptoms or were in contact with someone who was positive for COVID-19.
  • Consider having a pulse oximeter at home in case of COVID-19. This simple device measures the oxygen level in your blood and can indicate when you might need supplemental oxygen.

Please notify your medical team immediately if you develop symptoms for COVID-19, or other infections, as we now have treatments that work best when given early on.

For more information on COVID-19, visit our website.

Dimitrios Farmakiotis, MD, Ralph Rogers, MD, and Karen Tashima, MD

Dr. Dimitrios Farmakiotis is an infectious diseases specialist, with a focus on transplant infectious diseases. 

Dr. Ralph Rogers is an infectious diseases specialist focusing on diagnosis and treatment of infections in immunocompromised hosts and transplant recipients.

Dr. Karen Tashima is an infectious diseases specialist and the director of clinical trials at the Immunology Center at The Miriam Hospital.