CDC COVID-19 Action Plan for Immunocompromised Individuals
On January 27, 2023, the Centers for Disease Control and Prevention (CDC) issued a COVID-19 action plan for people with a weakened immune system (immunocompromised).
The Food and Drug Administration (FDA) has also announced, that in light of the omicron sublineages accounting for more than 90 percent of COVID-19 cases in the United States right now, Evusheld is no longer authorized for preexposure prophylaxis against COVID in the U.S.
Is there a link between COVID-19 and vasculitis?
A recent research study indicates that having COVID increases a persons risk of developing an autoimmune disease.
COVID-19 was most strongly linked to an increased risk of arteritis temporalis vasculitis, auto-immune driven thyroid problems, and psoriasis.
There are a couple important points to keep in mind. This research has not yet been peer reviewed, and this study only shows an association between COVID and autoimmune disease not causality.
Find out more about this research study:
Incident autoimmune disease in association with a SARS-CoV-2 infection: A matched cohort study
COVID-19 linked to increase in autoimmune disease risk
Setting Boundaries
Knowing how to set boundaries is an important skill for everyone, but it is especially important when you are living with a weakened immune system.
Check out A Guide to Setting Boundaries if You’re a People Pleaser from our friends at the Global Healthy Living Foundation.
Fast Facts
- Keep a supply of rapid home tests for COVID on hand. Click here to get free at-home COVID tests.
- Test yourself right away, and if negative, consider testing yourself again 24-48 hours later. It can take time for the viral load to be large enough for the test to detect.
- Contact your healthcare provider if you test positive. The treatments that can reduce your risk of COVID progressing to a severe disease need to be started early (within the first 5-7 days of onset of symptoms) to be effective.
- Begin treatment with an oral antiviral medication such as paxlovid or molnupiravir OR receive an infusion of monoclonal antibodies such as bebtelovimab.
- Consult with your healthcare provider on the timing of vaccines. It is preferable to wait as long as possible after your last rituximab/cyclophosphamide dose before being vaccinated. No matter how you space your rituximab/cyclophosphamide and your vaccines, you are unlikely to have a robust immune system response to vaccines.
- In some cases, you can hold rituximab to allow the vaccine time to work. This is a very individualized decision and there are a number of factors you and your healthcare provider need to consider.
- One guideline that may be helpful when making decisions about holding medications and the spacing of treatments and vaccines is to make decisions about your vasculitis first and vaccines second. Treating your vasculitis is your first priority.
- If you have not already done so, get your first two COVID mRNA vaccines (Pfizer or Moderna). These shots should be given 3 weeks apart.
- Get your first booster (third dose) 4 weeks after you receive the second dose of the COVID vaccine.
- Boost again (fourth dose) at least 4 months later after your previous booster.
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html
You can, but in most cases it is not helpful. There is currently no medical consensus on what level of antibodies is enough for protection. About all the test can tell you is if you have produced no antibodies or some antibodies (which may or may not be enough).
Flares do occur occasionally after vaccines, but they also occasionally occur after getting COVID-19. When balancing the risks and benefits, the benefits of being vaccinated outweigh the slight risk of a flare.
Information adapted from May 2022 VF Webinar: 2022 COVID Update featuring Dr. Cassandra Calabrese, DO and Dr. Leonard Calabrese, DO.
Additional Resources
The mission and vision of the COVID-19 Global Rheumatology Alliance is to bring together the global rheumatology community to collect, analyze, and share information about COVID-19 and rheumatology to patients and physicians.
Creaky Joints Article: Three doses of the Moderna or Pfizer COVID-19 vaccines found to prevent hospitalization in people taking immunosuppressive drugs.
One study looked at the risk of severe COVID-19 for people with vasculitis.
Plain Language Summaries of COVID-19 Global Rheumatology Alliance Research.
American College of Rheumatology 2022 Guidelines for Vaccinations.
CDC Vaccine Recommendations for People Who Are Immunocompromised.
If You Take Rituximab, Here’s How a Third COVID-19 Vaccine Dose Boosts Your Immune Response.
What Doctors Wish Immunocompromised Patients Knew During Covid.
If you test positive for COVID and are moderately or severely immunocompromised, the Centers for Disease Control and Prevention (CDC) recommends that you isolate for at least 20 days.
Guidance for physicians from the American College of Rheumatology for the spacing of immunosuppressant treatments and vaccinations.
https://www.rheumatology.org/Portals/0/Files/Vaccinations-Guidance-Summary.pdf
The Global Healthy Living Foundation is a nonprofit committed to improving the lives of people living with chronic conditions.
What the ending of COVID-19 emergency orders means for people living with a chronic condition.
This May 2022 webinar features Dr. Cassandra Calabrese, DO and Dr. Leonard Calabrese, DO.
Doctor’s Advice for How to Live Your Life While Staying Safe During COVID-19
