August 14, 2021
**Update: The CDC federal advisory panel voted unanimously Friday afternoon to recommend an additional dose of coronavirus vaccines for some immunocompromised individuals, followed quickly by the CDC’s final approval announcement. Immunocompromised people will not need a doctor’s permission or a prescription to get a third shot, CDC officials said. Patients will need only to attest that they meet the eligibility requirements for an additional dose, according to The New York Times. Experts also told The Times that patients should try to get the vaccine they already received, but if not possible, can take the other two-dose vaccine. Even after receiving a booster, patients should still wear a mask, maintain social distancing, and avoid crowds and poorly ventilated indoor spaces.
August 13, 2021
** Update: Late Thursday, August 12, the FDA authorized extra vaccine doses for immunocompromised patients to bolster protection against COVID-19. A CDC advisory committee meeting scheduled for today will address how the booster shots will be administered and, according to reports, will likely urge patients to talk to their doctors about the additional shots.
August 12, 2021
The emergence of the Delta variant of COVID-19 has permanently changed the way that myeloma patients must try to stay safe from COVID-19 infection. The highly infectious Delta variant can infect those who have been vaccinated. The good news is that the currently available Moderna and Pfizer vaccines protect against the development of severe disease. Vaccines work and are doing their job to protect against hospitalization and possible death. New data are helping clarify the best strategies to stay safe.
Key role of boosters
It is widely anticipated that as soon as today the FDA will authorize a third vaccine dose of the Moderna or Pfizer vaccines for those who are “immunocompromised,” which includes myeloma patients, especially those on active treatment. We know that only about a half of patients with blood cancers will develop adequate neutralizing antibodies after two doses of vaccine. In a newly published article in the NEJM we learn from a randomized trial (a placebo versus a third dose) in transplant patients that a third booster dose really enhances the neutralizing antibody response to COVID-19. The authors, from Toronto, Canada, recommend the third dose booster in order to achieve good antibody levels.
As soon as available, it is recommended that myeloma patients receive the third dose booster shot.
Strategies to cope with infectious Delta variant
The first step is to get vaccinated, including a booster shot. However, we know that well-protected, fully vaccinated people can still become infected with Delta variant. For example, in Iceland, 93% of the population over age 16 is vaccinated (96% of women and 90% of men). Yet there is a Delta variant infection surge right now in those who are vaccinated (approximately 80% of current infections).
The excellent news is that there have only been a few hospitalizations and no deaths. So, vaccination does not prevent possible infection, but it does prevent getting sick and ending up in the hospital!
Nonetheless, there are complications of getting infected, including the need for quarantine (of yourself and contacts) and the possibility of chronic, milder long-haul-type symptoms, which can sometimes be quite problematic. Obviously, this is a particular concern for myeloma patients who may have low, neutralizing antibody levels and suboptimal protection.
It is really important to protect against getting infected. Let me re-emphasize:
- Wear a mask. Use a K95 mask or double mask for maximum protection.
- Avoid crowded spaces, especially indoors.
- Definitely wear a mask in all risky situations where you might be exposed to those who are unvaccinated or of uncertain vaccination status.
Staying safe will require ongoing vigilance
With the emergence of the Delta variant, we have learned that COVID-19 will be a challenge not just in the coming months but in the coming years. Vaccination will be essential to control community spread and prevent serious medical problems. It will become a recurrent virus like a new flu, with standard vaccination to cover emerging strains. Ongoing testing and monitoring will be essential. Trust in the medical community is needed to implement guidelines and procedures for the safety of everyone.
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