“There will be no a priori contraindication in this context, specifies Professor Lelievre, immunologist and vaccine specialist. But there are no specific data for the moment, as immunocompromised people do not have been included in the phase 3 trials. “
We will therefore have to wait for phases 4 to learn more about the efficacy and safety of vaccines in populations affected by immunosuppression, whether due to an illness or a treatment.
Contraindicated live attenuated vaccines
According to current vaccination recommendations, only so-called live attenuated vaccines are contraindicated in these individuals. But the other vaccines, qualified as inert, are feasible and the majority of anti-covid-19 vaccines can therefore be performed.
“For Covid-19, only one company has developed a live attenuated vaccine, explains Professor Lelièvre. Other vaccines are possible. But people with immunosuppression are likely to respond less to the vaccine as they are immunocompromised. And in case of illnesses. autoimmune and inflammatory (such as multiple sclerosis or rheumatoid arthritis), the question is more about tolerance since we have no data at present. Cohorts are being set up to study the tolerance in specific populations. ”
In many cases, the benefits of vaccination will likely outweigh the potential severity of coronavirus infection. But the specialist believes that in certain pathologies such as lupus, there could be a risk of exacerbation, via the interferon pathway activated by covid-19: “But this is not the case with all autoimmune pathologies, he says. People with stabilized HIV do not pose any particular problem. “
Some learned societies come to update their recommendations, like the French-speaking multiple sclerosis society : “At this stage, the data concerning multiple sclerosis and immunosuppressive situations (inflammatory and / or autoimmune diseases receiving immunosuppressive treatment, HIV infection) do not allow us to conclude that there is an increased risk of serious forms (of Covid-19 NDLR).
This explains why people with MS or immunosuppression are not among the priority targets of the vaccination campaign. “The only exceptions are if they have a severe handicap or a risk factor identified in a serious form, such as an age of over 65 years old, obesity, etc.
On 11/27/20, the Haute Autorité de Santé issued its recommendations on the vaccination campaign, specifying the priority people (including transplant recipients, under immunosuppressant). She believes that the increased risk associated with inflammatory and / or autoimmune diseases receiving immunosuppressive treatment was significant but lower, and requires further studies to determine.
Patients who are not among the priority people will therefore follow the recommendations intended for the general population, after consulting their specialist. Their relatives, by being vaccinated too, would protect them even more.