Western Pa. hospitals, pharmacies offer 3rd dose of covid vaccine

Certain individuals with compromised immune systems are eligible to receive a third dose of the covid-19 vaccine, with UPMC, Allegheny Health Network and Giant Eagle among regional providers offering the shot.

The Food and Drug Administration and the Centers for Disease Control and Prevention last week announced that some people who are immune-compromised can get a third dose of the Pfizer or Moderna vaccines at least 28 days after their second vaccine.

UPMC is already administering third doses to people who are eligible. They gave 64 of these doses to patients on Saturday at their South Side clinic alone.

“We are not asking for proof of these conditions, but we are asking that people affirm they have one of the conditions on the list,” said Dr. Graham Snyder, medical director of infection prevention at UPMC.

Individuals who “meet and attest” to the eligibility conditions can receive a third dose of the vaccine at Giant Eagle pharmacies with no appointment required.

The new guidance impacts only those with certain conditions — about 3% of the population, said Dr. Imran Qadeer, chief medical officer of AHN’s Allegheny General Hospital.

The guidance is “pretty vague,” Snyder said. That means there may be slight differences in who health care providers recommend for a third dose of the vaccine.

“The short answer is talk to your doctor,” Snyder said. “Every immune compromising condition is a little different.”

Some immune-compromised people still “have a very good chance” of responding well to the initial two-dose regimen, Snyder said. Others may have had little response to the initial vaccine.

“We have some data, and it’s good data, but it’s not a tremendous amount of data like we have for the vaccine in everybody,” he said. “What we’ve learned is it depends on why your immune system is compromised.”

The CDC recommends a third dose only to people who have “been receiving active cancer treatment for tumors or cancers of the blood, received an organ transplant and are taking medicine to suppress the immune system, received a stem cell transplant within the last two years or are taking medicine to suppress the immune system.” Other qualifying conditions include people who have moderate or severe primary immunodeficiencies and advanced or untreated HIV.

In some people, Snyder said, the immune system may not have responded to the first two doses. For some of those patients, a third dose could trigger a better immune response.

“We learned that among that group that didn’t respond to the first two mRNA doses, about half of people did respond when they got a third — but that means about half didn’t respond when they got a third dose,” he said, adding that immunocompromised people who may not respond as strongly to the vaccine should pair the third vaccine dose with mitigation measures like masking and social distancing.

There is not yet enough data to determine whether additional doses of the single-shot Johnson & Johnson vaccine may be beneficial for immunocompromised people, he said.

“The data is starting to emerge that in those rare breakthrough infections that result in hospitalization, those with immunocompromised conditions constitute 40%-plus of them,” said Dr. Amesh Adalja, a Pittsburgh-based infectious disease expert and senior scholar at the Johns Hopkins Center for Health Security.

“They seem to be fairly protected against serious disease, hospitalization or death, but there’s still room for improvement here,” Adalja said.

There is approximately a 500-fold increase in breakthrough hospitalizations among those with solid organ transplants, he said.

“These are still small numbers,” Adalja said of the number of people hospitalized with covid-19 after being vaccinated. “These are big percentages of small numbers, but these are still small numbers.”

The reason immune deficient patients are making up such a large portion of breakthrough hospitalizations is because they “respond to vaccines less robustly,” he said.

The majority of patients hospitalized with covid-19 are unvaccinated, according to Qadeer.

“What we’re seeing in the hospital setting is those who are vaccinated and are getting admitted are those in an immunocompromised state, and that’s where this push is coming from,” he said, explaining that transplant patients and those actively undergoing treatment for cancer seem to be at the highest risk for breakthrough hospitalizations.

For those getting a third dose, Snyder said, they’re receiving “the same vaccine” as the initial inoculation.

“We don’t know whether or not side effects may be more common or more prominent,” he said.

Allegheny Health Network is organizing a plan for third doses this week. They’ll have a scheduling platform to help people get appointments “as soon as possible,” Qadeer said.

Excela Health also plans to have its online scheduling platform updated to allow individuals to schedule for a third dose within the next few days, said Dr. Carol Fox, Excela’s chief medical officer.

“We also intend to follow the guidance by the CDC and the state which encourages attestation from the patient that they are immunocompromised,” Fox said. “If somebody’s not certain about that, we would encourage them to work with their physician. We really feel that it makes the most sense for a patient and their physician to have a discussion together.”

While health officials are greenlighting a third dose of the vaccine for certain immunocompromised individuals, the general public is still well protected with the initial two doses of the Pfizer or Moderna vaccine or one dose of the Johnson & Johnson vaccine.

“When it comes to the general population, the vaccines seem to be durable in terms of providing protection against serious disease, hospitalization or death,” Adalja said.