Immunocompromised: definition, Covid, FFP2, how do you know?

[Mise à jour le 2 février 2022 à 19h04] Following the opinion of High Council for Public Healththe Ministry of Solidarity and Health recommends the wearing of the FFP2 mask for people at risk of severe forms of Covid-19, in vaccination failure and able to carry it. Data subjects can now receive FFP2 masks in pharmacies upon presentation of a medical prescription, covered by health insurance. Wearing a mask for the general public or a surgical mask remains recommended for the general population.

What does immunocompromised mean?

A person is said to be immunocompromised when their immune system is no longer able to properly deal with pathogens like bacteria, viruses, parasites or toxic agents. This leads on the one hand to infections, on the other hand to increased risk of cancer (the immune system usually takes care to destroy the tumor cells). L’immunodeficiency can have various originsthe best known being the AIDS (acquired immune deficiency syndrome).

What are the risks of Covid when you are immunocompromised?

People with congenital or acquired immunosuppression are more at risk of severe forms of Covid:

• drug immunosuppression: chemotherapy anti-cancer, immunosuppressant, biotherapy and/or corticosteroid therapy at an immunosuppressive dose,
• infection HIV uncontrolled or with CD4 <200/mm3,
• consecutive to a graft organ solid or hematopoietic stem cells,
• linked to a blood disease malignant under treatment.

According to the list recalled by the Advice on vaccine strategy in November 2021, the severely immunocompromised people what are solid organ transplant recipients, recent bone marrow transplant recipients, dialysis patients, patients with autoimmune diseases under strong immunosuppressive treatment such as anti-CD20 or anti-metabolites, patients with certain types of lymphoma treated with anti -CD20 or BTK inhibitors, patients with chronic lymphocytic leukemia, patients with rare forms of primary immunodeficiencyand myeloma under treatment2 are at very high risk of severe forms of Covid-19.

What recommendations with Covid vaccines?

The HAS recalled in April 2021 that immunocompromised people, in whom the risk of severe form and death from Covid-19 is high, must be vaccinated as a priority against SARS-CoV-2. “The use of a messenger RNA vaccine is recommended for immunocompromised people”remind the General Directorate of Health in January 2022. HAS recommends the vaccination of the entourage immunocompromised adults and children from the age of 5 years. In accordance with the opinion of the High Health Authority of December 23, 2021, the immunocompromised adolescents aged 12 to 17 with comorbidities are eligible for the booster doseaccording to the same procedures as adults, i.e. from 3 months after the last injection or infection with Covid-19 if this occurred after vaccination.

As part of the primary vaccination schedule for immunocompromised people, it is recommended:

• One 28 days between two injections vaccines in primary vaccination;
• A dosage of anti S antibodies by serology 15 days after the administration of the second dose. If protection is deemed sufficient2 , a third dose of vaccine can be administered to complete the primary vaccination course and serological monitoring can be carried out every three months to ensure that protection is maintained. If the protection is deemed insufficient, these people are eligible for the prescription of monoclonal antibodies for prophylaxis.
• The same scheme for a possible administration of fourth dose in the primary vaccination schedule.

As part of the vaccine booster campaign:

• Immunocompromised individuals who have previously received a two-, three-, or four-dose primary vaccination schedule are eligible for a booster dose 3 months after their last injection if they respond to vaccination, according to the anti-S response criteria set out in the framework of the primary vaccination.
• Anti-S serological monitoring must again take place, 15 days after the booster.

For severely immunocompromised people : it is recommended the systematic administration of a second booster dose vaccinated within 3 months after the first booster.

Are FFP2 masks free for immunocompromised people?

According to the decree published in Official newspaper on February 1, 2022, immunocompromised people can be willing free of FFP2 masks by going to pharmacy if they have a medical prescription as proof. This concerns people at risk of severe forms of covid-19 and who are immunocompromised, for whom vaccination does not induce the production and maintenance of an antibody titer at a sufficient level to ensure sufficient protection or in whom a disease or a treatment leads to a rapid drop in the level of antibodies, in the ability to support the wearing of this type of mask for several hours and for daily use. For them, “the purchase and delivery of FFP2 type masks by community pharmacies are reimbursed and remunerated by health insurance” specifies the decree. For these people, it will be possible to be delivered on medical prescription 20 FFP2 masks for 2 weeks Where 50 FFP2 masks for 5 weeks in pharmaciesinform the communicated of the Ministry of Health.

What causes immunosuppression?

The taking immunosuppressive drugs is the main cause. Immunosuppression can be genetic or due to environmental factors, behavioral or as a result of taking medication. HIV is, for example, an immunosuppression factor because this virus causes a decrease in the number of white blood cells, making the body more vulnerable to so-called infections. “opportunists”. “But malnutrition, cancer, severe heart, respiratory or kidney failure, obesity, unbalanced type 1 or 2 diabetes, certain drugs and therapies such as chemotherapy, lead to a state of immunosuppression” adds Dr. Philippe Goeb, general practitioner.

What are the symptoms of being immunocompromised?

This disease is characterized by:

• A tired intense and persistent.
• A big susceptibility to infection.
• Wounds that take time to heal.

“Immunosuppression is characterized by repetition, about 4 to 10 times a year, of serious illnesses such as respiratory pathologies, the recurrence of unusual conditions as well as a sudden change in weight and height”, says Dr. Goeb. Immunosuppression can occur at any moment of life: at birth, during childhood and adolescence, or in adulthood. The genetic part is important: if a member of the family is affected by this disease, a genetic diagnosis will be proposed.

Live attenuated vaccines such as BCG or measles are contraindicated.

What are the consequences of immunosuppression?

The inefficiency of the immune system leads the immunocompromised person to regularly catch all sorts of potentially serious and recurrent infections. “Healing is slow, despite taking appropriate treatment” says our expert.

Infection in the immunocompromised

Immunocompromised patients often need to resort to antibiotics to treat infections. “In the most serious cases, recourse to surgery is possible: it consists of the stem cell transplant, taken from a compatible donor, directly from the bone marrow of the immunocompromised patient. This technique aims to force these new cells to work for the immune system. explains the doctor.

Which vaccines are contraindicated when you are immunocompromised?

Immunocompromised people have a greater risk of contracting infections… Including following a vaccination. This is why live attenuated vaccines such as those against tuberculosis (BCG), measles, rubella and mumps (MMR) and chickenpox are contraindicated. On the other hand, the inactivated vaccines do not present any danger.

What to do in case of immunosuppression?

It all depends on the cause of this immunosuppression. “The immunosuppressive drugs prescribed to treat inflammatory and autoimmune diseases or to prevent transplant rejection are the main cause of immunosuppression. In these cases, immunosuppression is expected and may give rise to precautions, in particular isolation (during the transplant). In case of infection, taking antibiotics will be necessary. Finally, to strengthen the defences, specific prescriptions such as vitamins, in particular D, minerals such as zinc can also be made according to each patient.

Sources:

The Ministry of Solidarity and Health recommends the FFP2 mask for certain people at risk of developing a serious form of Covid-19. February 2, 2022

Advisory Council for the Vaccine Strategy Opinion of April 6, 2021: Expansion of priorities for access to anti-Covid-19 vaccination.

Coronavirus: who are the vulnerable? Ministry of Health, March 13, 2020.

Benedikt S et al., Hemodialysis Patients Show a Highly Diminished Antibody Response after COVID-19 mRNA Vaccination Compared to Healthy Controls, medRxiv 2021.03.26.21254259.

Geisen UM, Berner DK, Tran F, et al. Immunogenicity and safety of anti-SARS-CoV-2 mRNA vaccines in patients with chronic inflammatory conditions and immunosuppressive therapy in a monocentric cohort. Annals of the Rheumatic Diseases Published Online First: 24 March 2021.

Boyarski BJ et al., Antibody response to a single dose of SARS-CoV-2 mRNA vaccine in patients with rheumatic and musculoskeletal diseases Free.

Thanks to Dr. Philippe Goeb, general practitioner.