What does "moderately immunocomprimised" mean?

Parenting a D-Child
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So the new CDC guidance says that those 5-12 who are “moderately or severely immunocompromised” are able to get the 3rd shot (booster). And they list a couple of examples of what “moderately immunocomprimsed” includes (such as DiGeorge syndrome, Wiskott-Aldrich syndrome), but I’m left wondering…do T1D children 5-12 fit under this umbrella???

Does anyone have any conclusive information on T1D’s from 5-12 yo?

Update: I have used the Contact CDC method to reach out to them with my question…if/when they respond, I’ll post their response here for future information seekers.

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It is explained here, and T1D is mentioned.

Immunotherapy is a treatment that can suppress, or dampen, immune responses when the immune system is “overactive,” such as with an autoimmune disease in which immune cells attack healthy tissue— or with organ transplants. Autoimmune diseases that create this overactive response include rheumatoid arthritis, type 1 diabetes, multiple sclerosis (MS), and inflammatory bowel disease (Crohn’s and ulcerative colitis).

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Awesome, so according to this, he SHOULD be able to get the 3rd shot then. Erin is scheduling our kids on Monday. Thanks for the info!

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I have heard of trials that administer drugs to suppress the immune system to see if this slows the progression of T1D. Is your child receiving immunotherapy to suppress the immune system? According to my reading, that’s what would lead to the diabetic child being classified as “immunocompromised” as described in the article. It’s not at all clear to me that simply having T1D is evidence that our immune system is unable to properly protect us from infection.

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Previous research has shown conclusively (from the CDC) that Diabetics have more severe cases of Covid if contracted, so I don’t know that this is accurate?

From CDC website:

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With Omicron putting record numbers of children in the hospital, I would think it would be more important than ever to ensure T1Ds (who do have comprimised immune systems and contract more severe cases of Covid) can get that 3rd shot to have as much protection as possible.

Waiting for the CDC to get back with me on an official answer, though.

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Also, it has other categories in addition to those taking the immunosuppresent drugs. I’m referring to the category underlined…specifically the “moderate” reference…that’s what’s unclear to me.

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No. Neither T1D nor T2, nor (so far as I know) T3 etc are associated themselves with immune system compromise. Indeed the opposite in the case of T1D - the most common known cause is an immune “disorder”, but it’s actually an over active immune system (an autoimmune response), not a compromise. (There are other causes of T1D, like physical damage to the pancreas, so we can’t make general statements about T1D.)

Diabetics were regarded as at risk because diabetes generally compromises health. The numbers were completely clear in the case of insulin resistance (a large subset of T2), but there weren’t enough numbers in the US for the CDC to ever be sure about T1D. Common sense suggested no - we T1D’s should, on average, be less rather than more at risk, but there wasn’t enough testing, analysis etc for the CDC to be able to safely say. Anyway, given all the confusion over diabetes, it was a lot safer to stick to the line that diabetics were at risk.

So far as I know that is still the case; the “immunocompromised” classification is the first step in the rollout exactly like before - diabetics (including T2s) don’t count. There are a lot of people out there who are at enormous risk from the coronavirus and, despite joyous celebrations that it is milder (if, indeed, it is) that doesn’t help much if you are immunocompromised.

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T1Ds do NOT count as immunocomromised.

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primary immunodeficiencies mean you are basically missing a component of your immune system. One of my friends has a kid with this. It’s basically a genetic issue. T1Ds mainly have some aberrant immune responses but have all the basic components of the immune system, maybe not in all the optimal proportions but they’re all there.

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I appreciate the clarity @jbowler and @TiaG. Yet, i STILL wasn’t him to get that 3rd shot ASAP. Lol.

I was just called by the dentist office that Liam was supposed to get his dental work done tomorrow morning in… They advised me it has to now be pushed to Tuesday as someone in the office contracted covid and they all had to quarantine for 5 days (ending Monday evening).

I would feel so much better if he had that 3rd shot but it will have to be what it is. He needs this tooth work completed ASAP. Erin is calling the pediatrician tomorrow to see if we can get Liam the 3rd shot…if so great, if not we’ll have to hope the two shots give him enough protection… For himself and our youngest unvaccinated/unboosted child.

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Ugh, I hope that he gets in soon. IT’s so awful how this surge is disrupting ordinary medical care. A friend was just diagnosed with breast cancer and I am worried her surgery will be delayed :frowning:

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The CDCs very long response that still didn’t tell me what i wanted to know…glad you all did. Lol

Thank you for contacting CDC-INFO.

Here is the information you requested on the COVID-19 vaccine.

CDC recommends that fully vaccinated people with moderately or severely compromised immune systems should get an additional primary dose at least 28 days (4 weeks) after their second shot if they are

  • age 5 years or older and completed the Pfizer-BioNTech COVID-19 vaccine primary series, or
  • age 18 years or older and completed the Moderna COVID-19 vaccine primary series.

There is no maximum amount of time in which they should receive the additional primary dose. However, if someone receives their additional primary dose of mRNA COVID-19 vaccine fewer than 24 days after their second dose, the additional primary dose should be repeated. The repeat dose should be spaced after the improperly spaced dose by 28 days.

Studies indicate some immunocompromised people don’t always build the same level of immunity after vaccination the way non-immunocompromised people do. An additional primary dose may prevent serious and possibly life-threatening COVID-19 in people whose immune system may not have fully responded to their initial vaccine series.

CDC recommends that people who may be immunocompromised talk to their healthcare professional to see if they should get an additional primary dose of COVID-19 vaccine.

At this time, CDC does not recommend an additional primary dose of COVID-19 vaccine for people with moderately to severely compromised immune systems who received a single dose of Johnson & Johnson’s Janssen COVID-19 vaccine.

However, people with moderately to severely compromised immune systems who received a single dose of Johnson & Johnson’s Janssen COVID-19 vaccine at least 2 months ago (8 weeks) should receive a single COVID-19 booster vaccine dose. In most situations, Pfizer-BioNTech or Moderna COVID-19 vaccines are preferred over Johnson & Johnson’s Janssen COVID-19 vaccine for booster vaccination.

For more information about COVID-19 vaccine booster shots, visit the CDC website: COVID-19 Vaccine Booster Shots | CDC.

Currently, CDC is recommending that people with moderately to severely compromised immune systems receive an additional primary dose. This includes - but is not limited to - people who have:

  • been receiving active cancer treatment for tumors or cancers of the blood
  • received an organ transplant and taking medicine to suppress the immune system
  • received a stem cell transplant within the last two years or taking medicine to suppress the immune system
  • moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich (whis-COT Ald-RICH) syndrome)
  • advanced or untreated HIV infection
  • been receiving treatment with high-dose corticosteroids or other drugs that may suppress your immune response

Talk to your healthcare professionals about your medical condition and about whether getting an additional shot is appropriate for you.

For people ages 18 years or older who received either a Pfizer-BioNTech or Moderna COVID-19 vaccine series who are moderately or severely immunocompromised, a third dose of the same mRNA vaccine should be used for the additional primary dose. If the mRNA vaccine product given for the first two doses is not available or is unknown, either mRNA COVID-19 vaccine product may be administered.

For adults who received a mixed primary series, or one dose of Pfizer-BioNTech and one dose of Moderna, either mRNA COVID-19 vaccine product may be administered as the additional primary dose. If the mRNA vaccine product given for the first two doses is not available or is unknown, either mRNA COVID-19 vaccine product may be administered.

For children and adolescents ages 5-17 years old, only the Pfizer-BioNTech COVID-19 vaccine is authorized and recommended.

Immunocompromised people may discuss with their healthcare professional whether getting an additional primary dose is appropriate for them. If your healthcare professional is not at a site administering vaccines, you may self-attest that you are recommended to receive a third dose of mRNA COVID-19 vaccine due to your medical condition. Immunocompromised people may receive a third shot wherever vaccines are offered without a prescription.

At your first vaccination appointment, you should have received a CDC COVID-19 vaccination record card that tells you what COVID-19 vaccine you received, the date you received it, and where you received it. Bring your vaccination card with you to your additional primary dose appointment so your healthcare professional can fill in the information about your additional primary dose.

There is limited information about the risks of receiving an additional primary dose of a COVID-19 vaccine. CDC and FDA are continuing to monitor the safety and effectiveness of third shots in immunocompromised people. So far, reactions reported after the third shot were similar to those reported after the first and second shots. Fatigue and pain at injection site were the most commonly reported side effects. Overall, most symptoms were mild to moderate.

If you receive an additional shot, you are encouraged to update your v-safe profile. If you experience side effects after your third shot, you may report them to v-safe and the Vaccine Adverse Event Reporting System (VAERS).

Additional primary doses are not different from other doses in the series. The ingredients in COVID-19 vaccines have not changed since they were first introduced.

If you received doses of COVID-19 vaccine prior to undergoing a bone marrow or stem cell transplant, then you should be revaccinated with a primary vaccine series at least 3 months (12 weeks) after completing your treatment.

If you are then revaccinated with a 2-dose mRNA COVID-19 vaccine primary series, an additional primary dose is recommended if you continue to have moderate to severe immune compromise. The additional primary dose of mRNA COVID-19 vaccine can be administered at least 28 days after you receive your second dose. Please talk to your healthcare professional about the appropriate timing of your vaccination.

After receiving an mRNA vaccine primary series that includes an additional mRNA vaccine dose, people 12 years of age and older with moderately to severely compromised immune systems should get booster dose after their third mRNA vaccine dose. This means they should receive a total of four COVID-19 vaccine doses. At this time, only the Pfizer-BioNTech COVID-19 vaccine is authorized and recommended for adolescents ages 12-17 years old.

Although mRNA vaccines are preferred for adults 18 years and older, J&J/Janssen COVID-19 vaccine may be considered in some situations.

If the Moderna vaccine is used as the booster dose, the booster dose volume is used, which is half the dose volume of a primary series dose or additional primary dose.

Currently, CDC does not recommend a booster dose in children with moderately to severely compromised immune systems ages 5-11 years old. As more data become available, this recommendation may be updated.

CDC Resources

COVID-19 Vaccines for People with Moderately to Severely Compromised Immune Systems

Different COVID-19 Vaccines

Considerations for COVID-19 vaccination in moderately and severely immunocompromised people

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Sorry they didn’t actually answer your question. Pretty frustrating when they just send you a form letter that doesn’t answer the question you asked. Bad Bot

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Ok, look. Here’s my take on the whole thing. You can think I’m wrong or not. I’m responsible for my health, and I’m my own best advocate. In fact, I have to be my own best advocate.

If you think you (or your child etc.) are at greater risk with Covid, then go get the shot, booster etc. Don’t wait for someone (especially a bureaucrat) to tell you it’s ok.

We all know that there are different “levels” of T1D and every other disease/condition. Plus many people have more than one. I have T1D, RA, anemia of chronic disease (which means I can’t get the normal amount of O2, obviously important re covid) etc. So although my individual conditions may not be listed by the CDC, I think I am at greater risk for covid complications.

As soon as the vaccines were available, I got mine. As soon as the booster (or 3rd shot) was available, I got mine. No one objected, in fact they never asked me my medical status.

Be your own best advocate, no one else will.

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The problem is my wife isn’t as prone to doing this as I am…she wants to go through the Pediatrician’s office because she heard a single story of a kid getting a grown up shot and now thinks all pharmacists are incapable. :frowning: I have a nephew who WORKS in a local pharmacy and would probably happily give Liam his 3rd shot, but my wife won’t let me do it. I’m weighing whether this is one of those battles I should fight or not. lol He doesn’t go out that often although more recently than for the past 2 years with his 2 shots under his belt.

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It’s obviously anecdotal, but the only one in my household who got omicron is the lone completely unvaccinated one. So I am inclined to think that for Samson at least he’s generated a decent vaccine response. And I would say he is more like @Jan in that he’s already had a second autoimmune disease – one that is in some ways very similar to multisystem inflammatory syndrome in children. So I suspect two is enough for now for most T1D children.

I would also worry about the need for extra shots down the line. They’re showing the booster wanes in about 10 weeks, so are you going to need to give him a fourth shot in 3 months? Not the end of the world but maybe a lot of hassle and extra work for statistically pretty small gain.

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I think @mm2’s post (3 days ago) referencing the YaleMedicine article is highly appropriate still. The point is that (speaking as a “T1D”) if we are receiving immunosuppressant therapy (read the next but one paragraph in the article as to why it has to be suppressant) we are at risk of diseases which our immune system fights. I suspect immunosuppression is like Warfarin; too much of a good thing can kill you.

@mm2 did not quote the third paragraph, so I will :slight_smile: emphasis added:

Immunotherapy is also used to enhance immune responses, sometimes using drugs called “checkpoint inhibitors,” for example, to treat certain types of cancer. With checkpoint inhibitors, patients aren’t considered to be immunocompromised, Dr. Hafler adds. “After treatment, those patients may have a perfectly normal—or even a more robust—immune response,” he says.

I suspect checkpoint inhibitors are unlikely to be considered a good idea for people who have auto-immune disorders, specifically that subclass of T1D which is caused by an autoimmune destruction of parts of our pancreata.

All that said, there is a clear indication that people who have a family history of type 1 or type 2 diabetes should avoid COVID-19; i.e. get vaccinated PDQ. This is because there is statistical evidence (not, I believe, peer reviewed) of an association between COVID-19 infection and diabetes of the first two types. (So far as I have been able to determine the databases used as source for the statistics did not distinguish type 1 or type 2, so it may well be a liver problem, but so far no one knows.)

I think that is worth bearing in mind if you are T1 or T2 and have children; vaccination is a much softer, safer, bet than exposure without prep to a rabid killer.

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I am probably crazy but if NOT doing something meant Liam would have a 99.992% chance of not getting critically ill and/or dying, and DOING something meant he would have a 99.993% chance of not getting critically ill and/or dying, it would be worth the extra hassle to me to get that .001% increase in odds for a positive outcome. Just don’t ever want to leave a stone unturned.

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@jbowler
Please explain to me the significance of having a family history of T1 or T2 (I have neither and am T1).

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There’s a known correlation between onset of both T1 and T2 and family history of the same.

There is an observed statistical correlation between COVID-19 and onset of T1/T2 in one study based on two databases.

The latter is, so far as I can tell, not peer reviewed and is subject to the sunspot-cycle problem; it may be a spurious correlation. The former is not.

Nevertheless at this moment in time if you have T1 or T2 and you have children you need to seriously consider the latter correlation; by the time the scientists have worked it out it will be all over bar the cussing.

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