Doctor clarifies who needs 4th dose of vaccine; 10 new deaths reported

Christine Spencer fills a syringe with the Moderna COVID-19 vaccine at a Salt Lake County Health Department mobile site at Tejeda's Market in Salt Lake City on Dec. 29, 2021. Utah health officials reported another 10 deaths and 1,392 COVID-19 cases on Wednesday.

Christine Spencer fills a syringe with the Moderna COVID-19 vaccine at a Salt Lake County Health Department mobile site at Tejeda's Market in Salt Lake City on Dec. 29, 2021. Utah health officials reported another 10 deaths and 1,392 COVID-19 cases on Wednesday. (Scott G Winterton, Deseret News)

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SALT LAKE CITY — A University of Utah doctor and professor explained Wednesday that a fourth COVID-19 vaccine dose — currently recommended for immunocompromised patients — is really their first booster dose, after three doses are recommended in an initial sequence for people with certain conditions.

Dr. Hannah Imlay, with University of Utah Health, said the fourth dose will putimmunocompromised people at a similar vaccine response to someone who has had two initial doses and one booster.

Imlay, who is an assistant professor of infectious diseases at the U. School of Medicine with an expertise in immunocompromised patients, explained that the two-dose mRNA vaccine regimen did not work as well on people who were immunocompromised and so a third dose is considered part of the initial vaccine sequence. This booster shot they are now eligible for will be a smaller dose.

Immunocompromised patients are at a higher risk of severe disease and death and do not always respond well to vaccines, as has been the case with the COVID-19 vaccine. Those who should receive a fourth dose include anyone who has a deficiency in their immune system due to a disease or medications, like chemotherapy, or who have had transplants.

Utah health officials reported another 10 deaths and 1,392 COVID-19 cases on Wednesday, as numbers are showing that the surge in omicron cases is slowing.

Right now, the seven-day rolling average number of cases is 1,296 per day, and 28% of tests in Utah for different people are positive.

Imlay said that last summer it was determined that patients on chemotherapy, with organ transplants, with stem cell transplants or on other immune-modulating medicines did not respond to the vaccine primary series as well as others. A third dose of an mRNA vaccine was authorized for them, which is recommended at least 28 days after the second dose.

The U.S. Centers for Disease Control and Prevention clarified last week that these individuals can get a booster vaccine dose three months after the third dose. Immunocompromised people who got the Johnson and Johnson vaccine and then a dose of an mRNA vaccine are also eligible to get another booster dose.

"Most of our immunocompromised patients should go out and get their fourth dose of mRNA vaccine," Imlay said.

Although these are the current recommendations, she said the topic is still being researched and recommendations could change in the future, especially as studies of the impact of the omicron variant on immunocompromised individuals are still in progress. There is a possibility that a fifth or sixth dose may be authorized.

"I would recommend everybody ... whether you're immunocompromised, immunocompetent, or somewhere in between — to take advantage of all of the preventative therapies, especially vaccination, especially masking, because these really helped decrease both the incidence of SARS-CoV-2 in our community and also the number of patients who are getting severely sick or dying and who are leaving our community too soon," Imlay said.

The infectious disease specialist suggested people who may qualify should talk to their primary physicians about the booster, saying a conversation about your specific situation is important when considering something like a vaccine or medication, because there are risks and benefits to consider, especially when it has been given emergency use authorization.

Elderly individuals do not yet qualify for this fourth dose if they do not have something hindering their immune system, although Imlay said that elderly people do not have the same response to a COVID-19 vaccine or other vaccines as younger people, so Imlay said this guidance could change in the future.

There is no requirement for a doctor's note or prescription saying a person is immunocompromised to get the dose, but Imlay said people not immunocompromised probably do not need to get another dose right now. She said the CDC has not yet recommended a fourth dose for the general population.

"If you have medical conditions, but none of them affect your immune system, you probably have had a good immune response to the vaccine. And so again, you know, even with waning antibody responses, and waning responses to symptomatic infection, your response to vaccine is probably up there with the general population," Imlay said.

Imlay encouraged the public to continue to be mindful of the immunocompromised population and take steps to protect them, including wearing masks and getting the recommended COVID-19 vaccinations and boosters.

"Some of these same sort of public health measures that have worked or not worked when we've employed them this whole time, are really what we can all do to help our immunocompromised community members," Imlay said.

Wednesday COVID-19 numbers

Of the 1,392 cases reported on Wednesday, school children account for 183. Of those cases, 86 were children ages 5-10, 38 were ages 11-13, and 59 were ages 14-17.

The health department reported another 5,269 people were tested and 3,517 people were vaccinated since Tuesday.

Utah Department of Health is reporting that over the last 28 days, people who are not vaccinated have an 8.5 times greater risk of dying from COVID-19, are 4.3 times more likely to be hospitalized due to COVID-19 and are 2.4 times more likely to testing positive for COVID-19, compared to vaccinated people.

Health officials are currently reporting that 68.7% of Utahns have received at least one dose of a COVID-19 vaccine, 60.7% of Utahns are considered fully vaccinated and 26.2% of Utahns have received a booster shot. This data includes all Utahns, including those who are under 5 and do not have a vaccine approved for them.

There are now 498 people who are hospitalized throughout Utah with COVID-19, according to the health department. Prior to Wednesday, the last day that hospitalizations were below 500 was on Jan. 3.

COVID-19 is currently the cause of just over 5% of emergency room visits, down from almost 19% at the height of the recent surge of omicron variant cases.

The 10 deaths reported on Wednesday include:

  • A Box Elder County man, 65-84, unknown whether he was hospitalized or a long-term care facility resident.
  • A Box Elder County woman, 65-84, unknown whether she was hospitalized or a long-term care facility resident.
  • A Davis County woman, over 85, a long-term care facility resident.
  • A Salt Lake County man, 45-64, hospitalized.
  • Two Salt Lake County men, 65-84, unknown whether they were hospitalized or in long-term care facilities.
  • A Salt Lake County man, 65-84, hospitalized.
  • A Utah County man, over 85, hospitalized.
  • A Washington County man, over 85, hospitalized.
  • A Weber County woman, 65-84, hospitalized.

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Emily Ashcraft joined as a reporter in 2021. She covers courts and legal affairs, as well as health, faith and religion news.


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