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COVID-19 Vaccination Recommendations for Immunocompromised Patient Populations: Delphi Panel and Consensus Statement
Kira Zhi Hua Lai1, Stuart Greenstein2, Rajesh Govindasamy3
1ICON Clinical Research, Dublin 18, Ireland.
Insights
Expert consensus was reached on COVID-19 vaccine primary and booster series for immunocompromised patients with specific diseases. However, some recommendations regarding antibody titers and higher dosages did not achieve full agreement among physicians.
Area of Science:
- Immunology
- Vaccinology
- Public Health
Background:
- The United States Advisory Committee on Immunization Practices (ACIP) and Centers for Disease Control (CDC) recommend COVID-19 vaccines for all immunocompromised individuals.
- Patients with rheumatologic disease, renal disease, hematologic malignancy, and solid organ transplant (SOT) are at increased risk of severe COVID-19 outcomes.
- Disease-specific vaccination recommendations are crucial for optimizing protection in these vulnerable populations.
Purpose of the Study:
- To summarize expert consensus on COVID-19 vaccination strategies for immunocompromised patients in the US with rheumatologic disease, renal disease, hematologic malignancy, and SOT.
- To develop disease-specific recommendations for primary and booster COVID-19 vaccine dosing and administration.
Main Methods:
- A two-stage Delphi panel method involving key opinion leaders (KOLs) and subsequent iterative revision of recommendations.
- Qualitative interviews with KOLs followed by three rounds of consensus-building on vaccine statements.
- An online survey of physicians (n=200) to assess agreement with consensus statements across four disease areas.
Main Results:
- Moderate to strong consensus was achieved for primary and booster COVID-19 vaccine series recommendations across all disease groups.
- Physician agreement was high (62%-96%) for primary and booster vaccine recommendations.
- Lower agreement was observed for statements regarding antibody titer measurements, higher vaccine dosages, and timing of vaccination relative to disease-specific treatments.
Conclusions:
- Expert consensus was achieved for disease-specific COVID-19 vaccine recommendations concerning primary and booster series.
- The consensus recommendations were generally well-accepted by practicing physicians.
- Further discussion is needed on specific aspects like antibody titer monitoring and higher dosage strategies for immunocompromised patients.
Introduction:
The United States Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control (CDC) recommend COVID-19 vaccines for all immunocompromised individuals. Certain disease groups are at increased risk of comorbidity and death for which disease-specific recommendations should be considered. The objective of the Delphi panel of experts was to summarize expert consensus on COVID-19 vaccinations for patients with rheumatologic disease, renal disease, hematologic malignancy and solid organ transplant (SOT) in the US.
Methods:
A two-stage Delphi panel method was employed, starting with qualitative interviews with key opinion leaders (KOLs) in the four disease areas (n = 4 KOLs, n = 16 total) followed by three rounds of iterative revision of disease-specific COVID-19 vaccine recommendations. Final consensus was rated after the third round. Statements addressed primary and booster dosing (e.g., number and frequency) and other considerations such as vaccine type or heterologous messenger ribonucleic acid (mRNA) vaccination. Following the Delphi Panel, an online survey was conducted to assess physician agreement within the disease areas (n = 50 each, n = 200 total) with the consensus statements.
Results:
Moderate to strong consensus was achieved for all primary series vaccination statements across disease groups, except one in hematology. Similarly, moderate to strong consensus was achieved for all booster series statements in all disease areas. However, statements on antibody titer measurements for re-vaccination considerations and higher dosages for immunocompromised patients did not reach agreement. Overall, approximately 62%-96% of physicians strongly agreed with the primary and booster vaccine recommendations. However, low agreement (29%-69%) was found among physicians for time interval between disease-specific treatment and vaccination, recommendations for mRNA vaccines, heterologous mRNA vaccination, antibody titer measurement and higher vaccine dosage for immunocompromised groups.
Conclusion:
Consensus was achieved for disease-specific COVID-19 vaccine recommendations concerning primary and booster series vaccines and was generally well accepted by practicing physicians.
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