[Unmet Challenges in COVID-19 Prevention for Immunocompromised Individuals: A Consensus Analysis from Portugal]

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulted in significant disease burden and mortality. Despite vaccination successes, new virus variants persist, affecting unvaccinated and immunocompromised individuals (ICI) severely. These high-risk groups face elevated mortality and hospitalization rates. Vigilance and targeted health measures remain crucial post-pandemic. The aim of this study was to develop consensus on the unmet needs in COVID-19 prevention among ICI.

We performed a Delphi study involving 45 experts, including physicians, health managers, policymakers, public health experts, members of medical societies and patient organizations. Consensus was achieved at 65% for each identified strategy using a scale ranging from "strongly agree" to "strongly disagree." Three Delphi rounds were conducted to address four key questions: identifying unmet needs in COVID-19 prevention for ICI; identifying the characteristics that distinguish ICI as a susceptible group; determining the main outcomes of COVID-19 in ICI; and indicating action plans for protecting ICI. The first round involved voting on pre-identified indicators. The second and third rounds involved analyzing the gathered information and voting on each indicator to achieve consensus.

A retention rate of 80% was achieved. Out of 89 valid indicators analyzed, 23 achieved consensus. These included: eight indicators highlighting the importance of raising awareness about COVID-19 and vaccination outcomes, ensuring safety and understanding, and developing targeted immunization strategies for ICI; five indicators identifying susceptible groups within ICI, such as individuals undergoing chemotherapy or radiotherapy, those with primary immunodeficiencies, solid organ transplant recipients, patients with chronic kidney disease, and bone marrow transplant recipients; two indicators showing improvements in clinical outcomes and reduced hospitalizations; and eight indicators recommending the development of effective therapies, more immunogenic vaccines, and treatments for viral infections in ICI.

The study emphasized the importance of targeted immunization strategies, monitoring, and tailored education to address diverse needs of ICI. These findings provide a foundation for future policies to effectively manage and protect ICI during and beyond the COVID-19 pandemic.