[tpmx]

Relevant criteria for the question "does it it exclude old, fragile people with various common pre-existing conditions?" (not exhaustive, but indicative):

Included: Pre-existing conditions are okay as long as they are in a stable condition (defined as no significant change in therapy etc for the 3 months before enrollment).

Excluded: Immunosuppressive or immunodeficient state, asplenia, recurrent severe infections (HIV-positive participants with CD4 count ≥350 cells/mm 3 and an undetectable HIV viral load within the past year [low level variations from 50-500 viral copies which do not lead to changes in antiretroviral therapy [ART] are permitted]).

Looks fair enough to an amateur like myself.

Edit: Not sure how common a immunosuppressive or immunodeficient state is in a typical population. Perhaps it's common enough to be relevant?

[Majromax]

Immune suppressed/deficient patients are not good candidates for vaccines in the first place, since they would be unlikely to mount an effective immune response.

[tpmx]

I forgot that part.

That's the reason why also young healthy people need to take the vaccine in order to stop the spread. It's a solidarity gesture.

[maxerickson]

A vaccine is likely to be safer for low risk people than a course of infection, it's not just helping slow the spread.

[sp332]

I think tpmx's point is that the virus would also be less dangerous for them, so getting the vaccine has less chance of having a net benefit for the individual.

[tpmx]

Yeah, it was, but I think the argument that the vaccine is a safer option for this crowd is also a pretty persuasive argument.

I'm not exactly in this crowd (I'm 43) but given what I now know about the prevalence of scary long term covid-19 issues ("long haulers") in young people, I would take this vaccine in a heart beat "even" if I were young.

[dotuser]

That sounds backwards. Shouldn't those with weakened immune response be first in line for the vaccine? The vaccine would give them a boost. Those with strong immune response have a better chance of fighting off the virus.

[jrochkind1]

Marjomax isn't saying that those with weakened immune responses don't need protection against the virus. They are saying vaccines do not work well in immunosuppressed people, the vaccine will not necessarily provide protection.

Vaccines work by triggering the immune system in the first place. If your immune system is not functioning normally, the vaccine may work differently or not work.

I think it's more complicated than just as a blanket "won't work". But, yeah, more complicated means more complicated -- different vaccines may be infffective, or require a higher dose, or even be harmful to immunosuppressed people. As far as the study, it would probably require a separate study focused on immunocompromised people? The fact that these are new mRNA-style vaccines is possibly relevant, maybe we know even less? Obviously we're in a rush here, there's lots of studies that would be really good to do that haven't been done yet, all that's been done is like a basic "normal people everyone" study. From which immunocompromised people were excluded because they are likely to respond to the vaccine differently, so need a different study design etc.

https://immunisationhandbook.health.gov.au/vaccination-for-s...

(And btw, THIS is what "herd immunity' is about. If enough people are immune (say from a vaccine), then there aren't enough carriers to pass it around the population, so those who AREN'T immune (possibly because they are immunocompromised and the vaccine wouldn't work on them or would be dangerous) still have much reduced chance of getting infected. Because, yeah there are people who can't take vaccines because they would be dangerous or ineffective, but may still be at high risk for complications from the virus)

[tsimionescu]

Vaccines work by essentially teaching your immune system to recognize a pathogen. If your immune system is in a very weakened state, it likely will not 'learn', and even if it does, it may not be in any condition to fight the infection, even if it recognizes it as such. Of course, things are much more complicated, but in people with severe immuno-deficiency (such as advanced AIDS or people who are actively taking immune suppressants) a vaccine will not have any effect (some kinds of vaccines even risk infecting that person with the disease, though I beleiev this is not the case with any of the Covid19 vaccines).

[cm2187]

That could exclude people who are the most likely of dying of covid (a severe case of covid doesn't mean dying, for instance I heard an ICU specialist explaining that people who are seriously obese often require ICU treatment but rarely die from it, the people who die usually have serious co-morbidities and an already reduced life expectancy).

But it's kind of secondary anyway. The main goal of the vaccine is to stop the virus from spreading in the population and getting a chance to reach vulnerable people. Even if it were to only protect people who wouldn't die of Covid in the first place, that's the vast majority of the population and enough to significantly reduce the chance of spreading.

At the condition that these studies measure the right thing. If it merely stops the symptoms but doesn't stop the spread of the virus, that may be a problem.

[disgruntledphd2]

I think (from my parents and in-laws) that immunosuppression is normally associated with current cancer treatment.

So, for example, it looks like this protocol would exclude people getting chemotherapy.

Happy to be proven wrong on this by someone with more information.

[w45673456354]

And autoimmune conditions, robbing a list from wikipedia: celiac disease, diabetes mellitus type 1, Graves' disease, inflammatory bowel disease, multiple sclerosis, psoriasis, rheumatoid arthritis, and systemic lupus erythematosus.

I don't know how many people with conditions take immunosuppression medication. I take it for arthritis and alopecia and have come across many people on similar meds for diabetes or other things. But that could be a form of confirmation bias

[Skunkleton]

Don't forget organ transplants.

[TearsInTheRain]

Does this mean the vaccine wont be given to people with psoriasis?

[eropple]

It means it hasn't been, and thus needs more study in that regard.

My inexpert understanding is that mRNA vaccines such as this one are unlikely to have an impact on many autoimmune cases. In many, perhaps most, others, it appears from my reading to be likely that the generated interferons are not adding anything to the likelihood of developing an autoimmune condition that wouldn't eventually already happen. (It might be the nudge over the cliff, but so might have the next common cold you catch.) But it should be tested to understand, regardless.

[rjsw]

There was a suggestion that people with autoimmune conditions were more likely to get "long COVID".

[raducu]

What is "long covid"?

People experiencing long term symptoms? I can believe that, my tinnitus after covid-19 is still there, even if I don't notice it as much.

Actual viral infection? I really doubt that, thoug perhaps it could hide like the herpes virus.

[noneeeed]

The first. Long lingering after effects. For some they are fairly minor, but for many they seem to be quite tough, with significant problems doing any kind of physical activity.

At the moment it's all quite nebulous, with a lot of anecdote and not enough data. But there are some studies starting up that might start to untangle what's going on.

[chimeracoder]

> I think (from my parents and in-laws) that immunosuppression is normally associated with current cancer treatment.

There are other reasons a person would be considered immunosuppressed, and plenty of non-chemotherapy drugs that have immunosuppressive effects. But yes, cancer is one of them.

It would make no sense to include immunosuppressed people in the initial trials for a vaccine, the purpose of which is to determine whether a vaccine can induce an immune response.

[disgruntledphd2]

Yeah, agreed.

My selfish concern is then whether or not the vaccine will work for them.

[chimeracoder]

> My selfish concern is then whether or not the vaccine will work for them.

We won't have hard data on that specific question for a very long time, but it's something your/their doctor would be better equipped to make an educated guess about, given the specifics of their situation ("immunosuppressed" can mean a range of things). In some cases, a vaccine might do nothing. In some, it might be actively dangerous. In some, it might have a weaker but still nonzero protective effect. But I wouldn't trust anything you read on HN that tries tell you anything more specific than that.

[tsimionescu]

Unfortunately, vaccines can't really help immunocompromised people, as their immune system is simply unable to fight off any infection, regardless of whether it recognizes the infection or not (of course, this may be a matter of degrees). That is why, for example, people with advanced AIDS can die from essentially any pathogen.

[chimeracoder]

Your answer isn't exactly wrong, but it's painting with a broad brush. "immunocompromised" is a broad term (even more so than "immunosuppressed"), so there definitely are people who are immunocompromised who could potentially benefit from a vaccine (again, we don't have hard data on that yet for any of the vaccine candidates and won't for a while).

[iso1210]

They do help indirectly - by innoculating the 90% who can take a vaccine, the 10% who can't (for example babies when it comes to measles vaccines) are unlikely to actually catch the disease.

[tsimionescu]

Oh, for sure, I wasn't trying to say vaccines shouldn't be used! They are extremely important to a healthy population overall, and it is all the more important for people with healthy immune systems to get them to help protect those that can't benefit directly.

[lokar]

Transplant recipients (which must be on suppressants for life) can and do take vaccines and they work. They generally can't take live virus vaccines, but that's about it AFAIK.

[shabda]

Also, Anybody who has received an organ transplant is immunosuppressed. They take immunosuppressive drugs so that the transplanted organ is not rejected.

[raducu]

It would be so nice if those people could have access to a coctail of synthetic antibodies that gave some protection to covid-19, the flu and others. Or perhaps a generic antibody that protects against most viruses(unlikely, given such an atibody does not exist in nature).

[duskwuff]

Antibodies don't themselves help fight infections; their role is simply to identify dangerous pathogens to white blood cells. In immunosuppressed patients, those cells often aren't present (or aren't responding properly), so adding antibodies wouldn't help.

[projektfu]

Antibodies also initiate the complement cascade and can thus kill cells directly.

[JulianMorrison]

Also transplant recipients take suppressants so their immune system doesn't reject the graft.

[yread]

That's why it's so important that all the people who can get the vaccine get it - this is the herd immunity everyone is yammering about. If the healthy people are vaccinated the virus won't be able to spread to the people who can't get vaccinated.

[nicholasjarnold]

> Not sure how common a immunosuppressive or immunodeficient state is in a typical population.

Pregnant women are considered immunosuppressed to a certain extent. I'm a software engineer and not a doctor though, so someone could perhaps shed more light on this.

[lokar]

Almost 40,000 people got an organ transplant in the US in 2019

[reaperducer]

And almost 140,000 people got COVID in the US yesterday.