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Vaccine Update: COVID-19 Vaccination Guidance for People who are Moderately or Severely Immunocompromised

The Rocky Mountain MS Center’s medical team continues to strongly recommend all individuals receive the COVID-19 vaccination, including the most recent updated COVID-19 vaccination now available, unless you have a known allergy to a component of the vaccine.

The Centers for Disease Control (CDC) recommends that people aged 6 months and older who are moderately or severely immunocompromised and got COVID-19 vaccines before September 12, 2023 should get 1 or 2 doses of updated COVID-19 vaccine, depending on your age and the number of doses you got previously.

Individuals are moderately or severely immunocompromised if you are:

  • On anti-CD20 disease modifying therapy (Ocrevus, Rituxan, Kesimpta, or Briumvi)
  • Or on S1P disease modifying therapies, (Gilenya and its generics, Mayzent, Zeposia, or Ponvory), Lemtrada, Mavenclad, or any chemotherapy drugs.

For vaccine guidance for moderately or severely immunocompromised people by age and number of doses you got previously, please consult the CDC’s guidance table: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#table-02

And our medical team’s guidance on timing of your updated COVID vaccine based on your Disease Modifying Therapy is below:

For individuals on anti-CD20 disease modifying therapy or S1P disease modifying therapies, Lemtrada, Mavenclad, or any chemotherapy drugs, below is our timing guidance:

  • If on Ocrevus, Rituxan, or Briumvi,try to get your updated vaccine one month prior to your next infusion OR at least one month after your last infusion, preferably and if possible, 5 or more months.
  • If on Kesimpta, guidance is a bit less clear. In general we recommend to try to get your updated vaccine 4 weeks after your last dose of Kesimpta, and then, use the next Kesimpta injection 4 weeks after the vaccine. Thus, this means missing a single dose of Kesimpta. Discuss with your doctor.
  • For Gilenya, its generics, Mayzent, Zeposia, and Ponvory,there is no way to hold dosing, so we suggest the regular schedule to get your updated vaccine if you have not received a COVID-19 vaccine in the past 2 months.
  • We do not have specific timing guidance for Lemtradaand Mavenclad. Thus, we would suggest taking a dose anytime 3 months or more after last DMT dose and at least 4 weeks prior to next dosing.

Individuals taking any other DMT, including fumarate therapies (Tecfidera or dimethyl fumarate and its generics; Bafiertam or monomethyl fumarate; Vumerity or diroximel  umarate); Aubagio (teriflunomide); TysabriCopaxone (glatiramer acetate) or interferons such as Avonex, Rebif, Betaseron, and Plegridy; OR if you are NOT taking a disease modifying therapy should follow the general guidelines for COVID vaccination.

If you are 65 years of age or older, regardless of your age, the CDC recommends that you should receive 1 additional dose of any updated COVID vaccine at least 4 months following the previous dose of updated COVID-19 vaccine.

There are no absolute guidelines for those with recent COVID infection, but the CDC guidance is you may wish to wait three months before getting the next COVID vaccine.

New Preventative Medication for Immunocompromised Patients:  Pemivibart (Pemgarda)

For those who may not have adequate immune responses to the vaccine, Pemivibart (Pemgarda) is a monoclonal antibody prophylactic therapy for moderately to severely immunosuppressed patients who have been vaccinated but not developed protective antibodies. If you are on anti-CD20 disease modifying therapy or S1P disease modifying therapies, Lemtrada, Mavenclad, or any chemotherapy drugs, you likely qualify for Pemgarda. Talk with your health care provider about getting Pemgarda.

It’s important to note that Pemgarda is not a substitute for COVID-19 vaccination. People who are moderately or severely immunocompromised should receive COVID-19 vaccine according to the recommended schedule. It should not be taken within two weeks of a COVID vaccine, or recent COVID infection.


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