Immunocompromised: What does it mean and how does this affect you?

Upon encountering the global pandemic in March 2019, living with a weakened immune system (immunocompromised or immunosuppression) has not been easier. For some, it increases the chance of contracting illness and infection, as well as the renowned Covid-19. 

According to the Center for Disease Control and Prevention (CDC), the immune response to COVID-19 vaccination may not be as strong as in people who are not immunocompromised as their immune systems aren’t able to mount a robust response. 

With ongoing research and uprising of different variants of Covid-19, there are still loopholes and questions on the immunocompromised precautions and how this is going to affect their life in the long term.

How to know if I have a weak immune system?

Our immune system acts as a defence and protection against various health issues, including foreign (bacteria and viruses) and domestic diseases like cancer. However, certain conditions and/or treatments can weaken the immune system. Each state can be either permanent or temporary, depending on why it happens. Immunosuppression can be caused by:

1. Chronic diseases 

HIV and AIDS are commonly known to destroy immune cells, leaving your body vulnerable to other attacks. Autoimmune conditions turn immune cells into double agents that fight against your own healthy tissues. Common autoimmune diseases include:

• Lupus
• Rheumatoid arthritis
• Type 1 diabetes

One of the famous celebrities and former Disney star, Selena Gomez shared her experience of having the autoimmune disease (Lupus) for better understanding and awareness of this issue.

2. Medical treatments 

• Chemotherapy or radiation treatments lower your white blood cell count which helps to fight disease. With your white blood cell count lowered, the immune system is compromised.
• Long-term use of corticosteroids and therapies like biologics and disease-modifying antirheumatic drugs (DMARDS) to reduce inflammation and lower immune system function to calm it down.

3. Organ or bone marrow transplant

In the first few weeks of a bone marrow transplant, patients are more vulnerable to infections due to low counts of white blood cells. Patients are also put on anti-rejection drugs and immune suppressants to assist their bodies in accepting the new cells and to prevent the new immune cells from attacking normal tissues.

Covid-19 Risks on The Immunocompromised

It is hard to put a finger on which group of immunocompromised people would face the greatest danger when it comes to Covid-19, as the data is largely mixed. Due to this, it is hard to sort individuals definitively into risk categories.

David Hafler, a neurologist and immunobiologist at the Yale School of Medicine mentions that everyone has a different immune system. The variability really depends on the roles of genetics, which is why the severities differ for everyone.

However, the presence and level of SARS-CoV-2 antibodies in the blood (are products of the immune system’s defence against the virus) can be tested. Still, it does not guarantee full protection from the infection.

Ultimately, it is best to seek professional help to diagnose your immune system problems with a health care provider that knows you well.

Does pregnancy indicate a weak immune system?

The immune system in pregnant women is quite complex, but it does not mean that they are immunocompromised. It really just means that their immune system functions differently compared to non-pregnant people. 

Although, there is the usage of immunosuppressive treatments to aid with some inflammatory and autoimmune diseases, as well as transplantation. Unfortunately, this might be harmful when it comes to fertility, pregnancy outcomes and the unborn child.

• Steroids increase the risk of a rupture (breaking open) of the amniotic sac before labour begins, amplifying the risks of hypertension and gestational diabetes.
• Cyclosporine might contribute to high prematurity rates. 
• The risk of transmission of hepatitis viruses of a pregnant mother to their baby is approximately 5 % and varies depending on the amount of virus in the body after liver transplantation.

Protecting the vulnerable ones: what can we do?

Good basic hygiene goes a long way in helping those with immunosuppression. Here are some of the suggestions:

• Washing your hands with soap and water for at least 20 seconds or use a hand sanitiser  

• Wearing well-fitted masks in public places and avoiding the huge crowd

• Take your vaccinations as recommended and keep up to date with the latest vaccination news.

• Remain six feet away from others (social distancing) when you do have to go out in public.

• For those affected, it is advisable to keep taking the medications to avoid any life-threatening problems.

References

Vincent T. Armenti, Michael J. Moritz, Elyce H. Cardonick and John M. Davison (2002). Immunosuppression in Pregnancy Choices for Infant and Maternal Health,”THERAPY IN PRACTICE”, 62 (16), 2361-2375.

Monica Fung, Jennifer M. Babik. (2020). COVID-19 in Immunocompromised Hosts: What We Know So Far. Clinical Infectious Diseases, 72 (2), 340–350.

Harvard University. (2012, October 15). THE IMMUNOLOGY OF PREGNANCY. Science In the News, Issue 128. https://sitn.hms.harvard.edu/flash/2012/issue128.

Centers for Disease Control and Prevention. (2022, March 2). People with Certain Medical Conditions. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

Penn Medicine. (2020, May 13). What You Need to Know About Being Immunocompromised During COVID-19. https://www.pennmedicine.org/updates/blogs/health-and-wellness/2020/may/what-it-means-to-be-immunocompromised

Centers for Disease Control and Prevention. (2022, March 2). People with Certain Medical Conditions. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html

University of Utah Health Communications. (2022, March 2). LIVING IN A COVID-19 PANDEMIC WHILE IMMUNOCOMPROMISED. https://healthcare.utah.edu/healthfeed/postings/2022/03/immunocompromised-covid.php

Keren Landman. (2022. April 6). What immunocompromised people need to know right now. Vox.

Ashley Abramson. (2021, August 21). Selena Gomez Underwent Chemotherapy for Lupus—Here’s How the Treatment Helps Those With the Disease. Health. https://www.health.com/condition/autoimmune-disease/selena-gomez-chemotherapy-lupus

Lupus Foundation of America. (April 29, 2020). What is Lupus?. https://www.youtube.com/watch?v=RvqfsAMQ3Ic