Vaccine efficacy in Cirrhosis

[White-pine]

How effective are the vaccines for people with cirrhosis? I am assuming that since your liver is not as effective at providing immunity, even with the vaccine, you may still be at risk?

[AyrshireK]

That's correct, reduced vaccine efficacy in anyone with lowered immunity either through immune system damage or through immune suppressant meds etc. (it was detailed in the vaccine green book). So even if you've had the jag you still have to take care - as do we all in effect due to new variants etc.

[White-pine in reply to AyrshireK]

Thank you, AyrshireK! What is the vaccine green book? I’m in Canada and I’m looking at 4 months between shots, eek!

[AyrshireK in reply to White-pine]

In the UK the government have paperwork which goes into all the workings of the condition, the vaccine programme and all sorts of other details. I don't know whether you'd be able to access it in Canada as no doubt the system over there varies to ours. assets.publishing.service.g...

A section within it regarding immunosuppression and the vaccine reads:-

Immunosuppression and HIV

Individuals who have immunosuppression and HIV infection (regardless of CD4 count) should be given COVID-19 vaccine in accordance with the recommendations and contraindications above. Although AstraZeneca COVID-19 vaccine contains a live adenovirus vector, this virus is not replicating and is considered safe in immunosuppressed people. Other adenovirus vector vaccines have been trialled in populations with high prevalence of HIV and shown no serious adverse events (Kennedy et al, 2017). Although individuals with stable treated HIV infection were not excluded from the phase 3 trial of the Pfizer and Moderna mRNA vaccines, data on

safety and effectiveness in this group have not been presented. A study of the AstraZeneca vaccines in people living with HIV infection is underway.

Individuals with immunosuppression may not make a full immune response to vaccination.

As there is no evidence on response in immunosuppressed individuals there is also no

evidence upon which to base advice on the optimal timing of delivery. Specialists may

advise their patients based on their knowledge and understanding of their immune status

and likely immune response to vaccination, but should also consider the risk from

COVID-19 and the patient’s likelihood of exposure. The small number of patients who are

about to receive planned immunosuppressive therapy should be considered for vaccination

prior to commencing therapy (ideally at least two weeks before), when their immune

system is better able to make a response. Where possible, it would also be preferable for Chapter 14a - 16

COVID-19 -

SARS-Cov-2

Chapter 14a - COVID-19 - SARS-CoV-2 12 February 2021 the 2-dose schedule to be completed prior to commencing immunosuppression. This would entail offering the second dose at the recommended minimum for that vaccine (three or four weeks from the first dose) to provide maximum benefit that may not be received if the second dose was given during the period of immunosuppression. Any decision to defer immunosuppressive therapy or to delay possible benefit from vaccination until after therapy should not be taken without due consideration of the risks from COVID-19 and from their underlying condition. Although the immune correlates of protection are currently unknown, post-vaccination testing may be considered. Until further information becomes available vaccinated patients with immunosuppression should continue to follow advice to reduce the chance of exposure.

[White-pine]

Able to access! A ton of thanks for this!