Immunosuppression Prevalence Doubled, Linked to Medication Use and COVID: Experts

In 2021, an estimated 6.6 percent of U.S. adults were immunosuppressed. The estimate was 2.7 percent in 2013.

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Between 2013 and 2021, rates of immunosuppression in adults doubled, according to estimates from a Journal of the American Medical Association (JAMA) research letter.

In 2021, an estimated 6.6 percent of U.S. adults were immunosuppressed. “This rate of immunosuppression was higher than the previous national estimate of 2.7 percent using the 2013 [National Health Interview Survey],” the authors wrote in their paper.

The researchers estimated immunosuppression prevalence by analyzing National Health Interview Survey (NHIS) results.

Specifically, the authors analyzed responses to five questions. More than 29,000 individuals were asked if they had health conditions or were taking medications or treatments that would weaken their immune systems. They were also asked if they had cancer or malignancy and, if so, which type of cancer and what their ages were at the time of cancer diagnosis.

In 2013, more than 34,000 people were interviewed, garnering a response from 75 percent of households. In 2021, only about half of the households contacted responded to the survey.

Why the Rise in Immunosuppression?

“Given the documented increase in immunosuppression, studies are needed to understand the causes for this increase,” the authors wrote. However, they mentioned that the rise in self-reported immunosuppression may be because of increased use of immunosuppressive medications.

The use of adalimumab, a drug used to treat autoimmune conditions, increased 3.5-fold between 2014 and 2021.

Immunosuppression carries significant risks, “including an increased susceptibility to infections, potential organ rejection, side effects of immunosuppressant drugs, elevated cancer risk, and pregnancy-related concerns,” Mohammed Razzaque, professor of pathology at the Lake Erie College of Osteopathic Medicine, told The Epoch Times.

Immunosuppression occurs naturally with age, but it can also occur because of the individual being on various immunosuppressive therapies. People undergoing such therapies include organ transplant patients and those with autoimmune diseases or cancer.

Dr. William Schaffner, a professor of medicine and preventative medicine at the Vanderbilt University School of Medicine, reasoned that the rising prevalence could signify progress in science and health.

“There are more and more people being kept alive and are being treated with immunosuppressant agents in the United States, and that treatment is extending life, which means that the proportion of the population that is immunosuppressed is increasing,” Dr. Schaffner said.

Crude data from the NHIS have also shown a rise in self-reported rates of cancer. According to 2015 statistics from the U.S. Centers for Disease Control and Prevention, 8.7 percent of adults reported having cancer. In 2021, it was estimated that 9.8 percent of adults had cancer.

The most recent NHIS in 2022 estimated a slight decrease from the 2021 rate, with 9.6 percent of adults reporting having cancer.

The COVID-19 pandemic may have also made individuals more aware of their immune health and whether they’re immunosuppressed, the research letter authors said.

COVID-19 and Immunosuppression

Studies have shown that the COVID-19 disease can disrupt the function and order of the immune system, leading to immune dysfunction and possible immunodeficiency.

A 2023 study published in Nature Reviews Rheumatology found that people infected with COVID-19 are at greater risk of developing autoimmune diseases, which may be linked to potential immunodeficiencies.

The COVID-19 pandemic may have been particularly challenging to those already immunocompromised.

Immunocompromised people tend to have an increased disease severity if they become infected with COVID-19, and the vaccine appears to be less effective for them. Public health measures put in place during the pandemic may also have created obstacles for these people to access health care and therapies for their immunosuppression, Dr. Razzaque said.

Other researchers and physicians argue that the COVID-19 vaccines may also contribute to immunosuppression and deficiencies, although some research produced opposite findings.

Research from Cleveland Clinic suggests that repeated boosting of COVID-19 vaccinations has been shown to put a person at risk of future COVID-19 infections. Another letter to the editor from Columbia University authors published in The New England Journal of Medicine showed that people with higher vaccine antibody levels after vaccination were more strongly associated with breakthrough infections.

Most recently, an Australian review suggested that repeat COVID-19 vaccine boosting in immunocompromised individuals may impair immune activation within this population, possibly making them more vulnerable to infections and cancers.

In a publication, Dr. Razzaque pointed to increased influenza infections reported in people who receive repeat influenza vaccinations, speculating whether frequent boosting may be linked to immunosuppression.

Dr. Schaffner said whether increased infections linked to repeat vaccinations are a sign of general immunosuppression is debatable.

“It’s a very debatable issue,” he said, noting that even if there is an increased risk of COVID-19 infection linked to repeat vaccination, there doesn’t seem to be “serious evidence” indicating a “general suppression of the immune system.”

However, works by Nordic researchers Drs. Peter Aaby and Christine Stabell Benn suggest that non-live vaccines, including COVID-19 and influenza vaccines, tend to make the immune system “lazy” and less equipped to fight an infection. In contrast, live vaccines train the immune system to become better fighters.

Dr. Sabine Hazan, a gastroenterologist and the CEO of ProgenaBiome, has said that the COVID-19 vaccine may cause immunosuppression by reducing good bifidobacteria in the gut. She showed that after COVID-19 mRNA vaccination, bifidobacteria levels dropped by half among her trial participants.

Bifidobacteria are essential for boosting intestinal immunity. Dr. Hazan’s earlier work showed that people with reduced bifidobacteria in the gut were at risk of severe COVID-19 infections and that therapeutics that replenished the bifidobacteria, such as vitamins C and D and ivermectin, improved patient survival rates.

“The pandemic appears to have influenced what the public thinks about their immune system. There has been a big jump in perceived weakness in the immune system. More research is needed to determine if either SARS-CoV-2 infection or COVID-19 vaccine indeed has impaired human immunity according to these perceptions,” Dr. Peter McCullough, renowned cardiologist and internist, told The Epoch Times.