COVID-19 Response - Read our latest updates

COVID Vaccines

What do we know?

How many shots do I need? When do I have to receive them?

There are currently 2 approved vaccines: Pfizer vaccine is 2 shots given 21 days apart, while Moderna vaccine is 2 shots given 28 days apart. A couple of other vaccines are nearing the end of their studies and should be seeking FDA approval soon. Most likely, you will not have a choice of which to pick. Fortunately, we feel the current options are too similar to differentiate. We are expecting emergency use authorization for the Johnson & Johnson vaccine very soon. We would recommend taking any vaccine offered to you and not waiting.

Is the vaccine in general safe?

Yes. Although the technique to produce these vaccines is new to us, it has been studied for over a decade. Before FDA approval, it has been studied in thousands of patients. Now with release, they have been given to millions, including all 4 of the doctors at WSCA. Although there is a genetic component, it does NOT get into your cell nucleus and cannot alter your DNA. With millions of doses given, the side effects have all been typical of every other vaccine.

Is it safe for me to receive these vaccines with my auto-immune condition? Or with my medication?

Yes. It is safe for you. NONE of the vaccines under development or currently available in the United States are live virus vaccines. This is purposeful so that everyone can get them. The vaccines are currently messenger RNA based, which is the recipe our bodies use to make proteins. This recipe includes what is needed to stimulate your immune system to react against the virus if you get the infection. COVID-19 is a new virus. Without the vaccine, no one will have natural immunity. So, this is the ONLY additional way to protect yourself from getting the infection, which can be serious and life threatening. We are concerned that having an autoimmune condition may increase the risk of serious consequences from the virus. It is not clear if your medications increase this risk. There is some evidence that some biologics may PREVENT serious disease. Stay tuned.

How effective is the vaccine?

These vaccines appear to be >95% effective over the time studied-which is several months already. You most likely will need a booster even after the 1st 2 doses. We should learn when this is needed by following the thousands of people already in the studies that have at least a 3-4 month “head start”. It most likely will be at least yearly, like the flu vaccine. Good immunity against the virus occurs a week or 2 AFTER the second dose, so we will all need to continue to practice distancing and wear masks. There appear to be some strains that have mutated to a more virulent strain, mostly in Europe. Considering the immunology of the vaccine, it most likely will cover these strains although we need to follow closely. Vaccines can adapt to these strains as well.

What if I already have had COVID?

If you already had COVID, we believe you should be vaccinated also. But we do not have information on this situation either. People with prior infection were excluded from the vaccine study. There have been reports of some patients losing that immunity 3 months after contracting the virus.

Do I need to change my medication regimen to receive the vaccine? Here are the ACR recommendations:

We are now recommending a 1 week hold of methotrexate after receiving your vaccine if your arthritis is well controlled. If possible, hold again for 1 week at the second vaccine dose. This will enhance your body’s ability to develop immunity. None of these recommendations are based on safety concerns; they are in place to make the vaccine most effective.

Hold your JAK inhibitor (Xeljanz, Rinvoq, or Olumiant) for 1 week after each vaccine dose.

Hold SQ abatacept (Orencia) one week before and one week after the FIRST vaccine dose only. Do not interrupt the dosing for the second vaccine dose.

Ideally if you are on IV abatacept (IV Orencia), time your vaccine administration so that the first vaccination will occur four weeks after your last infusion (aka, when you are due for your infusion). Postpone your infusion by one week (ie, a 5-week gap in total). No modification should be made for your second vaccine dose.

Rituxan is a bit complicated. If you can maintain other preventive measures (like self-isolation, good mask use, social distancing) we would like to time the vaccine so you are receiving them both prior to your due date for your Rituxan (the last month before your next infusion). We would then hold the Rituxan for 2-4 weeks after the 2nd vaccine dose if disease activity allows (meaning the arthritis has not flared up). It would be preferable to talk to your doctor about your specific situation regarding Rituxan.

Ideally, we would like to have your prednisone dose below 20 mg prior to vaccination if this is possible. Please contact your doctor to discuss whether this is feasible before making any changes to your prednisone dose!

No modifications are needed if you are taking the following list of medication: hydroxychloroquine /Plaquenil, sulfasalazine/Azulfidine, leflunomide/Arava, Mycophenolate/Cellcept, Azathioprine/Imuran, Humira, Enbrel, Cimzia, Simponi, Remicade, Actemra, Kevzara, Ilaris, Cosentyx, Taltz, Stelara, Tremfya, Belimumab/Benlysta, tacrolimus, oral cyclophosphamide

https://www.rheumatology.org/Portals/0/Files/COVID-19-Vaccine-Clinical-Guidance-Rheumatic-Diseases-Summary.pdf

When will the vaccine be available to me?

The CDC is recommending that patients with chronic conditions are vaccinated in Group 1C. Group 1A is frontline healthcare providers and long-term care residents. Group 1B includes front line workers like police, firemen and teachers, and people over age 65. As this rolls out, it will become evident when you should get the vaccine. Stay in touch. Feel free to contact us for advice or if there’s confusion.

How long does immunity last after vaccination? Will I need a booster every year?

We do not know how long you will be protected from the vaccine. The current studies only guarantee a few months. However, the study will continue for 2 years to document how long patients remain protected. We will know this answer over time.

What are the side effects? I read on Facebook that they are severe! 

In the published Pfizer study, the main observed side effects were fatigue, headaches, muscle aches, arm pain, joint pain, fevers, chills, vomiting and diarrhea. All resolved within 2 days and they were more common after the second vaccine dose. Remember that side effects are not reported in most people; they are possibilities and not guarantees.

There have been a few cases of severe allergic reactions. No one has died from these allergic reactions. This has resulted in a recommended monitoring period after the vaccine is given to 15-30 minutes to monitor for these side effects. If you have a history of severe allergies requiring an epi-pen, we recommend discussing your situation with your allergist first.

BOTTOM LINE:

The infection fatality rate for people with COVID symptoms ranges between 0.5-3.6% in studies, while there are no fatalities (deaths) reported in vaccine recipients. Obviously, we believe these small, short lived risks are far outweighed by the benefit!

Each of the doctors at WSCA have received their 2nd doses!!