Support for COVID-19 Vaccines

From the American College of Rheumatology and the Arthritis Center of Nebraska

Modified December 15, 2020

Vaccinations are in the news again due to the approval of the first of many vaccines (more than 135 in development) against SARS-CoV-2 (i.e. the novel coronavirus that causes COVID-19). Rheumatologists have a long history of recommending specific vaccinations to our patients. This is because patients with rheumatologic conditions frequently take medicines which may:

  1. Make them more susceptible to infections
  2. Reduce their ability to mount an effective immune response following vaccination, and
  3. Increase the risk associated with live vaccines.

The Rheumatologists at the Arthritis Center of Nebraska have been following the intensive efforts of the international scientific and medical community to develop a vaccine against COVID-19. These vaccines are rigorously tested in clinical trials, to prove the vaccine’s efficacy and safety. We know that any vaccine which is approved for use in the United States will have robust and extensive data showing that it is safe and effective against COVID-19. The Pfizer vaccine has been tested in more than 22,000 people before its recent FDA approval.

There are 3 types of coronavirus vaccines:

1) mRNA Based Vaccine

The first is an mRNA based vaccine, which is a very new technology. A snip of coronavirus mRNA (its genetic code) is placed in a lipid nanoparticle. When injected, it is taken up by the human’s own cells, and for a period of time, these cells make a portion of the viral coating protein, and express it on the human’s cell surface. This produces a vigorous immune response (something we want). And since it is only one small portion of the virus, it is not infectious. The recently approved Pfizer vaccine (and soon to be approved Moderna vaccine) are mRNA vaccines. Easy to produce in large quantities, but mRNA can break down easily, so the vaccine must be stored at -70 degrees centigrade. So far the Pfizer vaccine has been very effective in reducing the risk of developing COVID-19 in healthy volunteers. Side effects include a sore arm at the injection site, and flu like symptoms (fever, muscle aches, headache, and fatigue) in 10-50%. Side effect symptoms usually last only 2 days or so. The experience of mass vaccination in Great Britain, has so far been well tolerated, with the only new caution to avoid vaccination in people with severe environmental allergies (defined as a person that carries an EpiPen wherever they go).

Since mRNA vaccines, including the Pfizer vaccine, are not live vaccines, they are perfectly safe to give to our rheumatic disease patients, even the ones that are immune suppressed. There is a small risk of a temporary inflammatory arthritis flare. About 5% of inflammatory arthritis patients will flare after the shingles vaccine, and we suspect the risk of flare is similar. Patients taking some medications, including methotrexate, rituximab, or Xeljanz may not have a good response to the vaccine. We recommend that patients on methotrexate, hold the methotrexate for 2 weeks after the first and second dose of the Pfizer vaccine. For those patients on rituximab infusions, we recommend waiting until 4 months after your last infusion, to start the vaccine series. If you are taking Xeljanz, we suggest holding the Xeljanz for 7 days after both doses of the vaccine. All other rheumatic disease drugs are safe to continue.

2) Protein Based Vaccine

The second type of vaccine, the most traditional type of vaccine (like the flu vaccine), is a protein based vaccine. These vaccines take longer and are more difficult and expensive to make. None of this type of vaccine for coronavirus are ready for approval. Novavax and Sanofi-SmithKline are working on this type of vaccine. When available, they will be safe and effective for our inflammatory arthritis patients with exactly the same concerns and caveats described above for the mRNA vaccines.

3) Attenuated Live Virus Vaccine

AstraZeneca and Johnson and Johnson are both developing attenuated live virus vaccines (the third kind of vaccine) against coronavirus. Not ready for FDA approval, but when approval comes, these vaccines will be, at least initially contra-indicated in our immune suppressed population.

A few additional things to know about vaccinations:

How effective are most vaccines?

Most vaccines offer some protection against infection but not do not give patients complete immunity. However, even partial protection will be helpful both to patients and the general public. Partial protection may mean that most but not all vaccinated people develop immunity, or that some people develop partial immunity, so that even if they develop COVID-19 infection, the symptoms of that infection will be less severe.

How long will protection last after I am vaccinated?

We do not yet know how long patients are protected from reinfection after having COVID-19. There have been a small number of cases reported where a patient clearly developed a second COVID-19 infection, after having an initial previously documented infection. We have even less information about how long protection will last following a vaccine against COVID-19. All people receiving vaccines against COVID-19, or recovering from COVID-19, should understand that prior infection or vaccination may not provide long lasting protection from future infections.

Categorized in: COVID, General