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This has been updated as of December 31, 2020.
If you have an autoimmune or inflammatory condition — such as rheumatoid arthritis, lupus, psoriasis, or inflammatory bowel disease — or take medication that affects immune system function, chances are you have questions and concerns about whether the COVID-19 vaccine is safe for you.
The U.S. Food and Drug Administration granted emergency use authorization (EUA) to COVID-19 vaccines from Pfizer-BioNTech and from Moderna, which work in similar ways.
Emergency use authorization does not mean that a vaccine is officially licensed or approved. It means that, given the life-threatening emergency of the COVID-19 pandemic, public health, virology, and infectious disease experts agree that the benefits of the vaccine outweigh any potential risks and side effects.
Both the Pfizer and Moderna vaccines are known as “mRNA vaccines.” They are not live vaccines, which means they do not contain a form of the coronavirus itself. These vaccines cannot make you sick with COVID-19. Generally, vaccines that are not live are safe for people on immunosuppressant medication.
The coronavirus germ is studded with spike proteins that protrude from it; these spike proteins allow the virus to enter your cells and start replicating. The mRNA vaccine contains messenger RNA, or genetic material that our cells can “read” to make proteins. The vaccine teaches your body’s cells to make the coronavirus spike proteins, so your body learns to recognize them and mount an immune system response.
We encourage you to check out these articles about COVID-19 vaccines in people who are immunocompromised or who have autoimmune conditions for more in-depth information:
- Getting a COVID-19 Vaccine: What to Know If You’re Immunocompromised
- Can You Get the Pfizer COVID-19 Vaccine If You’re Immunocompromised or Have an Autoimmune Condition?
- Can You Get the Moderna COVID-19 Vaccine If You’re Immunocompromised or Have an Autoimmune Condition?
Can You Get a COVID-19 Vaccine If You’re Immunocompromised?
Yes. People with autoimmune conditions or who are immunocompromised are not excluded from getting the vaccine, but they are part of certain groups that require extra consideration because there is not yet data on them specifically.
These groups were not included in the clinical trials that led to the vaccine getting emergency use authorization, but that is not unusual.
Most vaccine clinical trials do not include these patient groups because the goal of these studies is to make sure the vaccine is safe and effective in a large group of healthy adults. Other populations, such as immunocompromised patients, are typically studied in phase 4 (post-marketing) studies that occur after the vaccine has been approved and more is known about their safety and effectiveness.
All of the rheumatologists CreakyJoints and the Global Healthy Living Foundation have spoken with so far plan to recommend that their rheumatic disease patients get the vaccine as soon as it is available to them.
The general consensus is that there is no reason to expect that an mRNA COVID-19 vaccine — such as from Pfizer or Moderna — would be less safe in people who are immunocompromised. There may be a chance that the vaccine is less effective in those taking immunosuppressant medication — which dampens the immune system response — but there is not yet data that shows this. However, even a theoretically less effective vaccine is better than no vaccine.
People who are immunocompromised or on immunosuppressant medication should talk to their health care provider to decide together if getting the vaccine is right for them.
Because it’s easy to find inaccurate or misleading information about COVID-19 vaccines, we are paying close attention to what trusted medical experts and professional medical organizations are saying about the vaccines in people who are immunocompromised.
We will be updating this list as more information emerges.
U.S. Centers for Disease Control and Prevention (CDC)
Adults of any age with certain underlying medical conditions are at increased risk for severe illness from the virus that causes COVID-19. mRNA COVID-19 vaccines may be administered to people with underlying medical conditions provided they have not had a severe allergic reaction to any of the ingredients in the vaccine. The following information aims to help people in the groups listed below make an informed decision about receiving the mRNA COVID-19 vaccine.
People who have weakened immune systems
People with HIV and those with weakened immune systems due to other illnesses or medication might be at increased risk for severe COVID-19. They may receive a COVID-19 vaccine. However, they should be aware of the limited safety data:
- Information about the safety of mRNA COVID-19 vaccines for people who have weakened immune systems in this group is not yet available.
- People living with HIV were included in clinical trials, though safety data specific to this group are not yet available at this time.
People with weakened immune systems should also be aware of the potential for reduced immune responses to the vaccine, as well as the need to continue following all current guidance to protect themselves against COVID-19 (see below).
People who have autoimmune conditions
People with autoimmune conditions may receive an mRNA COVID-19 vaccine. However, they should be aware that no data are currently available on the safety of mRNA COVID-19 vaccines for them. Individuals from this group were eligible for enrollment in clinical trials.
Advisory Committee on Immunization Practices (ACIP) from the U.S. Centers for Disease Control and Prevention (CDC)
Persons with HIV infection, other immunocompromising conditions, or who take immunosuppressive medications or therapies might be at increased risk for severe COVID-19. Data are not currently available to establish vaccine safety and efficacy in these groups. Persons with stable HIV infection were included in phase 2/3 clinical trials, though data specific to this group are not yet available. Immunocompromised individuals may still receive COVID-19 vaccination if they have no contraindications to vaccination. However, they should be counseled about the unknown vaccine safety profile and effectiveness in immunocompromised populations, as well as the potential for reduced immune responses and the need to continue to follow all current guidance to protect themselves against COVID-19.
Persons with autoimmune conditions
No data are currently available on the safety and efficacy of mRNA COVID-19 vaccines in persons with autoimmune conditions, though these persons were eligible for enrollment in clinical trials. No imbalances were observed in the occurrence of symptoms consistent with autoimmune conditions or inflammatory disorders in clinical trial participants who received an mRNA COVID-19 vaccine compared to placebo. Persons with autoimmune conditions who have no contraindications to vaccination may receive an mRNA COVID-19 vaccine.
American College of Allergy, Asthma, and Immunology
From a press release:
On immunocompromised patients
The mRNA COVID-19 vaccines are not live vaccines and can be administered to immunocompromised patients. Physicians and other providers should inform such immunocompromised patients of the possibility of a diminished immune response to the vaccine.
On patients with a history of allergies
1. The mRNA COVID-19 vaccines should be administered in a health care setting where anaphylaxis can be treated. All individuals must be observed for at least 15-30 minutes after injection to monitor for any adverse reaction. All anaphylactic reactions should be managed immediately with epinephrine as the first line treatment.
2. The CDC has issued guidance on COVID-19 vaccines and severe allergic reactions. According to the CDC, if you have a severe allergic reaction after getting the first shot, you should not get the second shot. Additionally, the CDC notes patients who experience a severe allergic reaction may be referred by their doctor to a specialist in allergies and immunology to provide more care or advice.
3. The mRNA COVID-19 vaccines should not be administered to individuals with a known history of a severe allergic reaction to any component of the vaccine. Although the specific vaccine component causing the anaphylaxis has not been identified, polyethylene glycol is one of its ingredients and has been known to cause anaphylaxis.
4. Data related to risk in individuals with a history of allergic reactions to previous vaccinations and/or mast cell activation syndrome/idiopathic anaphylaxis is very limited and evolving. A decision to receive either of the mRNA COVID-19 vaccines should be undertaken by you with your physician or other provider administering the vaccine using their professional judgment balancing the benefits and risks associated with taking the vaccine.
5. People with common allergies to medications, foods, inhalants, insects and latex are no more likely than the general public to have an allergic reaction to the mRNA COVID-19 vaccines. Those patients should be informed of the benefits of the vaccine versus its risks.
American College of Rheumatology
Comprehensive safety checks are required as part of the process leading to FDA approval of a new vaccine. As with all vaccines that have passed rigorous testing and licensure procedures, the benefits of vaccination (preventing or reducing the severity of infection) are expected to far outweigh any risk from the vaccine. We anticipate recommending all patients, including rheumatology patients, receive an approved COVID-19 vaccine.
Hospital for Special Surgery
Thus far, there are no data on how the vaccine affects people with rheumatic diseases (RD). However, several research groups, including international consortia, are collecting and will be analyzing such data. We are following those results closely and will provide the best and most current advice to our patients and the RD community.
Based on information collected to date, we know that vaccination offers protection against COVID-19. The risks posed by vaccination appear minimal, unlike the risks of COVID-19. It is reassuring that the RNA vaccines have been constructed to minimize inappropriate immune system activation, which may reduce the likelihood of bad reactions. Some RD patients on immunosuppressive medications may be at increased risk of severe illness and death if they contract COVID-19, so vaccination may be very advantageous for these individuals, even if there is some risk involved.
Our understanding of effectiveness and safety will improve as data from clinical trials and other studies emerge during the roll out of vaccines. Once the vaccines become available to RD patients, we strongly suggest that you speak to your rheumatologist before receiving a vaccine so that you can discuss the most up-to-date information and the advisability of your receiving a vaccine.
We expect the benefits of COVID-19 vaccination will far outweigh the risks in patients with RD.
National Psoriasis Foundation COVID-19 Task Force
Patients with psoriatic disease, who do not have contraindications to vaccination, should receive a mRNA-based COVID-19 vaccine as soon as it becomes available to them based on federal, state, and local guidance. Systemic medications for psoriasis or psoriatic arthritis are not a contraindication to the mRNA-based COVID19 vaccine. If vaccine supply is limited, the TF [task force] recommends following CDC’s prioritization guidelines for early vaccination for selected groups based on their comorbidities and work setting.
It is recommended that patients who are to receive a mRNA-based COVID-19 vaccine continue their biologic or oral therapies for psoriasis and/or psoriatic arthritis in most cases. Shared decision-making between clinician and patient is recommended to guide discussions about use of systemic therapies during the pandemic.
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American College of Allergy, Asthma, and Immunology Updates Guidance on Risk of Allergic Reactions to mRNA COVID-19 Vaccines. December 22, 2020. https://acaai.org/news/american-college-allergy-asthma-and-immunology-updates-guidance-risk-allergic-reactions-mrna.
COVID-19 Task Force Guidance Statements. National Psoriasis Foundation. December 12, 2020. https://www.psoriasis.org/covid-19-task-force-guidance-statements.
COVID-19 Vaccination Considerations for Persons with Underlying Medical Conditions. COVID-19. U.S. Centers for Disease Control and Prevention. December 26, 2020. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/underlying-conditions.html.
Different COVID-19 Vaccines. Coronavirus Disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. November 24, 2020. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines.html.
Emergency Use Authorization for emergency use of Pfizer-BioNTech COVID‐19 Vaccine for the prevention of Coronavirus Disease 2019 (COVID-19) for individuals 16 years of age and older. U.S. Food & Drug Administration. December 11, 2020. https://www.fda.gov/media/144412/download.
Fact Sheet for Healthcare Providers Administering Vaccine (Vaccination Providers). Emergency Use Authorization (EUA) of the Pfizer-BioNTech COVID-19 Vaccine to Prevent Coronavirus Disease 2019 (COVID-19). U.S. Food and Drug Administration. December 2020. https://www.fda.gov/media/144413/download.
Fact Sheet for Recipients and Caregivers. Emergency Use Authorization (EUA) of the Pfizer-BioNTech COVID-19 Vaccine to Prevent Coronavirus Disease 2019 (COVID-19) in Individuals 16 Years of Age and Older. U.S. Food and Drug Administration. December 2020. https://www.fda.gov/media/144414/download.
HSS Statement on COVID-19 Coronavirus Vaccinations for People with Rheumatic Diseases. Hospital for Special Surgery. December 19, 2020. https://www.hss.edu/conditions_hss-statement-covid-19-coronavirus-vaccinations-rheumatic-diseases.asp.
Information from the American College of Rheumatology Regarding Vaccination Against SARS-CoV-2. American College of Rheumatology. December 21, 2020. https://www.rheumatology.org/Portals/0/Files/ACR-Information-Vaccination-Against-SARS-CoV-2.pdf.
Interim Clinical Considerations for Use of Pfizer-BioNTech COVID-19 Vaccine. Advisory Committee on Immunization Practices (ACIP). U.S. Centers for Disease Control and Prevention (CDC). December 20, 2020. https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/clinical-considerations.html.
Understanding mRNA COVID-19 Vaccines. Coronavirus Disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. November 23, 2020. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/mRNA.html.