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This has been updated as of February 14, 2021.
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 the safety and effectiveness of the COVID-19 vaccine.
If there’s one thing to take away from this article, it’s that doctors and public health experts strongly encourage most patients with autoimmune diseases and people who take immunosuppressant medications to get vaccinated.
In this resource, we will share updates from professional medical and public health organizations explaining why they recommend the COVID-19 vaccine for these patients.
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 may 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 for most immunosuppressed patients — based on what is known about how mRNA COVID-19 vaccines work — is that COVID-19 vaccines should be safe for people on immunosuppressant therapy but may be some degree less effective.
However, that doesn’t mean that the COVID-19 vaccine doesn’t work — it may just work less well than in people who don’t take these medications. But even a slightly less effective vaccine may still help prevent severe disease that requires hospitalization (or worse).
Think of it this way: If you had a choice between being in a snowstorm wearing a winter coat, hat, gloves, and scarf (fully effective vaccine) versus a just a winter coat (less effective vaccine) versus just a T-shirt (no vaccine), of course you’d prefer having all the winter attire. But having the coat is way better than just the T-shirt.
Recommendations from Medical and Public Health Organizations for Immunocompromised Patients
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.
American College of Rheumatology (ACR)
From COVID-19 Vaccine Clinical Guidance Summary for Patients with Rheumatic and Musculoskeletal Diseases:
In February 2021, the ACR issued comprehensive guidance about the COVID-19 vaccine for patients with rheumatic diseases, with an emphasis on autoimmune and inflammatory conditions. The guidance includes the following general recommendations:
- Rheumatic disease patients, including autoimmune and inflammatory disease patients, should get the COVID-19 vaccine.
- The effectiveness of the COVID-19 vaccine should be lower with immunomodulating medication, but you will still get some protection.
- There are no contraindications for the COVID-19 vaccine specifically for patients with autoimmune or inflammatory rheumatic disease.
The guidance also addresses specific immunosuppressant and immunomodulating therapies and whether patients should temporarily skip doses before or after receiving vaccine OR trying to time when you get the vaccine so it occurs at a certain point during the course of your treatment.
Patients should not stop taking most medications before or after getting the vaccine. This is because there is no reason to think, based on available data, that stopping these medications would increase your body’s immune system response to the vaccine.
There were a few medications for which dosing and timing changes were recommended, including:
- JAK inhibitors
For more details and a patient-friendly version of the ACR guidance, check out our resource:
U.S. Centers for Disease Control and Prevention (CDC)
From COVID-19 Vaccination Considerations for Persons with Underlying Medical Conditions:
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.
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)
From Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States:
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.
Persons with HIV infection or 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 mRNA COVID-19 vaccine clinical trials, though data remain limited. Immunocompromised individuals can 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, and the potential for reduced immune responses and the need to continue to follow all current guidance to protect themselves against COVID-19 (see below). Antibody testing is not recommended to assess for immunity to COVID-19 following mRNA COVID-19 vaccination.
At this time, re-vaccination is not recommended after immune competence is regained in persons who received mRNA COVID-19 vaccines during chemotherapy or treatment with other immunosuppressive drugs. Recommendations on re-vaccination or additional doses of mRNA COVID-19 vaccines may be updated when additional information is available.
American College of Allergy, Asthma, and Immunology
From Guidance on Risk of Allergic Reactions to mRNA COVID-19 Vaccines:
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. Anyone receiving the vaccine should be screened to determine possible risk of an allergic reaction to the mRNA COVID-19 vaccines. You should be asked if you have a history of a severe allergic reaction to any prior vaccine. If the answer is yes, you should be referred to a board-certified allergist/immunologist for further evaluation prior to COVID-19 vaccination.
2. According to the CDC, if you have had a severe or an immediate allergic reaction of any severity within four hours after getting the first COVID-19 shot, you should not get the second shot. Additionally, patients who experience a severe or an immediate allergic reaction of any severity (hives, swelling, wheezing) or who have questions related to risk of an allergic reaction, may be referred to a local board-certified allergist/immunologist to provide more care or advice.
3. 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. The majority of anaphylactic reactions have occurred within 15 minutes.
4. 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 (PEG) is one of the ingredients and has been known to cause anaphylaxis. Since polysorbate, a substance found in medications and foods, can cross-react with PEG, patients with allergic reactions to polysorbate should not be immunized with the mRNA vaccines.
5. Data regarding risk in individuals with a history of allergic reactions related to 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.
6. People with common allergies to medications, foods, inhalants, insects, and latex are probably 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.
Hospital for Special Surgery
From HSS Statement on COVID-19 Coronavirus Vaccinations for People with Rheumatic Diseases:
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
From COVID-19 Task Force Guidance Statements:
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.
Patients with psoriatic disease may be in a high priority group (“Phase 1c: Persons aged 16–64 years with high-risk medical conditions”) due to psoriasis associated comorbidities (such as those known to increase COVID-19 risk, e.g., chronic kidney disease, COPD, heart disease, obesity, type 2 diabetes, or smoking or might increase COVID-19 risk, e.g., hypertension, liver disease, or overweight*) or treatments that CDC classifies as making them more susceptible to infection. Examples of medications that may make a patient more susceptible to infection provided by CDC include use of oral (e.g., prednisone) or intravenous corticosteroids or other medicines that lower the body’s ability to fight some infections (e.g., mycophenolate, sirolimus, cyclosporine, tacrolimus, etanercept, rituximab**). Based on prescribing information, additional medications for psoriasis and/or psoriatic arthritis which may be classified as possibly lowering the body’s ability to fight some infections include apremilast, leflunomide, methotrexate, tofacitinib, and biologics which target cytokines TNF, IL12/23, IL17, and IL23 or T cells (e.g., abatacept).
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.
International Organization for the Study of Inflammatory Bowel Disease
From: SARS-CoV-2 Vaccination for Patients with Inflammatory Bowel Diseases: Recommendations from an International Consensus Meeting
- Patients with IBD should be vaccinated against the novel coronavirus.
- The best time to administer vaccination in patients with IBD is at the earliest opportunity to do so.
- COVID-19 vaccination should not be deferred because a patient is receiving immune-modifying therapies.
- Patients with IBD who get the COVD-19 vaccine should be counseled that vaccine efficacy may be decreased when receiving systemic corticosteroids.
British Society for Immunology
From Statement on COVID-19 Vaccines for Patients Who Are Immunocompromised or Immunosuppressed
While COVID-19 vaccination might provide a lower level of protection in people who are immunosuppressed or immunocompromised compared with the rest of the population, it is still very important that you get vaccinated as it will offer you a certain amount of protection against catching COVID-19. It is important that you receive two doses of the vaccine to maximise the protection that vaccination offers you.
COVID-19 vaccination will work best if you have a functioning immune system. For people currently undergoing whole organ or stem cell transplant and who may be severely immunocompromised, you should talk to your medical treatment team about the most suitable time to get your COVID-19 vaccination.
It’s important to remember that the COVID-19 vaccines can protect you from getting seriously ill with COVID-19, although if your immune system isn’t functioning optimally this protection will not be complete. We don’t currently have any evidence that the vaccines can stop you passing on the virus to others even if you make a good immune response. This means that even after you have been vaccinated, it’s very important that you still follow social distancing guidelines and wash your hands regularly.
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ACAAI Provides Further Guidance on Risk of Allergic Reactions to mRNA COVID-19 Vaccines. February 2, 2021. https://acaai.org/news/acaai-provides-further-guidance-risk-allergic-reactions-mrna-covid-19-vaccines.
COVID-19 Task Force Guidance Statements. National Psoriasis Foundation. February 10, 2021. https://www.psoriasis.org/covid-19-task-force-guidance-statements.
COVID-19 Vaccine Clinical Guidance Summary for Patients with Rheumatic and Musculoskeletal Disease. American College of Rheumatology. February 8, 2021. https://www.rheumatology.org/Portals/0/Files/COVID-19-Vaccine-Clinical-Guidance-Rheumatic-Diseases-Summary.pdf.
COVID-19 Vaccination Considerations for Persons with Underlying Medical Conditions. COVID-19. U.S. Centers for Disease Control and Prevention. December 29, 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.
Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States. Advisory Committee on Immunization Practices (ACIP). U.S. Centers for Disease Control and Prevention (CDC). February 10, 2021. https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/clinical-considerations.html.
Statement on COVID-19 Vaccines for Patients Who are Immunocompromised or Immunosuppressed. British Society for Immunology. January 19, 2021. https://www.immunology.org/news/bsi-statement-covid-19-vaccines-for-patients-immunocompromised-immunosuppressed.
Siegal CA, et al. SARS-CoV-2 vaccination for patients with inflammatory bowel diseases: recommendations from an international consensus meeting. Gut. January 20, 2021. doi: http://dx.doi.org/10.1136/gutjnl-2020-324000.
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.