Autoimmune diseases (AD) occur when the immune system attacks the body's own healthy cells. There are 80 to 100 known and growing autoimmune diseases affecting more than 14 million Americans. Based on what the World Autoimmune Institute has reviewed in the scientific literature regarding vaccination against COVID-19 and autoimmune diseases, the evidence available so far indicates that the benefit of the COVID-19 vaccine outweighs the risk of side effects. The Centers for Disease Control and Prevention (CDC) also states that “COVID-19 vaccines can be given to most people with underlying medical conditions.” Regarding immunocompromised people receiving a third dose of the vaccine, CDC has stated that “there is limited information on the risks of receiving an additional primary mRNA vaccine against COVID-19.” The safety, efficacy and benefits of a third primary dose in people with compromised immune systems are being evaluated on an ongoing basis.
Reactions to a third primary dose are similar to reactions following the two-dose primary series and are generally mild to moderate in nature. The University of Washington School of Medicine is conducting a study called CovariPad (responses to the COVID-19 vaccine in patients with autoimmune diseases).The team has just published research on the effect of immunosuppression on the effectiveness of mRNA vaccines against COVID-19. They found that 88.7% of patients with chronic inflammatory conditions* (DIC), such as rheumatoid arthritis (28.5%), Crohn's disease (16.5%), spondyloarthritis (15%), ulcerative colitis (13.5%), systemic lupus erythematosus (11.3%), multiple sclerosis (6.8%) and Sjöös syndrome Gren (6%), caused diseases detectable antibodies in response to the vaccine. Researchers found that immune responses varied depending on the medication taken, including glucocorticoids, antimetabolites, tumor necrosis factor (TNFI) inhibitors, B-cell-depleting therapy (BCDT), and Janus kinase inhibitors (JAKI). All CID participants continued to use their immunosuppressive medications during the study according to their treating physician, except for 3 who received methotrexate (antimetabolite) within the week of immunization. Those who received BCDT (60%) and glucocorticoids (65%) had no or numerically lower levels of antibodies after both vaccines, while the other immunosuppressants did not generate much lower levels of antibodies compared to those who did not take the medications.
It should be noted that the levels of antibodies in CID participants were one-third of the levels observed in healthy controls. The researchers highlighted the difficulty of determining if the levels achieved by those taking immunosuppressive drugs are high enough to protect them from severe COVID-19, given that the minimum level of antibodies required to protect against COVID-19 has not yet been established. However, the evidence that supports that vaccination does elicit a response in people with compromised immune systems remains encouraging for a population that is at high risk of serious illnesses. It is recommended that you talk to your doctor about any medications you are taking and how they may interact with the COVID-19 vaccine. There is a risk of asthmatic flare-ups.
That said, people living with autoimmune and inflammatory diseases have been found to have a higher risk of experiencing severe symptoms due to a COVID-19 infection. Because of this concern, the American College of Rheumatology has stated that “the benefit of the COVID-19 vaccine outweighs any small and possible risk of new autoimmune reactions or of an outbreak of the disease after vaccination. A study by the Sinai Medical Center in Cedar evaluated a longitudinal registry of vaccines and reported that the vaccine against Covid-19 was safe for patients with inflammatory diseases mediated by the immune system, such as IBD. The frequency and type of adverse events were similar to those in the general population. In addition, the authors have assured patients with IMID that the risk of adverse events “probably does not increase and can be reduced” while taking biological medications. A research study published in Frontiers in Oncology evaluated the safety of the COVID-19 vaccine (Pfizer and Moderna) in 566 immunocompromised patients, including those with hematologic malignancies (13), solid tumors (19), immunorheumatologic diseases (8) and neurological diseases (15), including multiple sclerosis and generalized myasthenia. Overall, the “incidence of serious adverse events” after administration of the vaccine was low, and research on adverse events of the COVID-19 vaccine in patients with autoimmune diseases was encouraging.
You can also submit your side effects to the Vaccine Adverse Event Reporting System (VAERS). CDC and FDA scientists monitor VAERS to decide which adverse events deserve further investigation. Other people may experience side effects similar to yours; presenting them to VAERS provides the best opportunity for CDC and FDA to learn about and study side effects from COVID-19 vaccines. This review analyzes frequency, treatment and outcome of neurological complications reported due to COVID-19 vaccines over an 18-month period, some of which have been verified by FDA and CDC. People living with autoimmune diseases and those receiving immunosuppressive therapies were not included in initial clinical trials for COVID-19 vaccines due to potential skewing efficacy data.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases is also sponsoring an observational study on how a COVID-19 infection affects patients with systemic autoimmune diseases, particularly inflammation, immune system and blood vessels. The study will also evaluate response to potential antiviral treatments and vaccines for those living with autoimmune diseases. Yale University and National Institute of Allergy and Infectious Diseases (NIAID) are collaborating to evaluate immune response to COVID-19 vaccination in immunodeficient patients, including those with autoimmune diseases who are being treated with anti-CD20 drugs. Talk to your doctor before getting vaccinated against COVID-19 as he or she may give you recommendations about timing and dosage specific to your medical profile.
CDC recently changed language around COVID-19 vaccines; recommendations now include keeping up to date with COVID-19 vaccines for adequate protection. That said, there are separate recommendations for those who are immunocompromised; boosters are vaccines that improve or restore protection against COVID-19 which may have diminished over time. This page details CDC's COVID-19 vaccination schedule effective September 9th 2020. Immunosuppressed individuals should consult their doctor before getting vaccinated against Covid-19 as they may need additional doses or different timing than what is recommended for healthy individuals.
It is important for everyone living with an autoimmune disease or receiving immunosuppressive therapies to stay informed about developments related to Covid-19 vaccines so they can make informed decisions about their health.
