People with autoimmune deficiencies face serious illness and possibly death should they contract COVID-19 and are encouraged to get vaccinated, despite questions over its effectiveness in the population.
Doctors expressed frustration over the lack of testing available to measure the immunity levels in their vaccinated patients, but agreed some protection is better than none.
“The COVID vaccination is definitely recommended for patients with rheumatologic and autoimmune disorders, particularly since these patients are considered to have a higher risk for hospitalization and worse outcomes from COVID itself compared to the general population,” said Dr. Marwan Haddad, medical director of the Center for Key Populations with Community Health Center Inc.
Haddad said those who should avoid the vaccine are people who have allergies to any ingredients in the vaccines. Those with autoimmune deficiencies should consult with their providers about when to get the shot.
Patients who suffer from an autoimmune disease have an overactive immune system that attacks itself, experts said. This family of illnesses includes SLE (systemic lupus erythematosus), rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease, and Type 1 diabetes, among others.
Many local doctors are taking vaccine guidance for autoimmune-deficit patients from the American College of Rheumatology (ACR) which released its recommendations in February.
“Although there is limited data from large population-based studies, it appears that patients with autoimmune and inflammatory conditions are at a higher risk for developing hospitalized COVID-19 compared to the general population and have worse outcomes associated with infection,” said Dr. Jeffrey Curtis, chair of the ACR COVID-19 Vaccine Clinical Guidance Task Force. “Based on this concern, the benefit of COVID-19 vaccination outweighs any small, possible risks for new autoimmune reactions or disease flare after vaccination.”
Doctors typically recommend the messenger RNA vaccines made by Pfizer-BioNTech and Moderna over the Johnson & Johnson shot. The mRNA shots contain a fragment of mRNA that directs cells to make a specific spike protein that mounts an antibody response to the actual virus. J&J utilizes a weakened virus in its vaccine.
“We don’t like giving weakened virus to people with immune disorders,” said Dr. John Magaldi, specialty chief of rheumatology at Hartford HealthCare.
Unfortunately, both the Pfizer and Moderna trials excluded volunteers on immunosuppressive therapy but because of the sheer size of the clinical trials and the millions of doses distributed globally, doctors are able to extrapolate results and develop best practices.
If there was a problem with flare ups, it would have appeared by now, Magdali said.
Autoimmune deficient patients want to get their vaccines when their immune system is strongest, which means delaying certain medication and immunosuppressive therapies a week to several weeks.
For now, the main consideration for patients with autoimmune or rheumatologic diseases is the timing of the vaccine. The primary recommendation from the ACR is to delay certain medications for one week after vaccination. Withholding the medication can increase the vaccine’s chances of success.
“One of the challenges presently is we don’t have a test to measure vaccine antibodies,” Magaldi said. “We can test for COVID antibodies if you had COVID. But to measure vaccine antibodies, it’s not readily available. It’s all a guessing game if they are immune compromised.”
Magaldi and other specialists have not seen too many cases of disease flareups following vaccination beyond the normal side effects.
If someone has lupus, for instance, and the lupus is attacking the kidney, doctors might delay the vaccine. But there have been plenty of rheumatoid and lupus vaccinations without evidence of flareups.
“A lot of our patients have been vaccinated,” Magaldi said. “The ones that haven’t said they are concerned about side effects. They should be equally nervous about getting COVID infection. COVID is a life and death difference.”
Doctors and scientists hope to learn more about the vaccine and levels of protection in autoimmune-deficient patients and risk of flareups as time goes on.
“It’s just like they’re studying it in kids,” Magaldi said.”There is now a database of 200 million. That’s a good-sized database. if there was something with an autoimmune response we would have had it by now. You’re not in the starting gate.”