Important information for vasculitis patients
Revised version: 4 Feb 2021
With the imminent arrival of a third vaccine, many people with vasculitis are understandably confused and worried about safety and suitability of the new vaccines for vasculitis patients. There is still much that we need to know about these vaccines – questions that nobody so far can answer. Below is a summary of what we do know.
There are two vaccines currently approved and available in the UK in sufficient quantity:-
- The Pfizer BioNtec vaccine
- The Astra-Zeneca (Oxford) vaccine
A third vaccine – the “Moderna” vaccine – has been approved and should be introduced later in the year as supplies become available.
For those wishing to understand more about the three vaccines and the virological mechanisms behind them, our in-house virologist, Gareth, has prepared a short document describing the nature and modus operandi of the two different types of vaccine currently available.
Vaccines contain other essential ingredients such as liquid carriers and preservatives. A few people may have an adverse reaction to these ingredients (see below).
Do remember that vaccination does not confer total immunity to the disease, and that immunity takes about a month to develop. The first dose confers a very significant degree of immunity which is reinforced by the second dose. So it is still better to have one dose rather than none.
The recommended interval between first and second dose for the Pfizer vaccine is 3 – 4 weeks. For the Astra vaccine it can be longer. As supplies of vaccine are limited initially, in order to ensure more people get access to at least some degree of protection from the vaccine as soon as possible, the Government has decided that the interval between doses should be extended to 12 weeks. For the Pfizer vaccine this is not the same as the the interval used in the trials. However, based on experience with numerous other vaccines, scientists confidently expect that changing from 4 to 12 weeks betwen first and second doses should not affect the degree of immunity which is conferred.
In all cases, people should carry on “shielding” for at least a month after the first dose and behave prudently after the second dose.
Some Questions & Answers:
Q1) Who should have the vaccine?
Everyone with vasculitis, especially those aged over 70.
Q2) Is there anyone who should NOT have the vaccine?
People who are hyperallergenic (ie, who have many allergies or have strong allergic reactions) should discuss this with the doctor or nurse before having the vaccine.
- People who are hyperallergenic ie (who have many allergies or have strong allergic reactions) should discuss this with the doctor or nurse before having the vaccine as they may have a reaction to the vaccine.
- Vaccination is not recommended during pregnancy or breastfeeding as the vaccines were not tested on people in these groups.
- The vaccines have not been tested on those under 16, but this group seems only rarely to be affected by Covid.
- See comments below about:
- People having rituximab infusions
- People recovering from Covid infection
Q3) Is either the Pfizer or the Astra vaccine superior?
Both vaccines are considered completely safe and highly effective.
There are few reports of anything worse than minor after
effects, (such as tenderness at the injection site) but there are a few
reports suggesting that a few people react worse to the Astra
vaccine and feel unwell for a day or two after the vaccination.
Breaking News. There are recent reports that the Astra-Zeneca vaccine may be more effective at preventing transmission of the virus to others. Results of a recent study have yet to be formally published.
Q4) Are the vaccines definitely safe?
Patient safety is always paramount when vaccines are developed. There is absolutely no evidence to suggest that any of the vaccines are harmful. It is not possible to catch Covid by having the vaccination.
Q5) Are the vaccines safe for people who are immune suppressed?
Yes, quite safe, but they might not work as effectively in those who are immune suppressed, especially those taking rituximab (see below).
Q6) Will the vaccine be effective people for who are immune suppressed – especially those who are taking rituximab?
Rituximab suppresses production of B cells, the most active component of the immune system. So you should not have your rituximab immediately before or after your vaccination.
DO NOT stop or delay your rituximab other than for a few days, as this may cause a relapse of your vasculitis. If you are having maintenance rituximab every 6 months, try to have your vaccine at least 2 months after your last infusion and 1 month before your next dose.
DO MAKE SURE that you tell whoever gives you the vaccine that you are heavily immune suppressed.
DO REMEMBER that even if the vaccine does not confer full immunity, due to your immune suppression, some immunity to Covid is better than none!
Q7) What counts as being immune suppressed?
Taking cyclophosphamide, azathioprine, methotrexate or mycophenolate (MMF) or taking more than 5mg of prednisolone daily. Rituximab causes greater immune suppression as it is administered in much larger doses at longer intervals.
Q8) Which vaccine is best for people taking immune suppressing drugs?
There is no reason to consider either of the two currently available vaccines to be superior or inferior.
Q9) Is it OK to have different vaccines for the first and second doses?
All the current vaccines require a second dose after a few weeks.
Theoretically, mixing vaccines for first and second doses should not cause any problem, but there is as yet no evidence to support “mixing”. So, at present it is advised that both first& second doses should be the same make.
Q10) Will the vaccine need regular booster doses?
As viruses tend to mutate (change) over time, it may be necessary to have a booster dose of a modified vaccine every so often, as is currently the case with the annual influenza vaccine. Not all mutations require a modified vaccine. As the Covid virus is new, we will only find out as time goes by.
Q10) I recently had the covid infection but seem to have recovered. Is it OK for me to have the vaccine?
It is recommended that you should wait at least four weeks after recovery before having the vaccine.
The vaccine takes a month to become effective, so if you have been shielding, you should carry on shielding for a further month.
The vaccination does NOT make you totally immune to covid infection. However, if you do become infected, you should should experience a much less severe reaction to it
The central message is that if you have active vasculitis, that is the most significant threat for you.
Do not stop or reduce your usual vasculitis medication unless you are instructed to do so by your vasculitis consultant.
Are the vaccines safe? Patient safety is always the first consideration when developing and when approving all new medicines. As the vaccines depend on copying only a tiny part of the DNA of the virus, it is not possible to catch the virus from the vaccine.
The UK’s MHRA (Medicines & Health Regulatory Authority) is recognised world-wide as being one of the most thorough & stringent medicines regulators.
But are they safe for immune suppressed patients? There have not so far been any vaccine trials specifically investigating use in immune suppressed patients. However there is no reason to suspect that these patients will experience abnormal or undesirable effects from the vaccine.
Will people who are immune suppressed respond less well to the vaccine? This is a grey area. There is insufficient evidence so far to know how well people who are immune suppressed will respond to the vaccine.
In general terms, as people get older, their immune systems become less effective at responding. Some vaccines offer different types with adjuvants” to make them more effective in elderly patients. So far we know of no variants of the covid vaccine being made with this variation. All the usual immune suppressing drugs (azathioprine, cyclophosphamide, methotrexate, mycophenolate, rituximab & prednisolone etc) impair the response of the immune system. Evidence-based advice on how best to use the vaccine in such patients is not yet available.
Unlike the other drugs, which are given daily or weekly,Rituximab is usually given in widely spaced (4-6 monthly) infusions. In this case, all vaccines should be 2-3 months after an infusion or 1-2 months before the next infusion.
Which vaccine is best for those on immune suppressing drugs? So far there is no evidence to suggest that any of the vaccines is superior or inferior in terms of effectiveness or duration of effect.
Will there be a need for periodic booster doses of vaccine? A million dollar question to which no-one yet has an answer!
The most important advice for all who are currently “shielding” is to carry on shielding – even if you have had the vaccine. As more people are vaccinated, the risk of catching covid will reduce, so you will benefit from “herd immunity” of others.
Like the current ‘flu vaccine, the covid vaccine does not guarantee that you won’t catch covid, but it should ensure that you do not have serious, life-threatening symptoms.
What we do not yet know.
- How effectively the immune systems of people who are immune suppressed will respond to the vaccine. There is research into this currently being undertaken at Cambridge and elsewhere.
- How long any immunity will last
- Whether people who have had the vaccination can become asymptomatic carriers of the disease (ie infectious, but with no obvious sign of disease).
14th January 2021
This information is based on the best available information we can find, but it it changes daily. We can take no responsibility for the accuracy of this information.