COVID Vaccine Guidelines for patients with autoimmune diseases
January 2021
As the opportunity to receive a vaccine for COVID-19 nears, we are offering the following guidelines for people with autoimmune disease:
Talk with your doctor. There are over 150 autoimmune diseases, some of which may put a patient at greater risk from COVID-19 than others. It is impossible to know if these guidelines, or any guidelines you might hear on the news or read on the internet, are appropriate for you, the patient. So, our first and most important guideline: talk with your doctor.
There is no research on this subject yet. We have not found anything indicating vaccines are, specifically, safe for people with autoimmune diseases, nor anything indicating they are, specifically, NOT safe for such people. As soon as studies are published, ARI will post the information. Until then patients should realize that anything they read is not based on actual research on autoimmune diseases and COVID-19, but relies on assumptions based on other vaccines and other diseases.
The case-mortality rate for COVID in the US, 1.7% (Johns Hopkins), means that 17 of every 1,000 people who contract COVID die. As of January 2021, 6.5% of the US population have been infected with COVID. Mortality is higher for those with some underlying conditions, and that would, logically, include some autoimmune diseases. There is no definitive evidence that vaccines, including those with adjuvants, increase the risk of flares in autoimmune diseases. If you take the vaccine, you are accepting an unknown risk in exchange for avoiding a known risk.
Doctors and researchers are actively monitoring the vaccine as it is rolling out, but even when research is finally published, it is likely to be based on a specific autoimmune disease. For example, it is not clear that evidence for a disease like rheumatoid arthritis would be applicable to patients with a disease like Crohn’s. Again, as we stated at the beginning, talk with your doctor.
It is known that the COVID-19 vaccines currently approved contain molecules that mimic the characteristics of COVID-19 to stimulate an immune response. Therefore, unlike some vaccines, these do not contain any dead or weakened (“attenuated”) virus at all, and it is reasonable to conclude that the COVID-19 vaccine cannot lead to accidental infection with COVID-19 in anyone, including patients with autoimmune disease.
Evidence from research on other vaccines (e.g., H1N1 influenza) suggest that autoimmune disease patients who take immune-suppressing drugs benefit less from these vaccines than other patients, but these vaccines have been shown to impart measurable protection to these patients. (Furer et al, 2020, Jain et al, 2017).
References
Pellegrini et al, 2009, “MF59-adjuvanted versus non-adjuvanted influenza vaccines: integrated analysis from a large safety database”
Garg et al, 2018, “Recommendations and barriers to vaccination in systemic lupus erythematosus”
Gunes et al, 2015, “Possible Triggering Effect of Influenza Vaccination on Psoriasis”
Perdan-Pirkmajer et al, 2012, “Autoimmune response following influenza vaccination in patients with autoimmune inflammatory rheumatic disease”
Hospital for Special Surgery: Vaccinations and Lupus: What You Should Know
American College of Rheumatology: Information from the ACR Regarding Vaccination Against SARS-CoV-2
