A Brief Overview of Lupus and the COVID-19 Vaccine

If you have lupus, you must be wondering, is it safe to get a COVID-19 vaccination?  The short answer is yes, but there are some facts you need to know as you consult with your healthcare provider on taking the vaccine.  Read on to find out more!

 

Introduction

In record time, scientists have developed, and continue to develop, several highly effective vaccines to protect against the COVID-19 virus.  According to the CDC, those with underlying conditions such as lupus, and those taking immunosuppressant medications are most at risk for serious and perhaps fatal illness from COVID-19.  The list of immunosuppressant medications taken by those with lupus, include:  prednisone, cyclosporine, cyclophosphamide, azathioprine, methotrexate and some biologics, like Benlysta and Rituxan.

So, for most living with lupus, the benefits should far outweigh the risks.  As always, check with your healthcare provider.

Here is a little more information, in the form of a Q & A, to help you be better informed.


I have SLE.  Is the COVID-19 vaccine safe for me?

Again, for most patients with lupus, the answer will be yes.  Those with autoimmune conditions, like lupus, have not been a part of the most recent trials, and so there is no specific data available.  However, after consulting your healthcare provider, you should be confident in the safety of the currently approved COVID-19 vaccines.  Why?

First of all, most vaccines, such as those for the flu and other viruses, have historically been safe for those with lupus.  There is every indication that it will be the same with these vaccines.

Second, the new coronavirus vaccines are quite different from the past.  They do not use live viruses as some as some have, and they are designed to be safer.

Third, the risks from COVID-19 itself are far more serious to those with lupus and patients who are immune-compromised, than the risks from the vaccines.

Here are some details that may help explain why!

 

How do most vaccines work?

Most vaccines provide immunity by exposing your body to a safe version of a virus, or other pathogen, in order to initiate an immune response.  Vaccines can be weakened (attenuated) versions of the virus or they can contain pieces of the virus – usually proteins (antigens) from the outer coat of the virus.  These antigens trigger the immune system to become vigilant for the real viruses and to produce antibodies that will quickly attack any such viral infection in the future – hopefully preventing the infection from becoming serious.

 

How is Covid-19 vaccine different?

There are several ways in which the COVID-19 vaccines are different:

None of the COVID-19 vaccines currently being approved use live virus, so there is no chance that anyone will get COVID-19 from the vaccine itself.  That makes them safer than many previous vaccines.

Specific to the two vaccines from Pfizer-BioNTech and Moderna:

  • Both are mRNA vaccines. This means that rather than exposing a person to a weakened or piece of antigen from a real virus, these vaccines actually give your body the instructions (in the form of messenger RNA) to make its own antigens.   that mimic the “spike“ protein of the COVID-19 virus. Then, your immune system can make the correct antibodies without being exposed to any part of the real virus.
  • This is an entirely new way of providing immunity and is technologically very difficult. However, it has been shown to be safe and effective at preventing COVID-19 symptoms of disease.  The Pfizer-BioNTech vaccine was 95% effective at preventing COVID-19.  The Moderna vaccine was 94.1% effective, though slightly lower for those over 65.  This is exceptional compared to the annual flu shot, which averages 40% – 50% effective. *
  • Both vaccines require two injections, an initial vaccination and a booster, roughly 3 weeks apart for Pfizer-BioNTech and 4 weeks for Moderna. You will need both to get the maximum protection.
  • Both vaccines require extremely cold storage in order to maintain the effectiveness of the mRNA, though the Moderna vaccine can remain effective at slightly warmer temperatures. This makes the distribution and physical delivery of doses to each person more challenging than most other vaccines.

* One important note is that, though both mRNA vaccines have been effective at preventing the expression of COVID-19 as a disease in individuals, it is not yet known whether it can prevent infections asymptomatic.  Meaning that it is possible for the vaccines to help those who are vaccinated and will prevent the serious affects that would require hospitalization, yet not prevent possible transmission to others.  It will take time to know this for sure.  Either way, vaccinations are infinitely worth the risks and the unknowns.

 

What are possible side effects or concerns?

Any vaccine that triggers an immune response and the production antibodies has the potential for side effects. If you get a reaction from your annual flu shot, you probably know these already.  They include:

  • pain, redness, and/or swelling at the injection site;
  • fever;
  • chills;
  • fatigue;
  • headache, muscle or joint pain.

Most reactions should resolve within 24-72 hours.  If you experience more concerning or long-lasting symptoms, reach out immediately to your healthcare provider.

Currently, there is very limited information on the safety and efficacy of these vaccines for children under the age of 16 and for women who are pregnant.  These groups were not part of the initial trials, but this is normally the case for any vaccine.  Once health authorities see how the results from initial vaccinations of the general adult population, they will be able to make recommendations for everyone else.

 

 Who is eligible and when?

The answer to these questions will vary widely depending upon where you live in the world.  In most countries, the vaccine will be given to the most exposed to possible infection and those with the most serious underlying conditions.

In the U.S., based on CDC recommendations, there is a phased approach to that begins with:

  • healthcare providers, and
  • those working and living in assisted care or long-term care facilities.

Later phases will include:

  • workers in essential or critical industries, like food production, transportation, etc.
  • adults at greater risk for COVID-19 due to underlying health conditions, such as those who are immune-compromised – like those with lupus.
  • Adults over 65 years of age.

Again, these guidelines will vary from country to country.  As an example, the UK’s National Health Service provides a detailed priority list based upon age and on mitigating health care inequalities.

 

Final Thoughts

Finally, until you are vaccinated, continue to protect yourself based upon your local health authority’s guidelines.  Even after you receive your vaccinations, the basics of wearing masks and limiting social interactions should still be maintained.  Even after many months of widespread vaccinations have taken place, some with compromised immunity in our community will still need to take precautions, and that requires all of us to be thoughtful and compassionate.

 

 

References

COVID-19 vaccine and lupus. (2020). Lupus Foundation of America. https://www.lupus.org/resources/covid19-vaccine-and-lupus?utm_source=LO&utm_medium=email&utm_campaign=covid-19_vaccine#

COVID-19 vaccines: Get the facts. (2020). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-vaccine/art-20484859

Hensley, S. (2020, December 15). FDA analysis of Moderna COVID-19 vaccine finds it effective and safe. National Public Radio. https://www.npr.org/sections/health-shots/2020/12/15/946554638/fda-analysis-of-moderna-covid-19-vaccine-finds-it-effective-and-safe

Interim clinical considerations for use of Pfizer-BioNTech COVID-19 vaccine. (2020). Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/clinical-considerations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fcovid-19%2Finfo-by-manufacturer%2Fpfizer%2Fclinical-considerations.html#contraindications-precautions

Mahase, E. (2020). Vaccinating the UK: How the COVID vaccine was approved, and other questions answered. British Medical Association. Doi: 10.1136/BMJ.m4759. https://www.bmj.com/content/371/bmj.m4759

Pfizer. (2020, November 18). Pfizer and BioNtech conclude phase 3 study of COVID-19 vaccine candidate, meeting all primary efficacy endpoints [Press release]. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-conclude-phase-3-study-covid-19-vaccine

Understanding mRNA COVID-19 vaccines. (2020). Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/mrna.html

Vaccines and Related Biological Products Advisory Committee Meeting. (2020). Moderna COVID-19 Vaccine. U.S. Food and Drug Administration. https://www.fda.gov/media/144434/download#:~:text=The%20most%20common%20solicited%20adverse,in%200.2%25%20to%209.7%25%20of

 

 Author: Liz Heintz

Liz Heintz is a medical research writer who received her BA in Communications, Advocacy, and Relational Communications from Marylhurst University in Lake Oswego, Oregon. She most recently worked for several years in the healthcare industry. A native of San Francisco, California, Liz now calls the beautiful Pacific Northwest home.

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All resources provided by us are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views expressed here do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your healthcare practitioner with any specific questions or concerns.