COVID-19 Vaccines Print Page

Note: this information is based on knowledge available at this moment in time (Last updated January 21, 2020); data about the effectiveness and safety of available vaccines will continuously be updated. Check back here for updated information as it becomes available.  For more information about COVID-19 in general and arthritis, click here.

 

Bottom Line

The mRNA vaccines are ~95% effective in preventing COVID-19 infection. Although there is no data proving their effectiveness in patients with rheumatic diseases, these vaccines can be used safely in patients with rheumatic diseases as well as patients receiving drugs that influence the immune system.

 

Which COVID-19 vaccines are available?

  • Pfizer-BioNTech (tozinameran or BNT162b2) COVID-19 mRNA vaccine is approved for people who are at least 16 years of age
  • Moderna Therapeutics (mRNA-1273) COVID-19 mRNA vaccine is approved for people who are at least 18 years of age

 

How is the vaccine administered?

  • Pfizer-BioNTech: provided as a 2-dose regimen, with an intramuscular injection (upper arm) spaced 21 days apart (up to 42 days)
  • Moderna: provided as a 2-dose regimen, with an intramuscular injection (upper arm) spaced 28 days apart (up to 42 days)

 

How does the vaccine work?

  • mRNA vaccines DO NOT alter your genetic information (DNA) and are NOT live, so there is no risk of you getting COVID-19 from the vaccine. The vaccines do not contain an adjuvant.
  • mRNA vaccines provide your cells with the recipe to make a small portion of the virus (the spike protein that helps the virus enter cells), which your immune system learns to recognize in order to protect you. After the protein piece is made, the cells break down the instructions (mRNA) and gets rid of them.
  • Once triggered by the protein piece, your body makes antibodies that help you fight the real virus if you are ever infected.

 

What goes into making sure vaccines are safe and effective?

  • Canada is recognized around the world for high standards for vaccine review, approvals, and monitoring systems. Only vaccines that are safe and effective are approved for use in Canada.
  • These vaccines were able to come to the market more quickly than usual due to the availability of funding for their development, broad interest in participation in the studies, and prioritization of review for market authorization, all of which normally prolong the approval time.

 

How effective is the vaccine?

  • Pfizer-BioNTech: based on studies in 44,000 people, the vaccine was 95% effective in preventing COVID-19 as measured 1 week after the second dose
  • Moderna: based on a study in 30,000 people, the vaccine was 94% effective in preventing COVID-19 as measured at least 2 weeks after the second dose

 

What are the possible side effects of the vaccines?

  • Side effects were generally considered to be mild or moderate, lasting for only a few days, and were experienced by more people following the second injection.
  • The most common side effects were pain at the site of injection, body chills, muscle or joint aches, feeling tired, and feeling feverish, which indicate that the immune system is responding.
    • Some patients may experience more severe reactions than seen with other vaccines such as the flu vaccine, including fever of 39-40°C. Acetaminophen (Tylenol®) or ibuprofen (Advil®) or naproxen (Aleve®) may be used to manage any side effects seen.
  • As with all vaccines, there’s a chance of rare but serious side effects, such as allergic reactions (a recent report suggested this occurs in 0.001% of COVID19 vaccinations). There have been no major safety concerns identified and Health Canada will continue to monitor vaccine safety.

 

Is the vaccine safe for patients with rheumatic diseases?

  • Experts agree that these vaccines can be used safely in patients with rheumatic disease, like rheumatoid arthritis and lupus, including those receiving drugs that influence the immune system.
  • Health Canada has stated that the vaccine may be offered to populations who were either excluded or included in small numbers in clinical trials, including those with autoimmune disorders, where a risk assessment deems that the benefits outweigh the risks. A small number of patients with autoimmune disorders were included in the Pfizer-BioNTech trial, however no data are currently available specific to this population.
  • The CDC in the US has recommended that persons with autoimmune conditions who do not have contraindications to vaccination may receive an mRNA COVID-19 vaccine.
  • It is known that vaccine response in general may not be as strong or last as long in patients on immunomodulating therapies (like methotrexate, leflunomide, biologics, JAK inhibitors); it is possible this is the same for the COVID vaccines.
  • Importantly, there is no data suggesting that vaccines are not safe for those with rheumatic disease or on immunomodulating therapies.

 

Will COVID-19 vaccines interact with therapies used to treat rheumatic diseases?

  • Some disease modifying therapies (methotrexate, rituximab) have been shown to decrease the immune response to other vaccines. This may be true for the COVID-19 vaccines as well.
    • If you are using rituximab, discuss optimal timing of vaccine administration with your rheumatologist
  • However, again, there is no data suggesting that vaccines are not safe for those with rheumatic disease or on immunomodulating therapies.
  • Your rheumatologist may recommend holding one or more of your disease modifying therapies around the time that you receive the vaccine.

 

Why is immunization important?

  • It is the single most effective means of protecting yourself from COVID-19 and will help ensure our most vulnerable and at-risk populations are protected as well.
  • The vaccine will also reduce the strain on our healthcare system to allow elective surgeries and other postponed services to continue.

 

How soon will I be protected from COVID-19?

  • Protection from severe disease occurs very soon after the first injection, with more complete and likely longer-lived protection occurring about 2 weeks after the second dose.
  • It may be that people who are protected by the vaccine can still ‘carry’ the virus and transmit it to others, so recommendations for masking will be ongoing for now.

 

Will I have to get the vaccine annually (like the influenza vaccine)?

  • At this time, this is unknown. It is also still not clear how long immunity from ‘natural infection’ (getting COVID-19) lasts.

 

I have been infected with COVID-19, do I still need to get the vaccine?

  • Although people who had previously been infected with COVID-19 were excluded from studies on the vaccine, there have been cases of re-infection so it is suggested that this group of people is also vaccinated.
  • Research with other diseases has shown that vaccine immunity tends to be stronger than natural immunity.

 

Who will be eligible for the vaccine first?

  • Alberta Health Services is prioritizing health care workers who are very difficult to replace, including ICU staff and physicians as well as some continuing care health care workers.
  • It is anticipated that COVID-19 vaccine will be available to the general public in Fall 2021.
  • At least 50-70% of people need to be vaccinated to achieve ‘herd immunity’, where the natural patterns of spread will change.


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