COVID-19 Vaccines Print Page
Note: this information is based on knowledge available at this moment in time (Last updated September 23, 2021); 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.
If you have a rheumatic condition, you are eligible to book an appointment for COVID-19 vaccine today. For more information and to book your vaccine appointment, please visit: https://www.alberta.ca/covid19-vaccine.aspx
As of September 21st, the Government of Alberta announced those with autoimmune disease and taking Prednisone > 20 mg, methotrexate, Imuran (azathioprine), leflunomide, sulfasalazine or any biologic are eligible to receive a third shot of the COVID19 vaccine (Pfizer or Moderna). If you are not sure if you are eligible, and/or to ensure the most effective timing for receiving the 3rd shot, please consult your rheumatologist. For more information, please read below and watch our video.
The available vaccines are highly effective in preventing COVID-19 infection, and in particular severe COVID-19 requiring hospitalization. Although there is limited data proving their effectiveness in patients with rheumatic diseases, this data is rapidly growing. 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 recommended for patients with rheumatic disease?
- Pfizer-BioNTech (Comirnaty, BNT162b2) COVID-19 mRNA vaccine is approved for people who are at least 16 years of age
- Moderna Therapeutics (SpikeVax, mRNA-1273) mRNA and the AstraZeneca (ChAdOx1-S) and Johnson & Johnson COVID-19 DNA vaccines are approved for people who are at least 18 years of age
How is the vaccine administered?
- Each vaccine is administered as an intramuscular injection in the upper arm
- Comirnaty (Pfizer-BioNTech): provided as a 2-dose regimen, generally spaced 21 days apart (up to 4 months)
- SpikeVax (Moderna): provided as a 2-dose regimen, generally spaced 28 days apart (up to 4 months)
- Health Canada and Alberta Health are now recommending a 3rd dose for people who have autoimmune diseases and are taking therapies including ‘antimetabolites’ (methotrexate, leflunomide, sulfasalazine, azathioprine, mycophenolate), alkylating agents (cyclophosphamide), biologics, and JAK inhibitors. The 3rd dose should be provided no sooner than 4 weeks after the 2nd dose of vaccine.
How does the vaccine work?
- mRNA (Pfizer and Moderna) and DNA (AstraZeneca and Johnson & Johnson) 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 and DNA 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 or DNA) 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 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?
- Comirnaty (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
- SpikeVax (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
- All of the COVID-19 vaccines (including the AstraZeneca and Johnson & Johnson vaccines) marketed to date have been >80% effective in preventing COVID-related hospitalization or death.
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 of mRNA vaccine but the first injection of the AstraZeneca DNA vaccine.
- 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° 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 COVID-19 vaccinations).
- Many national regulators, including Health Canada, believe very rare events of blood clots associated with low levels of blood platelets may be associated with the AstraZeneca vaccine. While still early, this may also be true of the Johnson & Johnson vaccine, which is also a viral vector DNA vaccine. There are currently no reported cases or concerns that the Pfizer or Moderna vaccines (mRNA vaccines) cause blood clots. 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 a COVID-19 vaccine.
- The American College of Rheumatology has recommended that patients with autoimmune disorders should be prioritized for vaccination due to their higher risk for hospitalization and worse outcomes compared to other people of the same age and sex.
- The Canadian Rheumatology Association has recommended that patients who have an autoimmune rheumatic disease or are immunosuppressed due to treatment should receive the vaccine as prioritized by Health Canada (outlined by Alberta Health in Alberta).
- 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. However, it is highly likely that patients with rheumatic diseases will still benefit from the vaccine.
- Further, the American College of Rheumatology has recommended a 3rd dose of mRNA vaccine for patient receiving immunosuppressive or immunomodulatory therapy.
- 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) and higher doses of prednisone (>20mg daily) 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. If the vaccine is provided too close to rituximab, it may significantly decrease the efficacy or the COVID-19 vaccine.
- 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 (i.e. methotrexate, leflunomide, tofacitinib, upadacitinib, abatacept) 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 is eligible for the vaccine?
- All Albertans >12 years old are currently eligible and encouraged to receive their first 2 vaccine doses.
- The National Advisory Committee on Immunization has recommended as of September 10, 2021 that those with autoimmune disease and on most medications for treatment be made eligible to receive a third shot of the COVID19 vaccine.
- As of September 21st, the Government of Alberta announced those with autoimmune disease taking immunosuppressive or immunomodulatory medications are eligible to receive a third shot of the COVID-19 vaccine (Comirnaty (Pfizer) or SpikeVax (Moderna)).
- For those on rituximab and prednisone higher than 20 mg daily, you must coordinate the timing with your rheumatologist to ensure optimal effectiveness of the vaccine.
- At least 80% of people need to be vaccinated to achieve ‘herd immunity’, where the natural patterns of spread will change. With COVID variants, this number likely needs to be higher.