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Questions and Answers Regarding the COVID-19 Vaccine

Read February 10, 2021 guidance on COVID-19 vaccines from the American College of Rheumatology

The following information was updated April 29, 2021, by the Scleroderma Foundation's Medical & Scientific Advisory Board Leadership Committee*

Preamble

The COVID-19 pandemic is from the SARS-CoV-2 virus and thus far is responsible for more than 75.2 million cases and 1.67 million deaths worldwide, with 17.3 million cases and 311,000 deaths in the USA (as of Dec 18, 2020). The numbers are rising. COVID-19 is now the leading cause of death in the USA.

Recommendations about receiving COVID-19 vaccinations may be changing as we learn more. These questions and answers are only a guide and should not replace discussion with your health care provider.

The three vaccines approved in North America are the Pfizer, Moderna, and Johnson & Johnson vaccinations. Other vaccines are available in different parts of the world. The Pfizer and Moderna vaccination will be in a series of two injections provided either three weeks (Pfizer) or 28 days (Moderna) apart. The Johnson & Johnson vaccine is a single dose. 

If receiving any other vaccine, such as the common flu, a period of 14 days should elapse before receiving either your first or second dose of the COVID-19 vaccine.   

Commonly Asked Questions

Should I get the COVID vaccine?

Yes, however if you have systemic sclerosis (scleroderma) there may be some things you should know before you receive it. The vaccines so far have not tested in pregnant women, children below age 16, or large numbers of patients with autoimmune diseases. As more data are available, recommendations may include them.

What is the benefit?

The vaccines against COVID-19 seem highly effective. However, they have not been tested in large numbers of people with autoimmune diseases and/or patients receiving immunosuppressive medications. There may be a dampened response such as in people with systemic sclerosis (scleroderma) who may be taking immunosuppressive medications. The benefits include prevention of COVID-19 infection, or less severe infection, and herd immunity (stopping the spread in your community when enough people are vaccinated). Due to the significant amount of people who have died or been very sick with COVID-19, the hope is to prevent severe infection and its long-term effects.

What do I do with my medications/drugs when I get the vaccination?

At this time, there is not enough information regarding the effect of immunosuppressive medications on the efficacy of the COVID-19 vaccine, and you should consult your health care provider on this matter. Some medications may be interrupted briefly during vaccination, however if you have been on prednisone for a long time, it cannot be stopped for the vaccination.

We know that with the flu shot, patients receiving methotrexate may have a better response if they hold their methotrexate for 2 doses after receiving the vaccination. There is no firm recommendation for the COVID-19 vaccination but perhaps interrupting your immune suppression medication for 2 weeks after each injection may lead to a better response. However, this is only speculation. This could include methotrexate, mycophenolate mofetil, azathioprine, tocilizumab, JAK kinase inhibitors, TNF inhibitors, abatacept. If you are receiving rituximab, the timing may be best to receive the vaccination 4 months after the last dose of rituximab and waiting a couple of months to receive your next dose of rituximab. This is only a guideline and you can show this as an example to your health care provider.

Will this flare my scleroderma?

We do not know, but a flare of scleroderma should not be common as many other vaccinations that boost the immune system do not routinely flare autoimmune diseases in the vast majority of people who receive vaccines.

The vaccine will not be 100% effective, so all recommendations after being vaccinated will still be present such as wearing a mask, frequent hand washing, and social distancing.

Is there a special risk for me as I have SSc?

The main risk factors for poor outcomes with COVID-19 infection are advanced age, heart disease, chronic obstructive lung disease, diabetes mellitus, high dose prednisone use, and other minor risk factors such as high blood pressure and high body mass index (obesity). It is likely that those with recurrent infections and those who are frail also have a higher risk of doing poorly. We suspect that having interstitial lung disease or pulmonary hypertension or recurrent aspiration from poor motility of the swallowing tube (esophagus) put those with systemic sclerosis at a higher risk, making vaccination an important consideration for these and most other patients. The risk is likely not increased in those with morphea and linear scleroderma unless they are on strong immune suppression treatment.

How long will the vaccine be effective for?

We do not know. The vaccine trials contained large numbers of patients, so antibody response and the safety are known for the short term, but the long-term benefit is currently unknown.

Will vaccines stop the pandemic?

This depends on how effective the vaccines are and how many people receive the vaccine (for herd immunity) and how long the benefit / response to the vaccination lasts. Also, so far, the virus is not mutating very much but if it mutates then benefit may be less. This is true for the flu vaccination where the influenza virus mutates every year, and the flu shot reflects the strains that are expected to be in your community.

Scleroderma Foundation Disclaimer: The Scleroderma Foundation in no way endorses any drugs, treatments, clinical trials or studies referenced in this document. Information is provided to keep the readers informed. Because the manifestations and severity of scleroderma vary among individuals, personalized medical management is essential. Therefore, it is strongly recommended that all drugs and treatments be discussed with the reader’s physician for proper evaluation and treatment.

[Revised May 17, 2021]

Important Guidance on COVID-19 & Scleroderma

Webinar Recordings on COVID-19 & Scleroderma

Guía de COVID-19 y esclerodermia

  • 17 May 2021 Actualizaciones: Medidas importantes para el covid 19 y el uso de mascarillas
  • 1 April 2020 Información Importante Traducida al Español Sobre COVID-19 y Esclerodermia Juvenil
  • 30 March 2020 Español "COVID-2019 ("Coronavirus") Información y Recomendaciones del Comité de Asesoría Médica y Científica de la Fundación de la Esclerodermia