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Covid-19 Vaccine FAQs - Rheumatology

The Frequently Asked Questions (FAQ) below have been generated from the “Understanding the COVID Vaccine” Webinar for Rheumatology patients under the Care of Swansea Bay University Health Board, held on the 3rd March 2021. 

Please note that questions have been put into themes and have not been answered on an individual basis. It is important to note that guidelines are constantly changing and answers given were based on the latest guidance that was available at the time.

There are some types of arthritis which are caused by the body’s immune system, which usually protects us from infection. When the immune system is affected by arthritis or drugs to treat the condition, the risk from COVID-19 is increased.

People who catch COVID-19 can become very unwell. Many people will need hospital treatment even if they don’t have a health condition.

Vaccines are a good way for people with rheumatology conditions to stay safe. Vaccines teach the immune system to recognise infections, stopping people becoming unwell.

There are many vaccines in development for COVID-19, but we don’t know exactly when each of these will be available. So far, three COVID-19 vaccines have been approved for use in the UK – the Pfizer/BioNTech vaccine, the Oxford AstraZeneca vaccine and the Moderna vaccine. The Pfizer/BioNTech vaccine became available in early December 2020, and the Oxford AstraZeneca vaccine became available from January 2021. The Moderna vaccine isn’t expected to be available in the UK until spring 2021.

There are many different types of vaccinations for COVID-19 in development around the world, which act in slightly different ways to cause the immune system to respond.

The Pfizer/BioNTech vaccine uses bits of genetic code to cause an immune response, and is known as an mRNA vaccine. The Oxford AstraZeneca vaccine uses a real virus that has been inactivated to cause an immune response. These are safe ways to show the body what COVID-19 looks like, so that the immune system is better prepared to fight a COVID-19 infection.

People with some types of arthritis take medicines to suppress the immune system. In general people on these treatments need to avoid live vaccines.

All of the COVID-19 vaccines available in the UK are safe for people with arthritis and people taking drugs that suppress the immune system, even if your condition is active.

The Pfizer/BioNTech vaccine is not made from a real virus, and people who take medicines to suppress the immune system can have this vaccine. People on drugs that suppress the immune system are on the priority list for vaccination that has been produced by the Joint Committee on Vaccination and Immunisation (JCVI).

Although the Oxford AstraZeneca vaccine is made of a real virus, it has been inactivated so it can’t cause a serious infection, even in someone whose immune system has been suppressed. This means that it’s safe for people who are on medicines to suppress the immune system.

There is no good evidence that one vaccine is more suitable than another for people who are on drugs that suppress the immune system. It may take many months of further research to determine this.

If you’re offered the vaccine and delay taking it, then you leave yourself at risk from COVID-19.

Some people who are taking drugs that suppress the immune system may be given advice to continue avoiding exposure to COVID-19 after they have had the vaccination. This is because their medications could mean their immune system doesn't respond as strongly to the vaccine as people who don't take these drugs. If you’re offered the vaccine and delay taking it, then you leave yourself at risk from COVID-19. If you’re already taking medicines that suppress the immune system, you shouldn’t stop or delay these to have the vaccine, as doing this could cause you to have a flare-up, which can increase your risk from COVID-19.

If you haven’t yet started treatment with medicines that suppress the immune system, or if you’re about to have a repeat course of treatment to suppress the immune system, it might be a good idea to delay this until a couple of weeks after you have had the last dose of the vaccine. But you should only think about doing this if your rheumatology team say that it is safe to delay your treatment.

Everyone in the UK will need to follow government advice on reducing the spread of COVID-19, even after they have had the vaccine. People who are clinically extremely vulnerable will need to follow the local advice for this group, even if they have been vaccinated against COVID-19.

It’s fine for you to have the vaccine while you’re taking steroids. There’s no reason to delay the vaccine if you’re taking steroids, or have recently had a steroid injection or finished a course of steroid treatment. Taking steroids as tablets, liquids, injections or drips might mean that your immune system doesn’t respond as well to the vaccine as someone who isn’t taking these drugs. This means that you may be advised to follow advice on shielding and social distancing guidance after you have had it. Steroid creams or eye drops should not affect your immune system or response to the vaccine. Your healthcare team might want to discuss delaying a dose of steroids or a steroid injection with you, especially if there is a high risk of getting COVID-19. It’s important that you don’t stop taking your steroid medication without speaking to a healthcare professional, as this can leave you at risk of having a flare-up, which can increase your risk of COVID-19.

Trials for the vaccine in children have only just begun, so it’s generally not recommended for children under 16. It’s also known that children and young people are at a very low risk of COVID-19 generally.

It’s possible these recommendations may change once more adults have had the vaccination.

The COVID-19 vaccine can be given to pregnant women in cases where the benefits outweigh the risks – for example, if the risk of being exposed to COVID-19 is high or if the woman is at an increased risk of serious complications of COVID-19. The benefits and risks can be discussed with a healthcare professional before having the vaccine.

Women who are trying to get pregnant don’t need to avoid pregnancy after having the vaccination.

Your doctor or midwife will be able to give you more advice. These vaccines haven’t been tested during pregnancy and breastfeeding, but there is nothing to suggest that they are harmful during pregnancy or breastfeeding.

Guidelines recommend people do not have major surgery and vaccines within one week of each other. This is because both surgery and the vaccine can cause a fever.

Vaccines are usually given as an injection into the upper arm.

The Pfizer/BioNTech vaccine is given in two doses, between 3 and 12 weeks apart. The Oxford AstraZenenca vaccine is given in two doses, between 4 and 12 weeks apart.

Both of the available vaccines are thought to offer short-term protection after the first dose. The second dose is important for long-term protection from COVID-19.

The Oxford AstraZeneca vaccine prevented COVID-19 in about 7 in every 10 people, with no severe cases from 14 days after the first injection. The Pfizer/BioNTech vaccine prevented COVID-19 in more than 9 in every 10 patients (95%) and starts to work around 10 days after the first dose.

It’s possible for people who have already had COVID-19 to have the vaccine for it. It’s not known yet how long the antibodies made by your body in response to COVID-19 last, so a vaccine could offer more protection or boost any antibodies your body has already made.

The most frequent adverse reactions in trials were pain at the injection site, fatigue, headache, myalgia (muscle pains), chills, arthralgia (joint pains), and fever; these were each reported in more than 1 in 10 people.

The vaccination takes 2 weeks after the second dose to be fully effective. Patients are still advised to follow government advice regarding shielding/mask wearing/social distancing despite being fully vaccinated. Vaccination is not an alternative to these measures.

You are far more likely to be unwell from contracting COVID than from the possible mild and transient side effects of the vaccine.

This would depend on the DMARD medication that you are taking.

No, there is no evidence to support this.

Ideally there should be a 2 week gap after vaccination before receiving i.v. Rituximab or Abatacept.  This doesn’t apply for other rheumatology treatments.

Please discuss this with your Rheumatology CNS/Consultant.

To ensure the safety of patients and staff during the pandemic, the number of patients attending out-patient clinics has had to be reduced.  Only urgent patients are being seen at the moment.  Clinic appointments are being held virtually, and from this consultation patients who require a face to face appointment will be seen in the hospital.

First published: 24 March 2020

Last updated: 5 February 2021

What do we mean by 'extremely vulnerable'?

Extremely vulnerable refers to people in Wales who have one of a very specific list of pre-existing and long-term serious health conditions.

Based on what we know so far the impact of their pre-existing, long-term health condition on their immune system puts them at high risk of serious illness if they are exposed to coronavirus.

People in the extremely vulnerable group include:

  1. Solid organ transplant recipients
  2. People with specific cancers: ◦ People with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer ◦ People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment ◦ People having immunotherapy or other continuing antibody treatments for cancer ◦ People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors ◦ People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
  3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe Chronic Obstructive Pulmonary Disease (COPD)
  4. People with severe single organ disease (e.g. Liver, Cardio, Renal, Neurological).
  5. People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as Severe Combined Immunodeficiency (SCID), homozygous sickle cell).
  6. People on immunosuppression therapies sufficient to significantly increase risk of infection and patients with a diagnosis of RA or SLE.
  7. Adults with Down’s syndrome.
  8. Pregnant women with significant heart disease, congenital or acquired.

The advice to those who are Clinically Extremely Vulnerable has changed.

You are advised that you should no longer attend work or school outside the home.

The Welsh Assembly Government have sent a letter to everyone on the Shielding Patient List confirming this advice.

We know long periods of isolation can be harmful for mental and physical health, therefore you can remain part of a support bubble, as long as you take care. You are encouraged to still go outside to exercise and attend medical appointments.

Everyone in Wales is currently subject to regulations in place at alert level 4 and therefore must stay at home as much as possible.

Useful websites:

Please note the majority of this advice is available on the websites below.

Follow this link to the Covid-19 guidance page on the British Society for Rheumatology website.

Follow this link to the Arthritis and Covid-19 page on the Versus Arthritis website.

Follow this link to the Coronavirus page on the Welsh Government website.

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