Should People with Lupus Take the COVID-19 Vaccine?
By Dr. Robert Katz
It is advisable that people with lupus take the COVID vaccine as soon as it becomes available to them.
On December 11, 2020, the U.S. Food and Drug Administration issued the first emergency use authorization (EUA) for a vaccine for the prevention of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals 16 years of age and older. The emergency use authorization allows the Pfizer-BioNTech COVID-19 Vaccine to be distributed in the U.S.
The Pfizer-BioNTech COVID-19 Vaccine is not a live vaccine (live vaccines are not recommended for lupus patients).
There are groups that are not approved for the vaccine and if someone with lupus falls into one of those groups, then they should not take the vaccine. Those groups are: children under 16 years of age, the immune compromised and individuals who have had adverse reactions to vaccines.
The Moderna vaccine is being reviewed by the FDA for approval. In addition there are other vaccines in phase III clinical trials (human test subjects vs. placebo). None of the vaccines in phase III trials have live COVID virus, so lupus patients taking immunosuppressive medications and prednisone and those taking biologics should be fine to receive these non-live vaccines.
Vaccines work by helping the body develop immunity by imitating an infection. This type of infection, however, almost never causes illness, but it does cause the immune system to produce T-lymphocytes and antibodies. Sometimes, after getting a vaccine, the imitation infection can cause minor symptoms, such as fever. Such minor symptoms are normal and should be expected as the body builds immunity.
Following natural infection with COVID-19, immunity with the development of antibodies takes between five and 14 days after the onset of symptoms.
At this time, it remains unclear how long protection against re-infection lasts following natural infection with the COVID-19 virus, or with vaccination. The durability of protection, or how long immunity lasts, remains to be determined, and even the presence of antibody responses may not confer reliable or durable protection from re-infection.
There are five COVID-19 vaccines completing phase III studies, and 50 vaccines in some stage of clinical testing. The vaccines are of several categories. One is messenger RNA vaccines. Messenger (m) ribonucleic acid (RNA) vaccines are part of, but not the complete virus. Another type is an adenovirus vaccine, which is part of a virus that causes the common cold and transports COVID viral material, but not the full COVID virus. Then there are other subunit vaccines.
The messenger RNA vaccines have the mRNA bundled in a fatty outer shell that gets incorporated into human cells upon vaccination. This messenger RNA encodes for the viral spike protein of the COVID-19 virus and instructs the human cell to produce the spike protein, which stimulates an immune response that ultimately provides protection against the COVID-19 virus.
One vaccine in trials uses a defective adenovirus vector that has been altered to code for the COVID spike protein. Once the inactive vector infects the host cell, its DNA enters the cell nucleus. The human host then produces the spike protein from the COVID-19 virus, which produces an immune response against the COVID virus.
Another approach is to use protein subunit vaccines that contain purified viral proteins, often the spike protein. The protein is processed by the immune system to trigger a protective immune response.
The Pfizer and BioNTech vaccine is a messenger RNA vaccine. Moderna has produced a messenger RNA vaccine that is about to be approved by the FDA. Astra Zeneca reported initial results using an adenovirus vector vaccine. Novavax has a protein subunit vaccine, but results have not yet been released, and Janssen is finishing up a one-dose vaccination study and preparing for a two-dose vaccination study using a viral vector vaccine. Most of these trials have over 30,000 participants.
When Dr. Jonas Salk invented the polio vaccine, throughout the nation on April 12,1955 church bells rang out, kids were let out of school, and people danced in the streets. This is another momentous occasion.
We’ll see how things progress with these vaccines.
Robert S Katz, M.D.
