For up-to-date information, news, and research developments on COVID-19 and autoimmune disease, check out our evolving timeline.
Since the start of the pandemic, researchers and health officials alike have wondered about the impact of SARS-CoV-2 on autoimmune disease.
Now, more than a year since the first case of COVID-19 in the United States, scientific research developments and hospital data have revealed answers to these salient questions.
The results of a retrospective cohort study recently published by New York-Presbyterian Hospital/Columbia University Irving Medical Center show this not to be the case.
Conducted in the spring of 2020, this was one of the most extensive inpatient studies evaluating the impact of COVID-19 on autoimmune disease patients. The results, which were peer-reviewed and published in February 2021, showed that ICU admission and outcomes were similar between patients with and without autoimmune disease. While autoimmune disease patients were more likely to have at least one comorbidity, take immunosuppressants, and/or have had an organ transplant, “there were no significant differences in ICU admission, intubation, or death” (1).
“Although some studies have suggested a higher risk of respiratory failure in patients with autoimmune disease, most have not observed an increase in overall mortality” (1). This can be seen as encouraging news for the autoimmune disease community. Across the board, hospital data reveals that, in general, autoimmune disease patients are not at a higher risk than the general population (2).
This discovery, however, does not negate the fact that certain autoimmune diseases and comorbidities may still be considered high risk. The myriad factors at play—including population groups, sex, and coexisting conditions—merit continued investigation.
Given the speed at which vaccines have been authorized for emergency use, raw data from clinical trials on COVID vaccines and autoimmune disease is lacking. This has left health and industry experts with the complicated task of guiding their communities on getting the vaccine and abating concerns about its safety.
The CDC updated their vaccination recommendations on March 5, 2021, stating autoimmune disease patients may receive the vaccine.
“People with autoimmune conditions may receive a COVID-19 vaccine. However, they should be aware that no data are currently available on the safety of COVID-19 vaccines for people with autoimmune conditions.”
To view specific vaccine recommendations from autoimmune organizations, scroll to the bottom of this page! Each organization makes their consensus clear: people with autoimmune diseases are highly encouraged to speak with their healthcare teams regarding the vaccine.
What could be a reason for allergic reactions or adverse effects to the COVID-19 vaccine? Contrary to what you may initially think, it would not come from the vaccine’s active ingredients. In the Moderna and Pfizer vaccines, this means the mRNA encoding the viral spike (S) glycoprotein of SARS-CoV-2; in the Johnson & Johnson (J&J) vaccine, the active ingredient is theAd26 vector encoding a SARS-CoV-2 S (S) spike protein. While available data around autoimmune disease and the COVID-19 vaccine is still scarce, previous studies with autoimmune rheumatic disease patients underscore the importance of vaccinations in general.
The materials that may trigger adverse reactions in certain individuals are known as lipid nanoparticles. These are used as a carrier mechanism to deliver the viral encoding, and can be found in scores of vaccines. However, this is the first time lipids are being used in a licensed, FDA-approved mRNA vaccine. Research published in the New England Journal of Medicine expounds on the possibility of a hyperimmune response to these lipids, leading to an adverse reaction in some recipients of the Pfizer and Moderna vaccines (3, 4). The J&J vaccine has reported less adverse reactions. Experts are unsure as to exactly why this is (5).
If you are living with contraindication—a health condition that increases the likelihood of an adverse reaction after receiving a vaccine—talk to your doctor about the best course of action. The only contraindications to the COVID-19 vaccine listed by the Centers for Disease Control and Prevention (CDC) are for patients who have experienced a history of “severe allergic reaction (e.g. anaphylaxis) after a previous dose or component of the vaccine, [or] immediate allergic reaction of any severity after a previous dose or known (diagnosed) allergy to a component of the vaccine.” Check out the CDC’s Appendix C: Ingredients Included in the COVID-19 Vaccine for a break-down of the ingredients in each US-approved vaccine.
The CDC website also explains the characteristics of adverse reactions and vaccine side effects for each vaccine.
Generally, individuals taking immunosuppressive drugs—such as corticosteroids, hydroxychloroquine, or biologics—are only included in studies after a vaccine receives FDA approval. If included before Phase 4 surveillance studies, they can skew the vaccine’s efficacy rates. This begs the question: are vaccines less effective if you’re taking immunosuppressants for your autoimmune disease? You may be wondering if your chance for creating a robust immune response after vaccination might be compromised by how you care for your health. Although experts recommend that the autoimmune disease community get vaccinated (see above), the question of efficacy rate is worth exploration (6).
What does “efficacy” mean in the context of vaccines? The New York Times wrote an informative piece breaking down efficacy numbers and implications of each US-approved vaccine. In short, 100% efficacy means that 100% of the risk for a COVID-19 infection is eliminated by the vaccine. Conversely, 0% means that those who’ve taken the vaccine are at the same risk as those who have not been vaccinated (or received the placebo during clinical trials).
For the J&J vaccine, there is an 85% efficacy rate against severe cases and death as of 28 days after vaccination (7). Of the variants tested during clinical trials (besides the B.1.351 variant in which the efficacy was 64%), that means there is 85% less risk of developing a severe case of COVID-19 compared to those who did not receive the vaccine. When taking a look at the J&J vaccine’s ability to reduce the risk of contracting COVID-19 in the first place, the efficacy rate is 66%.
While the data is still being evaluated, Dr. Fauci has stated a broad strokes recommendation that those who are immunocompromised and actively receiving immunotherapies should, in fact, get vaccinated against COVID-19. During the 62nd annual American Society of Hematology meeting in December 2020, Dr. Fauci reminded virtual attendees that those on immunosuppressant agents may not have as robust of an immune response to the vaccine since their immune system is compromised. That being said, Dr. Fauci is clear that “some degree of immunity is better than no degree of immunity” (8).
It is critical to speak with your healthcare provider regarding specific medications when considering getting the COVID-19 vaccine. Recommendations for which medications should be paused or continued are in flux, and your provider will have the most accurate information specific to you and your health plan.
New data and scientific research is being published regularly, speaking volumes toward the attention COVID-19 has brought to studying autoimmunity. These most recent developments, addressed by US health authorities like the CDC, create a solid starting point for autoimmune disease and immunocompromised patients to navigate their health. In regards to COVID long-haulers, we are working on a thorough round-up dedicated to understanding new developments around long COVID and autoimmunity. Until then, check out our initial insights on long COVID.
The following autoimmune disease organizations have released statements with vaccine recommendations for their specific communities:
Faye, A. S., Lee, K. E., Laszkowska, M., Kim, J., Blackett, J. W., McKenney, A. S., . . . Lebwohl, B. (2020). Risk of adverse outcomes in hospitalized patients with autoimmune disease and covid-19: A Matched cohort study from New York City. The Journal of Rheumatology, 48(3), 454-462. https://doi.org/10.3899/jrheum.200989
Haberman, R., Axelrad, J., Chen, A., & Hudesma, D. (2020, April 29). Covid-19 in Immune-Mediated Inflammatory Diseases — Case Series from New York [Letter to To the Editor].
Castells, M., Phillips, E. (2021, February 18). Maintaining safety with SARS-CoV-2 vaccines. The New England Journal of Medicine, 643-649. https//doi.org/10.1056/NEJMra2035343
Vrieze, Jop. (2020, December 21). Suspicions grow that nanoparticles in Pfizer’s COVID-19 vaccine trigger rare allergic reactions. Science.
Lyons, P. (2021, February 28). Here is how Johnson & Johnson’s vaccine differs from Pfizer’s and Moderna’s. The New York Times.
Chau, C., Chow, L., Sridhar, S., Shih, K. (2021, March 6). Ophthalmological considerations for COVID-19 vaccination in patients with inflammatory eye diseases and autoimmune disorders. Ophthalmology and Therapy. https://doi.org/10.1007/s40123-021-00338-1
Johnson & Johnson. (2021, February 27). Johnson & Johnson COVID-19 vaccine authorized by U.S. FDA for emergency use – first single-shot vaccine in fight against global pandemic [Press release].
Caffrey, M. (2020, December 6). Taking immunosuppressants? Fauci says get the COVID-19 vaccine. AJMC.