COVID-19 Vaccination Facts

Coronavirus Response and Updates

COVID-19 Vaccination Facts

UPDATE 2/5/2022: With so many changes to vaccine and testing recommendations and changes to treatments, RAB clinicians thought we could break this down a little to lend some understanding.


Vaccinations

“Fully Vaccinated” is defined as three (3) mRNA injections (Pfizer or Moderna) or one (1) J&J vaccine followed by one mRNA injection in people with a “normal immune system.”

Patients who are immunocompromised (taking a biologic medication, methotrexate, Cellcept, Azathioprine, Leflunomide, or Jak Inhibitor) are eligible for a fourth “booster” 5 months after the third vaccine.  It is recommended that you continue with the same vaccine that you have already received.


Prevention

Evusheld:  This is a new monoclonal antibody drug to “prevent” COVID -19 in severely immunocompromised patients.  The treatment consists of two (2) injections given together.  This is used for those immunocompromised patients who have a suboptimal response to vaccinations or who cannot take the vaccine to prevent infection.  This treatment can offer protection for up to 6 months.  Treatment with Evusheld is currently only available in select hospitals for patients undergoing Chemotherapy or Bone Marrow Transplant (and on certain immunosuppressive medications) due to its limited distribution.  Evusheld is not used to “treat” an active infection.

 

Treatments

Antivirals

Paxlovid:  This is a new treatment under EUA for “newly diagnosed” immunocompromised COVID-19 patients.  This medication is used for patients who are at risk of progressing into severe COVID-19, including hospitalization.  The medication is in pill form and is taken twice daily for five (5) days as soon as possible (within 5 days of diagnosis) after being diagnosed with COVID-19.  This medication is shown to reduce serious hospitalizations and death by up to 89%.

Molnupiravir:  This is a new treatment under EUA for “newly diagnosed” immunocompromised COVID-19 patients.  This medication is used for patients who are at risk of progressing into severe COVID-19, including hospitalization for whom alternative COVID-19 treatment options are not accessible or clinically appropriate. The medication is not indicated during pregnancy. It is taken as four (4) pills twice a day for five (5) days, (within 5 days of diagnosis) and the full course is required to achieve the benefit of the medication.

 

Monoclonal Antibodies

Sotrovimab:  Sotrovimab is a monoclonal antibody that is currently available for the treatment of outpatients with mild-to-moderate COVID-19 who have risk factors for progression to more severe disease. It is administered within 10 days of symptom onset, but it is most effective when given as soon as possible following diagnosis. This is a new monoclonal antibody infusion that is shown to be effective again Omicron.


Testing

There are two tests currently available:  PCR tests or Rapid Antigen Tests (Abbott Binax Now, Quidel QuickVue tests; both for home use).

PCR Test:  This test is very sensitive and can detect small amounts of the virus including during the very early infected stage.  This test may occasionally remain positive after the infection clears.

Rapid Antigen Tests (At home testing):  These at home tests may be delayed by 2 days before a positive result is seen.  This timing correlates with the stage of infectivity.  These tests are easy to perform and sold at many retail pharmacies and other store locations.

 

What should you do if you are immunocompromised and get COVID-19?

  • Call your doctor as soon as possible (this includes your primary care physician, rheumatologist, and other specialists you may see)

  • Isolate yourself from other

  • Wear a mask

  • You may need to modify chronic medications, especially steroid and immunomodulators.

  • Monitor your symptoms.  Serious warning signs include trouble breathing, chest pain, confusion or drowsiness, blue lips, and low pulse oximeter readings

  • Consider treatment with Paxlovid, or Sotrovimab

 

As always, your RAB clinician is here to answer questions and work to coordinate your care. 

UPDATE 8/16/2021: Recently there have been a number of questions surrounding the Covid-19 infectious risks in patients with chronic rheumatic diseases, especially vaccination recommendations.  On August 13, 2021 the CDC made further recommendations.  The important points include the following:

 

  • Patients on chronic Biologic* medications or on the following non-Biologic DMARDS:  Methotrexate, leflunomide, Jak inhibitors (Xeljanz, Rinvoq, Olumiant), prednisone above 20mg daily, should receive a third vaccine dose if they initially received either the Moderna or Pfizer vaccine.  Additionally, patients on Azathrioprine, Cellcept and cyclosporine should also receive a third vaccine.

  • There are no specific recommendations concerning using the result of testing of the Covid spike protein antibody to alter any treatment recommendations at this time

 

  • Patients should remain careful in situations where they would be exposed to non-vaccinated people, such as crowds, etc.  When in doubt, continue to use the same rules of masking and social distancing

 

  • Data has shown that a third vaccine has increased the antibodies in patients who are immunocompromised and that the vaccine has been well tolerated including a relatively low risk of causing flares of the underlying chronic disease

*Biologic medications include:  Enbrel, Humira, Remicade, Simponi, Cimzia, Orencia, Actemra, Kevzara, Rituxan, Cosentyx, Taltz and Stelara as well as biosimilar biologics for Remicade and Rituxan.  

UPDATE 4/19/2021: The American College of Rheumatology has recently come out with some new guidelines regarding medications and receiving the COVID19 vaccine. Please understand that these are Guidelines and RECOMMENDATIONS and may not apply to every patient. You will likely want to discuss with your provider caring for you if you have questions or concerns. 

 

The following guidelines were given: 

 

  1. Do not take methotrexate for one week following each COVID19 vaccination (for those with well controlled disease) 

  2. Do not take JAK-inhibitors such as Xeljanz (tofacitinib), Olumiant (baricitinib), or Rinvoq (upadacitinib) for one week following each COVID19 vaccination 

  3. No changes need to be made in terms of medications for: hydroxychloroquine, IVIG, or prednisone dose of less than 20 mg 

  4. Orencia (abatacept) Subcutaneous - hold for one week before and one week after the FIRST COVID19 vaccination injection ONLY. No change around second dose 

  5. Orencia (abatacept) IV - Time vaccine administration so that the first vaccination will occur four weeks after Orencia infusion (i.e., the entire dosing interval), and postpone the subsequent Orencia infusion by one week (i.e., a 5-week gap in total); no medication adjustment for the second vaccine dose

  6. Rituxan (Rituximab) -  schedule vaccination so that the vaccine series is initiated approximately 4 weeks prior to ext scheduled rituximab cycle; after vaccination, delay rituximab 2-4 weeks after the 2nd vaccine dose, if disease activity allows. 

  7. Cytoxan (Cyclophosphamide) - time for one week after each COVID19 dose if possible 

  8. No recommended modifications for: Sulfasalazine, leflunomide, azathioprine, cellcept, Actemra, Benlysta, tacrolimus, and TNF inhibitors such as Remicade (infliximab), Humira, (adalimumab), Enbrel (etanercept), Cimzia (certolizumab), Simponi (Golimumab), nor biologics used for psoriatic arthritis such as Cosentyx (secukinumab), Stelara (ustekinumab), Taltz (ixekizumab), Tremfya (Guselkumab). Biosimilars fall into this same category. No recommended modifications for Otezla (apremilast)

 

The ACR has voiced that recommendations in the guidance should not replace clinical judgement, and decisions about individual patients should be made as part of shared decision-making with patients that considers their underlying health condition(s), disease activity level, current treatments, risk of exposure to SARS-CoV-2 and geography. (In short, your provider will be the best person to help in making these decisions with you). Patients are also encouraged to continue following all public health guidelines regarding mask wearing, physical distancing and other preventive measures even after vaccination. Remember: Continue masking and social distancing......GET YOUR VACCINE!  

 

We would also like to use this space to say: As we learn more through studies in the coming months to years, we will do our best to share that information with you. These are merely eminence based recommendations/guidelines and not set in stone. If you have already had your vaccine and not made such changes, then we must remember this fact.  Again, the most important thing is to get vaccinated.

SOCIAL DISTANCING

Why do we take social distancing so seriously?  The attached 3-D demonstration from the New York Times helps to demonstrate why.  Click here to check it out. 

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