Coastal Immunology and Allergy Clinic | Covid-19 Frequently Asked Questions
Coastal Immunology and Allergy Clinic offer expert diagnosis and management for adults and children with conditions within the spectrum of Immunological and Allergic disorders.
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Covid-19 Frequently Asked Questions

Find out the answers to your most frequently asked questions

Here we have provided world expert information on the Covid-19 vaccine, to assist you in making informed decisions about your care.

SHOULD I HAVE THE VACCINE IF I HAVE AN ALLERGY?

This needs to be a conversation between you and your GP, who can advise on a case-by-case basis. But, generally speaking, there are no common allergies that should stop you having a COVID vaccine. If someone has a peanut allergy they can have the vaccine, and the same goes for shellfish, wheat, eggs or any other common allergies.

Some people are allergic to an ingredient called polyethylene glycol, or PEG, which is found in more than 1,000 different medications and is used in the Pfizer vaccine as a mechanism to help deliver the viral mRNA (genetic material) into your cells.

In the US and UK vaccine rollouts, a very small proportion of people seemed to have an allergy to this compound: with a million doses you might see about ten people have this allergic reaction. This means that if the entire population of Australia is vaccinated, approximately 250 people will have a PEG reaction. It is rare, albeit less rare than allergic reactions to influenza vaccines.

But no one has yet died from being vaccinated against COVID, so these cases are being captured effectively and are generally detected within the initial observation period of 15-30 minutes. Severe reactions can be treated with an EpiPen; less severe cases are just monitored.

People might already know they’re allergic to PEG and these people shouldn’t receive the Pfizer vaccine, but if they don’t know, there’s no way of knowing that in advance.

The Oxford/AstraZeneca vaccine doesn’t contain PEG. It contains a related compound called polysorbate, which appears not to trigger the same allergy. If you have a KNOWN allergy to PEG you would probably be given the AstraZeneca vaccine.

It’s important to stress that these compounds are not preservatives — they are mechanisms to deliver the vaccines effectively.

Although some of the vaccine side effects are similar to the symptoms of COVID-19, the coronavirus vaccines won’t give you COVID-19. The vaccines will also not make you contagious. For most people, the side effects of the vaccine are mild or moderate and last only a day or two.

WILL HAVING THE VACCINE MAKE MY AUTOIMMUNE CONDITION WORSE?

Remember that the Pfizer and AstraZeneca vaccines are not live virus vaccines, so there is no contraindication to receiving them if you are immunocompromised or have an autoimmune condition.

Most people deciding to be vaccinated against Covid-19 can support their choice with clinical trial data, which has demonstrated the safety and efficacy of both the Moderna and Pfizer/BioNTech vaccines. But people suffering from autoimmune conditions, particularly those on immune-suppressing medications, are facing the decision of whether to receive a shot without the benefit of robust evidence-based guidance, as they were excluded from the Moderna, Pfizer/BioNTech, and AstraZeneca clinical trials.

In the absence of clinical trial data, how should people with autoimmune conditions approach the risk/benefit analysis of getting vaccinated? Here’s what several experts had to say.

Autoimmunity is a big tent

Autoimmune (literally “self-immune”) disease happens when the immune system turns its aggression on the body’s own healthy cells and tissues.

Covid-19 vaccine clinical trials did involve some people with autoimmune conditions but excluded others. Autoimmune diseases vary as much in severity as they do in type, ranging from pesky to life-threatening. Some, such as Hashimoto’s thyroiditis, are targeted on a single area (like the thyroid) and may be manageable without medications. People in this category were involved in the vaccines’ clinical trials. People suffering from more systemic autoimmune conditions, such as lupus and Crohn’s disease, which often require immune-suppressing medications to manage symptoms, were excluded from the vaccine trials.

This isn’t unusual. People on immunosuppressive therapies, such as disease-modifying antirheumatic drugs (DMARDs) and biologics, are frequently excluded from clinical trials. Manufacturers generally determine a vaccine’s baseline safety and efficacy in the general public before evaluating any differences in other, more challenging populations. The response of these populations is then observed in phase 4, or “post-marketing,” surveillance, after the vaccine receives FDA approval.

But the lack of clinical trial data, while not unusual, means that people with autoimmune conditions may have concerns about how a Covid-19 vaccine might affect them. These concerns fall into two major categories: safety and efficacy.

 

Are the Covid-19 vaccines safe for people with autoimmune conditions?

“Because people on immunosuppressants were not in the trials, we’re left with no direct data to answer that question,” says Gregory Poland, MD, a vaccinologist at Mayo Clinic in Rochester, Minnesota, and the director of Mayo Clinic’s Vaccine Research Group. “So we ask, ‘Is there a biologic mechanism by which any vaccine would cause mischief or a problem for people with autoimmune disease?’”

There’s one category of vaccines for which the answer is yes: live vaccines that use an attenuated or weakened live virus. Examples include measles, mumps, and rubella (MMR); varicella; and intranasal flu vaccines. Because these vaccines use a live virus, people with compromised immune systems or on immunosuppressive drugs may be at increased risk of adverse events after receiving them.

“My general recommendation is to get the vaccine. Even if you may not have full protection, it’s probably still better to get it than not to get it.”

Importantly, though, none of the approved or expected-to-be-approved-soon Covid-19 vaccines fall into this category. Both the Moderna and Pfizer vaccines use a new vaccine technology that relies on messenger RNA (mRNA) — essentially slipping building instructions for the SARS-CoV-2 spike protein into the body so it can construct it and learn how to recognize and neutralize it when and if the real thing appears.

Is there any other way in which a vaccine could cause mischief for people with autoimmune disease?

“One concern is whether a vaccine can trigger a flare of autoimmune disease or cause autoimmune disease in someone who’s susceptible,” says Sarfaraz Hasni, MD, director of the Lupus Clinical Research Program at the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health in Bethesda, Maryland, USA. Autoimmune flares are the sudden and severe onset of symptoms such as fatigue, joint pain and swelling, fever, swollen glands, skin problems, and digestive issues.

“Studies looking at large datasets have not conclusively been able to say that getting a vaccine can trigger an autoimmune disease or cause a flare, though anecdotal reports are there,” Hasni says.

Poland, whose Mayo Clinic Vaccine Research Group has performed extensive NIH-funded research investigating the genetic drivers of viral vaccine response, says he’s seen no evidence for vaccines exacerbating autoimmune disease — though his research has not included the new mRNA vaccine platforms.

In a 2018 paper in Nature Reviews Drug Discovery, Drew Weissman, MD, PhD, of the University of Pennsylvania and a pioneer of mRNA technology, wrote, “A possible concern could be that some mRNA-based vaccine platforms induce potent type I interferon responses, which have been associated not only with inflammation but also potentially with autoimmunity.”

Some autoimmune diseases, including lupus, are shown to be driven by a high interferon response in the body, Hasni says. So, stimulating that pathway — as mRNA vaccines do — could theoretically cause a flare.

But at this point, that concern remains speculative. “Could you imagine a type 1 interferon response that could exacerbate an autoimmune disease? Theoretically, yes, but it hasn’t been observed,” Poland says. “I’d say someone with an autoimmune disease would be at much higher risk from complications of being infected with Covid-19.”

“If you’re already in [an autoimmune] flare where your immune system is going haywire, it can make the flare worse. In general, it’s better to wait until the flare is under control and things have calmed down.”

Hasni agrees. “If the benefit of a vaccine is that it can protect you from a viral infection that can be deadly or make you really sick, and the risk is a disease flare that can be controlled effectively with medications in most patients, then the vaccine gives a greater benefit.”

Both Hanaway and Hasni say that while the benefit of receiving a Covid-19 vaccine outweighs the risk of a possible autoimmune flare, people with autoimmunity should do everything possible to ensure they’re not in an active flare state when they receive the vaccine.

“When you give a vaccine, it revs the immune system,” Hasni explains. “If you’re already in [an autoimmune] flare where your immune system is going haywire, it can make the flare worse. In general, it’s better to wait until the flare is under control and things have calmed down.”

Let’s decrease inflammation and put the body in a state where it can have a useful immunologic reaction to the vaccine.

For Hanaway, that means using integrative dietary, supplemental, and stress-reduction tools to help reduce overreaction of the immune system and get the body into a more quiescent state. Hasni adds that depending on the condition and the severity of the flare, steroids may also be needed on a short-term basis to calm things down before a person receives a vaccine.

The bottom line on the safety of Covid-19 vaccines for people with autoimmunity: “Until we have data to the contrary, for the majority of people with autoimmune disease, their risk of complication from infection is far higher than the observed teeny risk attributable to any of the Covid vaccines,” Poland says.

Hanaway agrees, adding that the potential for SARS-CoV-2 infection to lead to post-Covid-19 syndrome (lingering symptoms suffered by so-called long-haulers) is all the more reason for people with autoimmune disease to opt for vaccination.

Are Covid-19 vaccines effective for people with autoimmune conditions?

The other area of concern: Can immunosuppressive drugs that help autoimmune patients manage their symptoms affect the body’s ability to mount a robust immune response to a Covid-19 vaccine?

Perhaps, Poland says. “Under normal circumstances, the [Moderna and Pfizer] vaccines are 95% effective, so roughly 5% won’t respond,” he says. “That number is likely to be higher in people on immunosuppressants.”

“In some subset of autoimmune disorders, you don’t get enough immune response to vaccines, but it’s not true across the board,” Hasni adds. Important factors include the type of disease, whether it’s active or in remission, and, most critically, the kind of medications being taken.

According to Hasni, three medications in particular can dampen an effective vaccine response:

  • Rituximab (Rituxan) is a cytotoxic medication that kills B cells, which are responsible for forming antibodies. It’s generally given via infusion once every six months. “If we can delay giving that drug for two to four weeks and give the vaccine in that window, a person should be able to develop enough immunity,” Hasni says.
  • Methotrexate (Methoblastin) is used to treat multiple conditions, most commonly rheumatoid arthritis, and is administered weekly. If it can be held for two weeks before the vaccine is given and another two weeks afterward so the body can mount an immune response, that can be helpful, Hasni says. “But sometimes that’s not possible if a patient is flaring. In that case, you can still give the vaccine—it just may not be as effective as you’d hope.”
  • Prednisone (Prednisolone) or other steroids are commonly used across a range of autoimmune conditions and can blunt the immune response in high doses. “If someone is on 7.5 milligrams or more daily prednisone, their response might not be as good,” Hasni says. “If less than that, it’s usually not a problem.”

As clinicians and researchers gather more data over time, there may be further recommendations regarding different vaccine dosing regimens or booster shots.

“My general recommendation is to get the vaccine,” Hasni says. “Even if you may not have full protection, it’s probably still better to get it than not to get it.”

Once you do receive the vaccine, Hanaway advises against trying to “knock out” any symptoms or side effects that may occur in the immediate aftermath. “If you feel dizziness, fatigue, a low-grade fever, that’s the innate immune system responding appropriately,” he explains. “Let the body have the immune reaction — that’s what will give you protection.”

It is possibly suggested that it may be worthwhile for immunocompromised people to undergo a COVID antibody test (of the type which detects antibodies to the S protein) about three weeks or so after vaccination to be certain that an antibody response developed. It is speculated that some patients with autoimmune conditions could conceivably fail to make a robust response due either to immunomodulatory treatments or their underlying disease.

It is acknowledged that while individuals with autoimmune disorders may be at increased risk for infection due to immunosuppressive therapy, the currently available literature provides perspective on the risk of exacerbations of disease and prior vaccinations.

CAN YOU STILL GET COVID IF YOU HAVE THE VACCINE?

There’s no evidence that any of the current Covid-19 vaccines can completely stop people from being infected – and this has implications for our prospects of achieving herd immunity. Even once you have had the vaccine, you may still potentially become infected, although will not likely become severely unwell with the disease.

DOES THE FLU VACCINE PROTECT AGAINST COVID-19?

The flu vaccine does not protect against COVID-19, but if anyone becomes ill with both influenza and COVID-19, it can be very serious.

SHOULD CHILDREN HAVE THE COVID VACCINE?

No. The covid vaccine is currently only approved in Australia for people aged 16 years and over.

WILL THE VACCINE PROTECT FROM COVID STRAIGHT AWAY?

No. You will need two doses of the vaccine to be properly protected. It takes between 2-3 weeks to become fully protected from Covid.

And it’s worth remembering that the vaccine won’t necessarily stop you from getting COVID and spreading it, but will help your body not to get sick if you do contract it. 

WILL I FEEL SICK AFTER THE COVID VACCINE?

According to clinical trials, yes, you may feel a bit unwell after the jab — especially after the second one.

These are “normal signs that your body is building protection”.

Think of it as a positive sign — the vaccine is doing what it’s meant to and helping your body develop immunity to the virus.

WHAT SIDE EFFECTS MIGHT I EXPERIENCE?

You may experience minor side effects following vaccination, especially after the second shot.

Common reactions include pain, fever, tiredness, headache and joint pain. Less common side effects include redness and swelling at the site of injection, nausea and insomnia.

It’s also important to remember these side effects are temporary. Most last no more than a couple of days and patients recover without any problems.

Rare but serious side effects are why health authorities continue to closely monitor vaccines once they’ve been approved for use.

Severe allergic reactions to COVID-19 vaccines are “exceedingly rare” according to health authorities, but you should report any unusual or adverse reactions to the doctor that gave you the injection.

SHOULD I WAIT AROUND AFTER THE INJECTION?

The Australian Technical Advisory Group on Immunisation (ATAGI) recommends you be observed for at least 15 minutes after being vaccinated, just to make sure you don’t have any unusual reactions.

Of course, if you have a history of anaphylaxis to any antigen (including food, insect stings, medicines) or if you have an adrenaline autoinjector (such as an EpiPen), you should let medical professionals know, and be monitored for 30 minutes after your vaccine.

WHY DO I NEED TO WAIT AROUND FOR 15-30 MINUTES?

Waiting for 15-30 minutes allows health workers to watch you for any signs of an allergic reaction. That way if anything does go wrong, you’re in the right place for help and support.

HOW WILL I BE MONITORED FOR SIDE-EFFECTS?

As doctors, when we vaccinate people we generally like to look after them for about 15-30 minutes, just to check they haven’t had an adverse reaction. That should be the practice for the COVID shots, just the same as for any vaccine.

For those 15-30 minutes you will generally just be sitting in a waiting area at the clinic. You will be monitored to see if you develop any symptoms such as hives or a rash, or wheezing. In those cases, you would be monitored even more carefully and staff would take your blood pressure and pulse rate, and observe you.

If you experience any symptoms once you’ve gone home, it is up to you to contact your local doctor. Obviously, when trying to vaccinate 25 million people, health authorities can’t follow up with every individual. It’s very much up to you to follow up with whoever gave you the vaccine — whether your GP clinic or other health service.

 

IF I HAVE AN ALLERGIC OR ANAPHYLACTIC REACTION, ARE THERE LONG TERM EFFECTS?

No. True allergic reactions are rare and readily managed with a shot of adrenaline (EpiPen).  Aside from some short term temporary clinical observation, there is no long term harm. If you were to have a true allergic/anaphylactic reaction, a different vaccine would be used for your second shot.

WHY DOES THE SECOND COVID 19 SHOT MAKE YOU SICK?

Fever, headache, and body aches have all been reported after the second dose. Studies indicate the symptoms are more noticeable after the second shot.  These symptoms aren’t side effects; they are a response. This is because the first shot did such a good job priming your immune system that the cells in your body readily see what was in that first shot and respond accordingly. It acts like a kind of memory. This is a good sign your immune system is working well.

HOW LONG DOES THE VACCINE TAKE TO BUILD UP IMMUNITY TO COVID 19?

You will not be protected straight away. Depending on the vaccine you may take 2 or 3 weeks to develop immunity. No vaccine is 100% effective. Even after you’ve waited those first few weeks, and following your second dose, your vaccination may not offer you complete protection from becoming unwell with coronavirus.

How long after second Pfizer Vaccine is it effective?

The effectiveness jumped to 94% more than two weeks out from the first shot and 95% efficacy a week after the second shot.

WILL I BE FULLY PROTECTED? DO I STILL NEED TO FOLLOW COVID RESTRICTIONS?

The two vaccines have different efficacy rates — 95% for Pfizer62% for AstraZeneca — but these refer to their ability to prevent infection rather than disease. The fact is both are very good at preventing serious disease.

This means that, although you may still have a chance of being infected, you are much less likely to develop severe symptoms, and therefore less likely to infect others. Someone with severe COVID might be coughing and spluttering and spreading the virus more easily, while someone without symptoms might not.

Bear in mind there are two main reasons for the vaccine rollout. The first is to protect members of the public from getting very ill or dying.

The second aim is to provide a degree of immunity in the general population that will ultimately stop the virus circulating.

Of course, this second goal is much harder, which is why it’s still important that we follow any and all COVID precautions. But the hope is that over time we’ll see fewer and fewer people who are COVID-positive, and the risk of spread will fall.

SHOULD I TAKE PAIN KILLER?

It is preferable to allow the vaccine to do its job of boosting your immune system which is the reason you have some mild to moderate symptoms. However, if you find that you do need to take some paracetamol, it is best to take Panadol after you receive your shot, not before.

SHOULD I HAVE THE FLU VACCINE AND THE COVID VACCINE TOGETHER?

No. Current recommendations indicate a spacing of minimum 14 days apart is best.

FURTHER COVID-19 VACCINE INFORMATION

 

Download vaccine position statements:

 

 

 

 

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