{"id":915,"date":"2021-04-23T16:32:26","date_gmt":"2021-04-23T20:32:26","guid":{"rendered":"https:\/\/vasculitis.ca\/?p=915"},"modified":"2021-04-23T16:42:11","modified_gmt":"2021-04-23T20:42:11","slug":"important-takeaways-on-vasculitis-and-covid-19-vaccines-from-dr-joanne-jiangs-presentation-at-the-2021-vfc-agm-on-april-17-2021","status":"publish","type":"post","link":"https:\/\/vasculitis.ca\/?p=915","title":{"rendered":"Important takeaways on vasculitis and COVID-19 vaccines from Dr. Joanne Jiang\u2019s presentation at the 2021 VFC AGM on April 17, 2021"},"content":{"rendered":"<p>In case you missed Dr. Jiang\u2019s presentation during the 2021 VFC AGM, or you need a refresher, here are some of the key takeaways that vasculitis patients need to keep in mind with regards to the COVID-19 vaccinations. <strong>Please note:<\/strong> This information is based on the best available information as of April 17, 2021.<\/p>\n<ol>\n<li>\n<p>Individuals with autoimmune disease <strong>(including vasculitis) <span style=\"color: #ff0000;\">are more likely to have a more severe form of COVID-19 infection<\/span><\/strong>.<\/p>\n<\/li>\n<\/ol>\n<ol start=\"2\">\n<li>\n<p><strong>Vaccine efficacy and its ability to provoke an immune response (immunogenicity)<\/strong> in immunosuppressed individuals is uncertain, but is <span style=\"color: #ff0000;\"><strong>expected to be lower<\/strong><\/span> than what is observed in the general population.<\/p>\n<\/li>\n<\/ol>\n<ol start=\"3\">\n<li>\n<p>Factors associated with increased severity of COVID-19 infection in <strong>vasculitis patients<\/strong>:<\/p>\n<\/li>\n<\/ol>\n<p>from a small study of 65 patients (UK\/Ireland study):<\/p>\n<ul>\n<li>\n<p><strong><span style=\"color: #ff0000;\">Prednisone use (any dose)<\/span><\/strong><\/p>\n<\/li>\n<li>\n<p><strong><span style=\"color: #ff0000;\">Lung disease<\/span><\/strong><\/p>\n<\/li>\n<li>\n<p>Disease activity and other immunosuppressives were not associated with severe COVID-19 outcomes <strong>in this particular study<\/strong>, however another study done on 3729 patients (with variable rheumatic conditions) found that these factors were associated with <strong>increased odds of death related to COVID-19 infection<\/strong>.<\/p>\n<\/li>\n<\/ul>\n<ol start=\"4\">\n<li>\n<p>A recently published study in Lancet Rheumatology found you\u2019re more likely to have <strong><span style=\"color: #ff0000;\">severe COVID symptoms if you received rituximab last in the last 50 days<\/span><\/strong> or so (with some up to 100 days), and <strong>you also have a higher risk of dying from COVID within that same timeframe<\/strong>.<\/p>\n<\/li>\n<\/ol>\n<ol start=\"5\">\n<li>\n<p><span style=\"color: #ff0000;\"><strong>Do I need to bring a formal doctor signed letter to get the vaccine? No<\/strong><\/span>. Some places may ask you to fill out an attestation form with your physician\u2019s information,<strong> but it DOES NOT need to be filled out by your physician UNLESS a signature is needed, and this appears NOT to be required so far. In Ontario, the ORA (Ontario rheumatology association) has <span style=\"color: #ff0000;\">officially confirmed that attestation letters from physicians are NOT needed<\/span> and is actually acting as a barrier to vaccination.<\/strong><\/p>\n<\/li>\n<\/ol>\n<ol start=\"6\">\n<li>\n<p><strong>Can I request a shorter interval for the 2nd dose? <span style=\"color: #ff0000;\">No, not yet for vasculitis patients!<\/span><\/strong> This is determined by Ministry of Health, in Ontario visit: <a href=\"https:\/\/www.health.gov.on.ca\/en\/pro\/programs\/publichealth\/coronavirus\/docs\/vaccine\/COVID_19_medical_exceptions_vaccine_dose_intervals.pdf\">https:\/\/www.health.gov.on.ca\/en\/pro\/programs\/publichealth\/coronavirus\/docs\/vaccine\/COVID_19_medical_exceptions_vaccine_dose_intervals.pdf<\/a> <br \/>\n<strong>Current exempted special populations only include: transplant<\/strong> (solid organ, or stem cell), and <strong>those receiving chemotherapy<\/strong> or immunotherapy <strong>for cancer, NOT vasculitis!<\/strong><\/p>\n<\/li>\n<\/ol>\n<ol start=\"7\">\n<li>\n<p><strong>Which Vaccine should I get? <span style=\"color: #ff0000;\">The first vaccine, approved for you, that you can get, is the best vaccine to get!<\/span><\/strong> The most important thing is that they <strong>all prevent hospitalization and death.<\/strong> All approved vaccines in Canada reduce the severity and hospitalizations due to COVID-19 infection, and virtually eliminate the risk of death for those in the general population.<\/p>\n<\/li>\n<\/ol>\n<ol start=\"8\">\n<li>\n<p><strong>Most clinical trials often exclude people with autoimmune diseases and those on immunosuppressive treatment<\/strong> including those with cancer, transplants, chronic infections, pregnancy and children are usually excluded in early studies.<\/p>\n<\/li>\n<\/ol>\n<ol start=\"9\">\n<li>\n<p>Early data from a John Hopkins study shows that <strong>individuals with autoimmune disease can produce antibody response even after 1 dose of the vaccine<\/strong>. However, only 2 had vasculitis (out of 123), <strong>Methotrexate did not negatively impact antibody development.<\/strong> <br \/>\n<span style=\"color: #ff0000;\"><strong>Rituximab and MMF (mycophenolate\/cellcept), did affect antibody development!<\/strong><\/span><\/p>\n<\/li>\n<\/ol>\n<ol start=\"10\">\n<li>\n<p><strong>There remain<span style=\"color: #ff0000;\"> many unanswered questions!<\/span><\/strong> For example, <strong>what is the minimum (threshold) COVID-19 antibody titre<\/strong> that is sufficient to prevent active infection, <strong>what is the vaccine response in those who have TOO FEW immunoglobulins<\/strong> (hypogammaglobulinemia), what is the vaccine response in those who produce TOO MANY immunoglobulins (hypergammaglobulinemia), is there a role for a 3rd shot (aka 2nd booster) in immunocompromised populations?<\/p>\n<\/li>\n<\/ol>\n<ol start=\"11\">\n<li>\n<p><strong><span style=\"color: #ff0000;\">Timing of vaccination<\/span>, and timing of immunosuppressive treatment may vary,<\/strong> see chart below as a reference, and consult with your rheumatologist for your individual recommendation.<\/p>\n<\/li>\n<\/ol>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\"size-full wp-image-917 aligncenter\" src=\"https:\/\/vasculitis.ca\/wp-content\/uploads\/2021\/04\/vaccine-chart-precautions.png\" alt=\"vaccine chart precautions\" width=\"624\" height=\"399\" srcset=\"https:\/\/vasculitis.ca\/wp-content\/uploads\/2021\/04\/vaccine-chart-precautions.png 624w, https:\/\/vasculitis.ca\/wp-content\/uploads\/2021\/04\/vaccine-chart-precautions-300x192.png 300w\" sizes=\"(max-width: 624px) 100vw, 624px\" \/><\/p>\n<p><strong>Note:<\/strong> Patients on <strong>some immunosuppressive therapies may have reduced protection from the COVID-19 vaccines<\/strong>. However, given the overall benefit of the COVID-19 vaccines the benefits of vaccination will still be large for most vasculitis patients. Furthermore, <strong>even a little bit of protection is better than no protection at all!<\/strong> <strong>Continuing medications will often be the safest option to prevent disease flares<\/strong> until more evidence is available. <strong><span style=\"color: #ff0000;\">There is no scientific agreement on when the best time is to get the COVID-19 vaccines when you are on Rituximab.<\/span><\/strong><\/p>\n<ol start=\"12\">\n<li>\n<p>See the chart below to compare the <strong><span style=\"color: #ff0000;\">lower risk of blood clots<\/span> compared to the higher risk of COVID-19 disease!<\/strong> Thrombosis Canada concludes: \u201cThe benefits of preventing <strong>blood clots and other disease caused by COVID-19 far outweigh any possible risks<\/strong> [of vaccination], which we consider very low.\u201d<\/p>\n<\/li>\n<\/ol>\n<p align=\"CENTER\"><img decoding=\"async\" class=\"size-full wp-image-918 aligncenter\" src=\"https:\/\/vasculitis.ca\/wp-content\/uploads\/2021\/04\/covid-vaccine-blood-clot-risks.png\" alt=\"covid vaccine blood clot risks\" width=\"800\" height=\"571\" srcset=\"https:\/\/vasculitis.ca\/wp-content\/uploads\/2021\/04\/covid-vaccine-blood-clot-risks.png 800w, https:\/\/vasculitis.ca\/wp-content\/uploads\/2021\/04\/covid-vaccine-blood-clot-risks-300x214.png 300w, https:\/\/vasculitis.ca\/wp-content\/uploads\/2021\/04\/covid-vaccine-blood-clot-risks-768x548.png 768w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><\/p>\n<ol start=\"13\">\n<li>\n<p><span style=\"color: #ff0000;\"><strong>Things to do:<\/strong><\/span><\/p>\n<\/li>\n<\/ol>\n<p>&#8211; <strong>Sign up<\/strong> for the first COVID-19 vaccine available to you.<\/p>\n<p>&#8211; <strong>Discuss<\/strong> holding or delaying of medications with your specialists.<\/p>\n<p>&#8211; <strong>Remember<\/strong> that the guidelines &amp; recommendations exist in an IDEAL situation, but the real world is full of surprises!<\/p>\n<p>&#8211; <strong>Continue<\/strong> to take personal health measures to protect yourself from COVID-19 exposure, even after receiving the vaccine.<\/p>\n<ol start=\"14\">\n<li>\n<p><span style=\"color: #ff0000;\"><strong>Don\u2019t do the following:<\/strong><\/span><\/p>\n<\/li>\n<\/ol>\n<ul>\n<li>\n<p><strong>Delay or hold<\/strong> treatment if your vasculitis is active<\/p>\n<\/li>\n<li>\n<p><strong>Stop prednisone<\/strong> abruptly without discussing with your specialists, especially if your dose of prednisone is 5mg or greater.<\/p>\n<\/li>\n<\/ul>\n<p>If you are interested in the journal references used in this website post please reach out <a href=\"mailto:contact@vasculitis.ca\">contact@vasculitis.ca<\/a> for additional information.<\/p>\n<p align=\"JUSTIFY\"><span lang=\"en-US\">The vasculitis community is at increased risk to COVID-19, keep safe and take extra precautions in these challenging times<\/span>.<\/p>\n<p>Jon Stewart<\/p>\n<p>President<br \/>\nVasculitis Foundation Canada<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In case you missed Dr. Jiang\u2019s presentation during the 2021 [&hellip;]<\/p>\n","protected":false},"author":2059,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[],"class_list":["post-915","post","type-post","status-publish","format-standard","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/vasculitis.ca\/index.php?rest_route=\/wp\/v2\/posts\/915","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vasculitis.ca\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vasculitis.ca\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vasculitis.ca\/index.php?rest_route=\/wp\/v2\/users\/2059"}],"replies":[{"embeddable":true,"href":"https:\/\/vasculitis.ca\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=915"}],"version-history":[{"count":3,"href":"https:\/\/vasculitis.ca\/index.php?rest_route=\/wp\/v2\/posts\/915\/revisions"}],"predecessor-version":[{"id":920,"href":"https:\/\/vasculitis.ca\/index.php?rest_route=\/wp\/v2\/posts\/915\/revisions\/920"}],"wp:attachment":[{"href":"https:\/\/vasculitis.ca\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=915"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vasculitis.ca\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=915"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vasculitis.ca\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=915"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}