The time is getting close with regards to several different vaccines being ready for the general public to help combat COVID-19.
For those of us living with ulcerative colitis, it is once again a crossroads of tons of information, decisions we need to make, and trust in ourselves and the healthcare system. Not an easy time, but we have all been here many times before(well…minus this covid mess.)
Dr. David Rubin is a pretty well known gastroenterologist doctor based in Chicago, and he has authored or co-authored an incredible amount of research.
And, he has just tweeted out some ideas on the upcoming vaccines and I wanted to share them with you below. So just give them a read through and see if you get some questions answered.
Everything below is Dr. Rubin’s tweet he is at @IBDMD on Twitter. If you use Twitter, I’d suggest you find him and follow him. He is a very informed GI doc who does a crapload for the IBD world.
*** Please do continue to read through to the comment section after Dr. Rubin’s data. Graham has added a comment which brings up several key ideas and studies about vaccinations and autoimmune disease which are important. I’m a firm believer in learning as much as possible from science before making health decisions, and Graham’s comment citing additional is a benefit to all of us.
****Updated here on December 9th, 2020. Ok, in the past few days, there has been quite a bit of comments on this posting. Particulary with respect to the absence of the alternative views to taking a vaccine right away without knowing what we all might be able to expect as potential adverse events (side effects). Also, with so much of the focus on vaccines for people who are “healthy” but very limited information on vaccines for people like us who have IBD, it compounds the question marks and frustration regarding next steps.
But, don’t worry folks, there are some very kind souls right here, and a very big thank you to Shirl, Olive Oil an Graham and many others for sparking the conversation on the other side of the story.(I must admit, as much as I am skeptical of how the modern healthcare system treated me in the final parts of 2008 and 2009 after my UC diagnosis, I failed to think of the other side before writing the original post here. My bad. But thanks for not being shy. All ideas are fair game.
So, here are some bits of research and news.
First is a link from the United Kingdom government concerning Pfizer’s COVID vaccine. There are several documents within the link, documentation about the vaccine for healthcare professionals and even vaccine ingredient information can be found. One iHaveUC user named Doug pointed this out and even highlighted some important aspects of the review regarding the lack of studies relevant to those with suppressed immunity/on medication. The downloadable version has highlighted areas regarding this for those interested.
Thank you again to all who are taking part and reading the discussion, below is the main body of the original post:
“Here are my thoughts and a few updates about #SARSCoV2 vaccines, and also about implications for our #IBD patients.
A tweetorial in 20 parts.
1) Development of multiple #SARSCoV2 vaccines in the timeframe we have seen is a monumental scientific achievement.
Necessity literally bred invention.
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2) The @pfizer and @moderna_tx vaccines are messenger RNA vaccines. They use genetic material to trigger the body’s immune system to make antibodies against the spike proteins on the surface of #SARSCoV2. They DO NOT contain actual viral particles and can’t cause infection.
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3) Two doses are required with these vaccines. This is not uncommon for vaccines. The first exposes the immune system to the antigen, the second will activate memory cells, so your body will remember how to protect you if it gets exposed to #SARSCoV2.
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4) The reason for the cold temperature is to stabilize the messenger RNA so it maintains its structural integrity and then can do its job in your body. This is a well-described but surmountable logistical challenge.
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The vaccines will come with temperature monitors so you will know if it has been kept at the right temp during transport.
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5) I am told that the @US_FDA is reviewing the @pfizer vaccine on 10 Dec and the @moderna_tx on 13 Dec. The @CDCgov has committed to rapid review and updated recommendations within 24 hours of the FDA decisions.
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6) First in line for the vaccine will be front line healthcare workers. Also key will be residents of long term care facilities. The @CDCgov Advisory Committee on Immunization Practices (ACIP) voted today on this stratification.
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https://www.cnn.com/2020/12/01/health/cdc-acip-covid-19-vaccine-recommendation-vote/index.html
7) The @CDCgov Advisory Committee on Immunization Practices (ACIP) has previously outlined plans for vaccination. Technically, our #IBD folks will be in the second tranche under the category of “use of immune weakening medicines”. But please read on 🔽
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Reminder that #IBD pts have not been at increased risk for #SARSCoV2 infection or #COVID, and that the immune therapies used in #IBD (except steroids) have not been associated with worse outcomes. There may even be some protection while on these meds.
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https://pubmed.ncbi.nlm.nih.gov/32425234
8) Key questions: Will #IBD patients on immune therapies be less likely to develop immunity? Does it matter which therapy you are receiving whether you will develop immunity? MAYBE?
READ ON 🔽
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There are some data that older vaccines like for pneumococcal pneumonia (PSV-23) or influenza are less likely to result in immunity if patients are on combined anti-TNF and immunomodulators (azathioprine or 6-MP).
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https://pubmed.ncbi.nlm.nih.gov/19755964/
https://pubmed.ncbi.nlm.nih.gov/17544875
But it’s variable! Some patients are more immunogenic than others. With vaccines, being immunogenic is a good thing (you are more likely to respond to the vaccine). With monoclonal antibodies, being immunogenic is not a good thing (you become “immune” to the therapy).
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So what about this messenger RNA vaccine? I’ve discussed a bit with experts here. Seems that anti-TNF (inflix, adalim) and anti-IL12/23 (ustekinumab) and possibly JAKinib (tofacitinib) will not impair immunity to these new vaccines.
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Unclear whether cellular trafficking inhibitors (vedolizumab) may impair since they may affect lymphocytes ability to respond to the virus in the gut. Thiopurines (azathioprine, 6-MP) (which affect lymphocytes) may impair immunity.
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5-ASAs (mesalamine), antibiotics will not affect immunity to the vaccine.
▶️ But also important is the potency and “immunogenicity” of the vaccine itself, which may overcome any effect of these therapies and be effective anyway… MORE 🔽
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Example is the modern herpes zoster (shingles) recombinant vaccine (Shingrix) which is quite potent and effective at inducing immunity even in patients who are receiving chemotherapy. If you want to read more, look at this great study:
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https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/cncr.31909
I believe that these vaccines against #SARSCoV2 will be appropriate and safe for our patients who are on immune therapies. I do not know that they will be AS effective at inducing immunity, but I suspect based on descriptions that they will come very close to being so.
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There will be 3 years of f/u from the current vaccine trials. There will be post-marketing surveillance in the general population and the ACIP will adjust their recommendations.
But it is clear that we need as a society to work together with good leadership to get this done.
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I will get vaccinated. I will work hard to get my patients vaccinated. In the mean time, everyone please stay safe and be vigilant.
Protect each other.❤️
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Originally tweeted by David T. Rubin, MD (@IBDMD) on December 2, 2020.
So, big thank you UC’ers for reading up on some of the current thinking in terms of the upcoming vaccines which are soon to be among many of us. My expectation is that there will be future news with regards to the vaccines in the coming days and weeks and months ahead, but all we can do sometimes is to keep informed.
For all vaccines there are post authorization studies and side effect monitoring that is mandated by various national drug administrations (i.e. FDA in the USA) so we should all be kept informed as things unfold and develop.
And, a very big thank you to Dr. Rubin who was kind enough to allow me to reproduce his thoughtful post here for everyone to read who doesn’t use Twitter. I have actually never intereacted with him before but heard about him for years and just a few minutes writing him he wrote back saying of course post it up. Yeah to Doc for that.
I started site shortly after being diagnosed in October of 2008 with severe pancolitis (when my whole colon was inflamed).
For me, it was a very rough start with severe symptoms. Getting bounced from medication to medication was not easy or too helpful. But, I did meet another UC’er, changes several parts of my diet, and of course the rest is history.
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