With the current pandemic and the Delta variant surging, many autoimmune patients are concerned about the risks of Covid infection. Not only the infection, but most have concerns about the risks of vaccination. Even though many people have gone for the vaccine, lots are still skeptical about the vaccination triggering their autoimmunity.
Personally, I have chosen to get the vaccination and have no regrets at all. But, in full transparency, getting vaccinated has flared my autoimmune condition in the worst possible way.
Fatigue, pain, brain fog, and weakness kept me from performing at 100%.
I also know many autoimmune patients who are perfectly fine after getting the vaccination. My Rheumatologist highly recommended it as I was in remission from autoimmunity. And also because I work with patients who are immune-compromised.
In my perspective, there are three common questions.
- Should autoimmune patients get vaccinated?
- Which vaccination is best?
- What if you are on an immunosuppressive regimen?
The answer to this is that everyone’s different. There is no right or wrong. Just what the patient decides as well as their response to the vaccination.
Autoimmunity and Vaccination
There are three options for autoimmune patients;
- Risk Covid
We know that the Delta variant is highly contagious, so the risks are high for option 3. Isolating is hard for patients as it’s not practical, and we can’t live in a bubble.
Vaccination has its risks. The main concern would be that the antibodies can cross-react and cause autoimmune flares. This can result in getting a wider range of tissue damage which is not ideal.
Also, due to the higher viral load of the Delta variant, one can expect higher antibodies if one gets infected. On the other hand, the ingredients in the vaccine can promote an autoimmune flare.
Couldn’t the patient stay home and isolate?
First, the main problem is that most patients don’t know how to self isolate. They try to manage without fully understanding what isolation is. In fact, the common mistake they make is thinking that if someone isn’t sick, they are not infectious. This is indeed incorrect. The virus can be present and transmitted in people who aren’t symptomatic yet. It can be present for up to 14 days before symptoms start, as well as once symptoms start.
Second, most patients believe that a negative PCR test means they can’t transmit the virus. The problem is that the PCR test is only sensitive on day 5 of having symptoms. On the fifth day, the chance of positive test results in an infected patient is up to 70%.
Lastly, many think that they can’t get Covid from a vaccinated person. The truth is that vaccinated individuals can also transmit the Delta variant.
Immune Suppression and Vaccination
What if you are on immunosuppressive therapy? If you are on T cell inhibiting therapy (Cellcept) or a B cell inhibitor (Rituxan), then you are likely to have compromised T and B cell-mediated immunity. In which case, despite vaccination, isolation is still important.
Testing for antibodies may be recommended in deciding on the booster shot. The reason is, vaccinations are not foolproof in protecting against infection. If the patient does have antibodies, it’s useful to test periodically for 2-3 months depending on the patient. It will help assess if the antibodies are protective or not.
To get vaccinated or not is a personal choice. There is so much we don’t know and we must stay compassionate toward each other and respect everyone’s own decisions.
Talk to you soon!