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Ask the Expert: COVID-19 Vaccines and Chronic Conditions

Managing RA

April 02, 2021

Content created for the Bezzy community and sponsored by our partners. Learn More

by Alan Carter, Pharm.D.

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by Alan Carter, Pharm.D.

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The COVID-19 vaccines are becoming more widely available throughout the United States, yet there’s still a lot of confusion — and misinformation — around.

It can be hard to break through the social media noise and understand the real risks and benefits for you.

This is especially true for those who may be immunocompromised due to treatment for a chronic condition and people living with autoimmune diseases and cancer.

Is it safe if you’re in treatment? Should you stop taking your meds? Should you wait until people with your condition have been included in trials?

Here are answers to common questions among Bezzy’s chronic condition communities, including Bezzy MS, Bezzy BC, and Bezzy RA, as well as folks who read our sister site, Healthline‘s, weekly newsletters.

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What should I do if my condition hasn’t been studied in vaccine trials? Should I wait until it’s been studied?

You should discuss your condition and risk for the disease with your doctor.

Vaccine clinical trials are not large enough to include all medical conditions, but in the case of COVID-19, the risks of severe complications from the disease are higher in people with existing medical conditions.

The safety and efficacy data accumulated has resulted in FDA, UK, or EU approval for emergency use.

There are no known medical conditions, other than previous allergic reaction to vaccine ingredients, that prohibit receiving a COVID-19 vaccine.

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Which shot is best? Is there one that’s safer than the others for people who are immunocompromised?

At this point in time, there is no particular shot for COVID-19 that seems to be better than the others.

All COVID-19 vaccines currently approved for emergency use show good efficacy in reducing symptoms and hospitalization.

There is not enough data yet to determine one is safer than the other.

Discuss your options with your doctor. Being immunocompromised comes with a much greater risk of severe symptoms and hospitalization from COVID-19 than risks of side effects from a vaccine.

What side effects can I expect?

Soreness around the injection site is common and, for the two-shot vaccines, the second shot seems to cause more symptoms of headache, muscle and joint pain, fatigue, chills, and fever.

There have been some reports of a delayed rash occurring in some people but no lasting effects. Although rare, severe allergic reactions are possible.

If you’ve had allergic reactions to vaccines in the past, you should discuss options with your doctor and inform those giving the shot that you’ve had allergic reactions to vaccines before they give you the shot.

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Are there side effects that are more likely if I have a chronic condition?

People with chronic conditions have not been shown to have greater risks for side effects.

How would I know if I am allergic to something that is in the vaccine?

Unless you have had an allergic reaction to vaccine ingredients in the past, there is no way to know for sure.

Because of this unknown, the standard protocol for everyone is to remain at the vaccination site for at least 15 minutes after the shot is given. The trained staff can provide emergency care for allergic reactions.

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Should I avoid it if I’ve had bad reactions to vaccines like the flu shot in the past?

The COVID-19 vaccines have different ingredients than flu shots so they may not cause similar reactions.

If you’ve had severe allergic reactions to flu shots in the past, you should discuss your options with your doctor.

If I have a reaction to the first dose, should I decline to take the second?

If your reactions were headache, pain, chills, or fever from the first dose, you can expect to have similar reactions and should take the second shot.

If your reaction to the first dose was an allergic reaction, you should decline the second shot and discuss options with your doctor.

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How long after getting vaccinated will I be protected from the virus?

Current information indicates resistance to the COVID-19 virus was reached in 100 percent of Johnson & Johnson study participants within 57 days of the shot.

Antibodies to the virus that causes COVID-19 should last 6 months, perhaps up to a year, but studies are ongoing.

How soon after vaccination can I start socializing again?

The CDC recommends waiting 2 weeks after taking the Johnson & Johnson vaccine or 2 weeks after the second shot of the Pfizer or Moderna vaccines before socializing indoors with other fully vaccinated people or some unvaccinated people.

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My meds are prescribed to suppress my immune system — wouldn’t a vaccine that strengthens the immune system do the opposite of what I need?

According to the American College of Rheumatology (ACR), those with autoimmune conditions appear to have a higher risk for serious COVID-19 infections, and vaccination is recommended.

Talk with your doctor about your medications and possible timing of your immunosuppressant medication doses with vaccination shots to minimize impact on your system.

How can I be sure that it’s safe for me?

Talk with your doctor about your risks for developing COVID-19 and possible interference with your autoimmune therapy.

We’re learning about benefits and use with autoimmune conditions on a near daily basis, so regular communication with your doctor is important.

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Is it safe to take pain medication to help with arm soreness after my vaccine?

Talk with your doctor about what you should take for side effects that would be safest for you.

Acetaminophen (Tylenol), aspirin, or ibuprofen (Advil) may be helpful for the arm soreness, but it is not recommended to take one of them before getting the shot to prevent side effects.

Should I stop taking my medication if I’m going to get the shot?

For most medical conditions, medications should be continued as prescribed.

For some medications for autoimmune conditions, it’s recommended that dosage schedules be altered.

Your doctor will be able to guide you through the process.

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What kinds of medications might have negative interactions?

The ACR recommends that the timing of medication dose cycles of methotrexate, JAK inhibitors, abatacept, cyclophosphamide, and rituximab should be adjusted.

More information about additional recommended therapy adjustments may become available, so stay tuned and keep an open dialogue with your healthcare team.

I’m scared because I keep hearing how the second shot makes people really sick. I can’t afford to feel worse. Is there a risk that the vaccine will cause a flare-up of my condition?

The risk of causing a flare-up is much less than the risk of COVID-19 complications.

Your doctor will work with you to reduce your risk for a flare.

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I’m in breast cancer treatment right now. Should I get the vaccine if it’s offered?

Yes. According to the American Cancer Society, experts recommend that most cancer patients get the vaccine.

Those with weakened immune systems are at risk for a more severe case of COVID-19, so gaining some protection from the vaccine is better than none at all.

I have a vaccine appointment scheduled, but I’m having a flare-up of my chronic illness. Should I reschedule the appointment until after my flare-up ends?

Talk with your doctor about options for coordinating medication doses with the COVID-19 vaccine schedule.

Currently, there are no known contraindications to COVID-19 vaccinations in those with chronic diseases.

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The bottom line

While there are a few situations in which you may need to adjust your medication timing, the overarching recommendation for folks living with chronic conditions is this: get vaccinated when you can.

The COVID-19 vaccinations being offered:

  • are extremely safe
  • are very effective
  • increase our ability to return our lives to “normal”

Article originally appeared on April 2, 2021 on Bezzy’s sister site, Healthline.

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About the author

Alan Carter, Pharm.D.

Dr. Alan Carter is a clinical pharmacist with interests in medical research, pharmacy practice, and medication formulary management. He is an independent contracted medical director for pharmaceutical development, clinical pharmacy specialist, and adjunct clinical assistant professor of pharmacy.

Education

  • University of Missouri – Kansas City, BS, PharmD

Certifications

  • Licensed Pharmacist
  • Kansas Board of Pharmacy
  • Missouri Board of Pharmacy
  • Certified Immunizing Pharmacist
  • Certified Smoking Cessation Specialist

Professional Accomplishments

  • Published 20 journal articles to date, performs medical journal peer review, and serves on many professional committees and boards
  • Awarded the Pharmacy Career Achievement Award by the University of Missouri – Kansas City, 2019
  • Served as Principal Investigator for the National Institutes of Health, NINDS BRAIN Initiative for Neurological Drug Development, 2015-2018

Affiliations

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