COVID19 Vaccine Information for Patients
What vaccines are currently available in the United States?
There are currently 2 vaccines for COVID19 that have received emergency use authorization (EUA) by the FDA and are being distributed across the country.
One vaccine is made by Pfizer and BioNTech and requires that it be kept at extremely cold temperatures ( -94F) until shortly before its administration.
A second vaccine made by Moderna in association with the NIH (National Institutes of Health) requires only refrigeration and will be distributed to residents of nursing homes and other long term care facilities.. The second dose of this vaccine is given at 28 days.
How do these 2 vaccines work?
This is a new type of vaccine that unlike many prior vaccines does not include a live or inactivated virus. The vaccines contain only a small piece of information (mRNA) that allows our cells to make the S (spike) protein found on the surface of the SARS CoV2 virus that causes COVID19. The mRNA enters the outer cytoplasm of cells but not the nucleus and does not alter your genetic material. It triggers an immune response so your body will make antibodies and instruct other cells to recognize this foreign protein if you were to become infected with the SARS CoV-2 virus in the future. The clinical trials have demonstrated 90-95% efficacy within 1-2 weeks of receiving the second (booster) injection. Other types of vaccines are also being studied but clinical trials on these vaccines have not yet been completed.
Are there side effects associated with this vaccine?
Like many other vaccines, it is not uncommon for the mRNA vaccine to cause low grade fever, muscle and joint pain as well as headache for up to several days with the first and/or second dose. Although unpleasant this is not harmful to you and is not indicative of an allergic reaction. All people who receive the vaccine should be monitored for 15 minutes at the location where they receive the vaccine.
If you have had severe allergic reactions to foods such as shellfish or medications it has been suggested that you be monitored for 30 minutes. If you carry an Epi-pen or similar device it may be prudent to bring it with you when you are vaccinated. As of the date of this posting (12/28/2020) we are aware of only a single patient with a history of severe allergies to shellfish who developed an anaphylactic like reaction to the Moderna vaccine. He used his Epi-pen and was transferred to an urgent care facility where his symptoms rapidly cleared without further adverse events.
Who should not receive the vaccine?
Individuals who have had severe allergic reactions to vaccines and other injections in the past including anaphylaxis that lead to trouble breathing and may have required hospitalization. Please discuss further with your rheumatologist for additional information as there may be unique scenarios where vaccine would be indicated such as a prior reaction to an i.v. antibiotic and current risk for COVID 19 infection is quite high.
Individuals who experienced a severe allergic reaction to the first COVID19 vaccine should not receive the booster vaccine.
Individuals with a known allergy to polyethylene glycol (PEG) or polysorbate ( which may cross-react with PEG) should also not receive the vaccine.
Dr Anthony Fauci has recommended that the vaccine not be given to individuals who have had Guillain barre’ syndrome (GBS) in the past because of concern that it could trigger another episode. However, there has been strong pushback on this from neurologists who specialize in treating patients with GBS. They feel that there is currently no reason to not receive the vaccine. ( gbs-cidp.org). If you have had GBS we suggest that you consult with your healthcare provider.
What about the safety of the vaccine for other special groups?
Individuals with autoimmune rheumatic diseases with or without a compromised immune system who are on medication(s) to treat their disease: There does not appear to be a contraindication to being vaccinated at this time (aside from what is posted above) and AOCC providers are recommending that you proceed with the vaccine when it becomes available to you. Please refer to the last section of this document for specific recommendations regarding possible changes to the dosing of your medication at the time you receive your vaccine. The American College of Rheumatology plans to offer more detailed guidance by the first Quarter of 2021. Here is a link to the information posted by the ACR which is current as of 12/21/2020. (https://www.rheumatology.org/Portals/0/Files/ACR-Information-Vaccination-Against-SARS-CoV-2.pdf ).
Pregnant women and those who are breastfeeding: Pregnant women and those who are breastfeeding “and are part of a group recommended to get the shots — for instance, health-care workers — might want to consider talking with their medical providers beforehand. Pregnant people have been excluded from coronavirus vaccine trials, so there is no data on the safety of the vaccines for them, or its effects on the breastfed infant. The American College of Obstetricians and Gynecologists says a conversation with a clinician may be helpful but should not be required. Pregnant people who get infected with the coronavirus are at greater risk of death and severe illness than those who are not pregnant, even as the overall risk remains small. The Pfizer-BioNTech and Moderna vaccines do not contain live virus, or any enhancers to boost an immune response, and are not thought to be a risk to the breastfeeding infant. They do not alter human DNA in the people who get it and cannot cause any genetic changes. Also, this type of vaccine breaks down quickly and doesn’t enter the nucleus of the cell. Pfizer said it is planning to report to the FDA by the end of the year on a developmental and reproductive toxicity study in animals that could help clarify any risks.” (https://www.washingtonpost.com/health/interactive/2020/covid-vaccines-what-you-need-to-know) For additional helpful information the CDC website has a page dedicated to women who are pregnant or trying to conceive (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html ).
Children under the age of 12: Not recommended at this time. It is not known if the dose of the vaccine and timing of the second booster vaccine should be different or whether there should be more than 2 doses given. Pfizer is currently conducting a trial in children under the age of 12 that might have clinical results to submit to the FDA for approval by late 2021.
Prior COVID19 infection: You should still get this vaccine if you already have had COVID19 but it is recommended that you wait at least 30 - 90 days from when you tested positive. We do not know for certain how long immunity/protection from re-infection lasts but a just-published study in the New England Journal of Medicine strongly suggests that it is a minimum of 6 months. (https://www.reuters.com/article/uk-health-coronavirus-reinfection/covid-19-reinfection-unlikely-for-at-least-6-months-study-finds-idUKKBN28015E)
Will I still need to wear a mask and practice social distancing once I get the vaccine?
After receiving the vaccine you will still need to wear a mask in public and practice social distancing since we don’t know if the vaccine prevents transmission to other individuals although it has a 90-95 % likelihood of preventing you from developing the infection.
When will it be my turn to receive the vaccine?
A timeline for distribution and where you are in line for the vaccine will depend on which state you reside in. The CDC is providing general guidance as to how the vaccine should be prioritized including adults who are definitely at increased risk as opposed to those who might be at increased risk (https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html) but it is up to the states to determine the specifics. Determining where in line people should be is complex and requires considerations of which individuals are most vulnerable as well as the value of their occupation to a functioning society. For a more detailed discussion of this debate see this link https://www.nytimes.com/2020/12/24/magazine/who-should-get-the-covid-vaccine-next.html?referringSource=articleShare
We have provided links here for information that is currently available for:
Butler County: http://health.bcohio.us/schedule_for_a_vaccine_clinic/index.php
List of Vaccine Providers. Contact directly: https://vaccine.coronavirus.ohio.gov
COVID-19 Vaccine Provider Locations
At this time, Ohioans age 80 and older are the first group eligible. Weekly age groupings, outlined below, start with the most vulnerable to allow for a smooth opening to Phase 1B, gradually adding more eligible Ohioans each week. Please visit the COVID-19 Vaccination Program webpage [ https://coronavirus.ohio.gov/wps/portal/gov/covid-19/covid-19-vaccination-program/welcome/covid-19-vaccination-program] for more information on Ohio’s Phased Approach at vaccine distribution. Phase 1B of vaccine distribution will include the following audiences. When a new age group begins, vaccinations may not be complete for the previous age group. It will take a number of weeks to distribute all of the vaccine given the limited doses available. Someone in the first age group, for example, will still be able to be vaccinated once the next group begins.
The week of Jan. 19: Ohioans 80 years of age and older.
The week of Jan. 25: Ohioans 75 years of age and older; those with severe congenital or developmental disorders.
The week of Feb. 1: Ohioans 70 years of age and older; employees of K-12 schools that wish to remain or return to in-person or hybrid models.
The week of Feb. 8: Ohioans 65 years of age and older.
Each provider manages its own schedules and appointments. This tool is intended help make site information easily accessible to Ohioans. It is important to call or visit the website of a provider in advance to ensure the provider is conducting vaccinations at this time and to make arrangements to be vaccinated. Websites, contact information, and addresses listed are submitted by vaccine providers.
These links will be updated as more information is provided. Although the CDC has provided specific recommendations for the order in which people should receive the vaccine, individual states have the ability to modify the order.