Can rheumatism patients who take hormones and immunosuppressants get the new crown vaccine?

*For medical professionals to read and refer to Quick Collection~ To say which vaccine is the hottest recently, it is the new crown vaccine.
At present, the COVID-19 new crown virus continues to wreak havoc and seriously affects ordinary people.
With the launch of the vaccine, For the vaccine against the new coronavirus, the State Council has notified the people of immunization, but at the same time, many patients with rheumatism are wondering whether they can get it? 01Can patients with rheumatism immune disease be vaccinated? "I have rheumatoid arthritis.
Can I get the new crown vaccine? I have diagnosed autoimmune diseases (AIDs) such as systemic lupus erythematosus and dermatomyositis.
I am still taking hormones and immunosuppressants.
Can I get the new crown vaccine?" Patients with AIDs and rheumatologists have expressed their own concerns about vaccination.

This article answers some of the most concerned questions about the SARS coronavirus type 2 (SARS-CoV-2) vaccine based on the recommendations of international societies and relevant foreign guidelines.

026 big question to understand 1 What is the general principle of vaccination for patients with rheumatism? The European Union against Rheumatism (EULAR) has already given recommendations on vaccination for adult patients with AIDs: 1.
The vaccination of patients with rheumatism should preferably be carried out during the static period of the disease.
If the disease is in the active phase, vaccination is not recommended.

2.
Patients who are being treated with systemic glucocorticoids and immunosuppressive agents can be vaccinated with inactivated vaccines, but the protective antibody titers produced may be lower than the general population.

3.
For adult patients with AIDs, live attenuated vaccines should be avoided or carefully vaccinated to reduce the risk of infection and adverse reactions.

4.
Pregnant women have been treated with biological agents (such as tumor necrosis factor antagonists) in the second half of pregnancy.
Newborns who give birth should avoid vaccination with live attenuated vaccines within 6 months. 2 Are patients with rheumatic immune diseases more likely to be infected with the new coronavirus? Due to the imbalance of the autoimmune system and the use of glucocorticoids, immunosuppressants or other biological agents and targeted drugs to suppress immune and inflammatory reactions, patients with rheumatic immune diseases will have reduced defenses against pathogens and may be more susceptible to infection New coronavirus, and the risk of serious complications after infection is higher, so more attention should be paid to the issue of vaccination.

3Can patients with rheumatic immune disease receive the new crown vaccine during the use of hormones or immunosuppressants? At present, the new coronavirus vaccine for emergency vaccination in China is an inactivated vaccine.

The United Kingdom, the United States, and other national societies including Greece recommend that all immunosuppressed patients should be vaccinated against SARS-CoV-2.

The position statement is based on the long-term experience of vaccinating patients with rheumatism, the available data from clinical trials and the latest recommendations of the health authorities.

It is safer for people with low immune function to receive inactivated vaccines; patients who receive hormone or immunosuppressive therapy, whose immunity is still normal, and have stable disease are not contraindicated to vaccinate, but the protective antibody titer produced may be lower than that of the general population .

We also recommend that patients receive the inactivated Covid-19 vaccine after consulting a specialist before being vaccinated.

4Can the new crown vaccine be given before and after the use of biological agents? Previous studies have shown that in biological agents, TNF-α inhibitors only slightly reduce the response of the vaccine, and the use of TNF-α inhibitors in patients with connective tissue diseases will not significantly affect the efficacy of the vaccine.

There is currently no clinical study on co-treatment of the new crown vaccine and adalimumab, and the effect of adalimumab on the response of the new crown vaccine is unclear.

However, the application of biological agents targeting B cells (such as rituximab) will seriously affect the humoral immunity stimulated by the vaccine, thereby reducing the effectiveness of the vaccine.

Therefore, experts recommend that patients with rheumatoid immune disease should be vaccinated 4 weeks before or 6 months after the use of anti-B cell biological agents, otherwise it will not be effective.

5 If a patient who is using biological agents or immunosuppressive agents is infected with the new coronavirus, should the drug be stopped? After the new coronavirus infects the human body, it may cause direct damage to important human tissues and organs such as the lungs, liver, kidneys, and even the heart, leading to various diseases such as the respiratory system and the cardiovascular system.
The most common of these is the new coronavirus pneumonia.

However, patients with rheumatism and immunological diseases will use certain immunosuppressive agents or biological agents due to their condition, resulting in reduced immunity, and the infection of new crown may be more serious than the general population.
Therefore, in the case of weighing the pros and cons, immunosuppressive agents or biological agents can be used.
Disable or reduce volume.

6 How should family members of patients with rheumatoid immune disease be vaccinated? Family members with normal immune function of patients with rheumatism should be encouraged to vaccinate age-appropriate vaccines in accordance with national guidelines.

It is not recommended for family members of patients with rheumatism to vaccinate oral polio vaccine and smallpox vaccine, because it has a lower risk of causing vaccine-related paralytic polio in patients with rheumatism in the family.

03 Summary In summary, all new coronavirus vaccines try to introduce viral antigens into the immune system to obtain an effective immune response, thereby eliminating or preventing the virus from entering the cell and causing disease.

At least, patients exposed to this will develop an asymptomatic or mild form of new coronary pneumonia.

The ultimate goal of the vaccine is to provide long-term protection against the virus for patients with rheumatism, without putting them at risk of outbreaks or complications.

For individuals with impaired immune function and low immunity, who are at high risk of severe new coronary pneumonia, they still need to be actively vaccinated with inactivated vaccines without other contraindications.

References: [1]Furer V, et al.
2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases.
Annals of the Rheumatic Diseases.
annrheumdis-2019-215882.
[2]Rubin LG,et al.
2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host.
Clinical Infectious Diseases, 58(3), e44–e100.
[3]Kathleen D, et al.
The Advisory Committee on Immunization Practices' Interim Recommendation for Allocating Initial Supplies of COVID-19 Vaccine-United States, 2020.
MMWR Morb Mortal Wkly Rep.
2020 Dec 11;69(49):1857-1859.
[4]Tsvetelina V, et al.
SARS-CoV-2 vaccines and autoimmune diseases amidst the COVID-19 .
Rheumatol Int.
2021 Mar;41(3):509-518.
[5]Vaccination Against SARS-CoV-2 in Immunosuppressed Patients with Rheumatic Diseases: Position Statement of the Greek Rheumatology Society.
Mediterr J Rheumatol.
2020 Dec 28;31(4):430-432.