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September 23, 2021
Q:

My mother takes abatacept (i.e., Orencia) for her rheumatoid arthritis, which is an autoimmune disorder. This medicine slows the body’s immune system from causing bone and joint destruction. If the medicine slows her immune system, could she get COVID-19 from the vaccine?

A:

 I will take this opportunity to talk about some of the reasons New Brunswickers may be hesitant to get the COVID-19 vaccine and about why vaccination matters.

Pharmacists across New Brunswick have administered over a half a million doses of COVID-19 immunizations since the vaccine first became available last February. We have been patient in answering your questions and concerns. It is true that disease modifying anti rheumatologic drugs (i.e., biologics [Orencia] and biosimilars, methotrexate, leflunomide, hydroxychloroquine, etc) may weaken your body’s ability to produce antibodies in response to a vaccine. Experts recommend vaccines for people with autoimmune disorders because the magnitude of the benefit of the COVID-19 vaccines, even with a lessened response, is still significant to provide some degree of protection. 
 

Having a condition that compromises your immune system makes it even more important for you to get immunized because your immune system may be less likely to defend your body from COVID-19 infection. For those people on a biologic medication, chemotherapy, or other medication that suppresses your immune system, in most cases this involves planning your COVID-19 immunization at an appropriate time to ensure your body will be able to build immunity. The vaccine will not cause COVID-19 or make you sick. There are reports that COVID-19 immunization of those with autoimmune diseases and disorders (i.e., psoriatic arthritis, polymyalgia rheumatica, systemic lupus, etc) may cause disease flares. Expert consensus from Canadian physicians and scientists recommends that these groups of people still stand to benefit from vaccination because of the potential for severe illness if they are infected with COVID-19.

 

In New Brunswick, the two vaccines currently available are mRNA vaccines manufactured by Moderna and Pfizer. None of the COVID-19 vaccines approved by Health Canada are live vaccines. This means it is not possible, even with a compromised immune system, to get COVID-19 from a vaccine.

 

There are very few reasons that it would not be appropriate for you to receive a COVID vaccine. Those who have a history of life-threatening anaphylaxis to an ingredient in the vaccine product would be a rare example of someone who would be referred for consultation to an allergist prior to immunization. If you have an active COVID-19 infection, or a temperature greater than 38.3 C, it may be decided to postpone your immunization until this acute illness has passed.

We are seeing the beginning of a fourth wave of COVID-19 in New Brunswick. Effective September 22, 2021, all individuals aged 12 and older will be required to provide proof of vaccination for access to some events, services, and businesses. This is an effort to reduce the number of unvaccinated New Brunswickers. As of my writing this, approximately 77.5 percent of New Brunswickers are immunized against COVID-19 with two vaccine doses. Most infections are occurring among younger adults who are either not vaccinated or who are only partially vaccinated. The majority of COVID-19 cases currently in hospital or in intensive care are either unvaccinated or only partially vaccinated people. We also know that unvaccinated adults do transmit COVID-19 to children. There is currently no vaccine for children under 12 years of age, so vaccinated adults help protect kids. We also know that transmitting the virus to adults and children who are immunocompromised can cause devastatingly severe disease and death. 

Let’s remember the level of protection vaccination provides: immunization makes it less likely that you will become severely ill, require hospitalization, or die from COVID-19. Getting two doses of immunization is the best way to protect yourself from COVID-19, including the Delta variant.   

Please, do your part. To my colleagues, I see the hard work you are doing each day and it matters. Visit gnb.ca to book an appointment for your COVID-19 vaccine.

Dr. Kevin Duplisea (PharmD BSc. Pharm, BSc. ACPR) is a pharmacist at Sharp’s Corner Drugstore in Sussex, New Brunswick. His opinions expressed in this newspaper are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com.