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Covid-19 vaccination

Psoriasis And Psoriatic Arthritis COVID 19 (1)
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Vaccines, COVID-19 and you

The advent of an effective vaccine for COVID-19, is wonderful news and represents a truly astonishing scientific achievement.  Over the past few months, the UK Government has implemented a comprehensive, nationwide vaccination programme, which is finally beginning to bring the current pandemic under control. The aim is to eventually protect the entire UK population and similar programmes are currently underway across Europe and the US. 

If you have psoriasis and or psoriatic arthritis, you will obviously have important questions, including whether it is safe for you to be vaccinated against COVID-19.  A number of organisations have issued expert guidance on this and other relevant issues, including:

  • The US, National Psoriasis Foundation (NPF) COVID-19 Task Force1
  • The International Psoriasis Council (IPC)2
  • The British Association of Dermatologists3
  • Versus Arthritis4

What follows is based on the advice of these organisations, along with relevant information from other expert groups.  Before addressing specific questions, a note about the COVID-19 vaccines themselves is important and relevant.

The Covid-19 vaccines

At present, three vaccines for COVID-19 have currently been approved for use in the UK: (1) the Pfizer/BioNTech vaccine (2) the AstraZeneca (Oxford) vaccine, and (3) the Moderna vaccine.  Both the Pfizer and the AstraZeneca vaccines are currently deployed across the UK and the roll out of the Moderna vaccine has now commenced in Wales. 

Until now, most vaccines involve taking the live virus itself and modifying it in the laboratory so that it is no longer dangerous – so called live-attenuated virus.  In psoriasis and or psoriatic arthritis patients receiving immunosuppressive medication, it is recommended that live-attenuated vaccines be avoided.  Both the Pfizer and Moderna vaccines are based on messenger RNA (mRNA) technology, so are not live vaccines.  Although the AstraZenica (Oxford) vaccine is made of real virus, it has been inactivated so that it cannot cause serious infection.   

What this means in practice, is that all three COVID-19 vaccines being used in the UK are safe, even for those who are taking medicines to suppress the immune system. The advice which follows here is based on the Pfizer and AstraZenica vaccines.

Questions and Answers

Is it recommended that patients with psoriasis and or psoriatic arthritis should be vaccinated against COVID-19?

Yes. The expert guidance recommends that patients with psoriasis and or psoriatic arthritis should be immunised against COVID-19 as soon as the vaccine is made available to them.

Should I have the COVID-19 vaccine?

The decision whether to have the vaccine or not, is a personal one.  You should consider all the available information and make a decision based on your own circumstances.  If you are unsure, you should discuss this with your own doctor. 

Will the vaccine make my skin condition worse?

There is currently no evidence that the vaccine will make your psoriasis worse and no reason to think it would.  Whilst it is true that we do not yet have specific information about COVID-19 vaccines and psoriasis, evidence from other vaccination programmes (e.g., the flu vaccine) does not suggest any detrimental effect. 

There are several COVID-19 vaccines - is one vaccine more suitable than another for people who are on drugs to suppress the immune system?

As stated above, there are three vaccines currently in use in the UK. Pfizer BioNtech, AstraZeneca (Oxford) and Moderna and others will doubtless be approved for use in the future. 

It is not yet known whether one vaccine is more suitable than another, for people who are on medication designed to suppress the immune system - and it will be some time before we can give clear guidance on this.  In the meantime, the recommendation is that you should receive whatever vaccine you are offered, since delaying will leave you at risk from COVID-19.  

Is it safe for me to have the COVID-19 vaccine if I am taking immunosuppressant medication?  

The short answer is - yes.  As described earlier, COVID-19 vaccines are non-live vaccines.  This means that they can generally be given quite safely to people receiving drugs such as methotrexate and biologic injections, that affect the immune system.  As research continues on COVID-19, doubtless more specific information regarding different medical conditions will become available. 

Can I have the vaccine if I am taking steroids?

Yes, it’s quite safe for you to have the vaccine while you are taking steroids and there is no reason to delay vaccination.  There is a theoretical risk that steroid medication (tablets and injections) could weaken your response to the vaccine, so it would be prudent to follow the usual shielding and social-distancing advice after you have had it.  Steroid creams or eye drops will not affect your response to the vaccine. 

Is it safe to have the vaccine during pregnancy? 

The COVID-19 vaccines have not been specifically evaluated for use in pregnancy, but there is nothing to suggest that they are dangerous or harmful in this context.  The latest advice is that COVID-19 vaccines should only be considered for pregnant women when their risk of exposure to the virus is high and cannot be avoided, or if the woman has underlying conditions that place her at a high risk of complications of COVID-19.  In other words, vaccination in pregnancy should only be considered where the potential benefits clearly outweigh the risks. 

If you are pregnant, you should discuss the question of vaccination with your doctor/midwife.  Note that women who are trying to get pregnant don’t need to avoid pregnancy after having the vaccination.

Is the COVID-19 vaccine effective in people taking immunosuppressant medication?

It is not yet known whether the vaccine will be as effective in patients on immunosuppressive medication, such as methotrexate and biologic injections. More research in this specific area is needed and will eventually become available. 

However, given that there is no reason to think the vaccine will not be effective, the advice is that patients on psoriasis and or psoriatic arthritis immunosuppressant medication should not delay being vaccinated against COVID-19.   If you are unsure, speak to your healthcare team.

Should I stop my medication if I decide to have the COVID-19 vaccine?

In general - no.  Expert guidance says that patients may continue their oral or biologic psoriasis or psoriatic arthritis treatment without interruption, when receiving these immunizations.  As always, however, discuss this with your family doctor. 

Is it safe to have the vaccine if I have already had a COVID -19 infection or a positive antibodies test result? 

The short answer is - yes. There is currently no evidence of any safety concerns from vaccinating people with a history of COVID-19 infection or with detectable COVID-19 antibodies.

Can I have the vaccine if I am about to have surgery?

Although there is no specific information available regarding COVID-19 vaccination and surgery, general guidelines recommend that individuals should not have major surgery and vaccines within one week of each other.

NOTE – Blood Clots and the AstraZenica (Oxford) Vaccine

At the time of writing (8 April 2021) the Medicines and Healthcare products Regulatory Agency (MHRA)* has issued new advice, concluding there is a possible link between AstraZenica COVID-19 vaccine and extremely rare forms of blood clots on the brain. 

The evidence suggests that these clots are more likely to occur in younger adults (under 30 years) and in the setting of certain blood abnormalities.  For this reason, those in this younger age-group, should be offered an alternative to the AstraZenica vaccine if available. 

However, it is very important to understand how small the risk of this complication is: Around 1 in a million.  That's roughly the same risk as being murdered in the next month or - if you get into a car and drive for 250 miles - the risk of you dying in a road accident on that journey. 

Accordingly, at PAPAA we continue to endorse the view of the MHRA that the benefits of vaccination overwhelmingly outweigh any risks. 

We also note the MHRA recommendation that careful consideration should be given to people who are at higher risk of specific blood clots because of their medical condition. 

Clearly this issue will continue to be closely monitored by the regulatory authorities.  

Please note that the above are general guidelines.  If you are still unsure as to whether vaccination against COVID-19 is right for you, please discuss it with your family doctor. 

*For further and the latest information about COVID-19 vaccinations, visit the MHRA website 

Author:
Dr David Ashton MD PhD

For more information read our COVID-19 FAQs page

References and resources 

[1]The US, National Psoriasis Foundation (NPF) COVID-19 Task Force
National Psoriasis Foundation COVID-19 Task Force Guidance for Management of Psoriatic Disease During the Pandemic: Version 1 - Journal of the American Academy of Dermatology (jaad.org)

[2]The International Psoriasis Council (IPC)
IPC - IPC Statement on SARS-CoV-2 Vaccines and Psoriasis (psoriasiscouncil.org)

[3] The British Association of Dermatologists
COVID-19: Provisional Guidance on Vaccination (Subject to approval and supply of vaccines) (bad.org.uk)

[4] Versus Arthritis
Vaccines-for-covid-19-your-questions-answered (
versusarthritis.org)

This article was first published on 21 December 2020, with revisions and updates on 6 January 2021, 17 March 2021 and 8th April 2021