While I’m used to being home a lot as a result of surgeries related to my disease and regular flare-ups, the pandemic was doubly hard for me because I have been in remission, and in good health to go out and about. Sadly, the pandemic had other plans. So when the news of the high efficacy rates of the Pfizer and Moderna vaccines hit the airwaves back in November, it was music to my ears. I thought to myself, finally there is hope! Finally, we may turn a corner! While I am planning on getting the vaccine as soon as it becomes available to me, I have been hearing a lot of vaccine hesitancy from the IBD community. Fellow patients have been reaching out to me for the past few weeks, asking for my opinion as an IBD patient advocate on the vaccines. People want to know how the vaccines work, if there is enough trial data to prove that it is safe for IBD patients regardless of their medication, if the vaccine will cause IBD symptoms to flare, if it will affect fertility, and on and on. I was so busy fielding questions that I didn’t even have time to take a break over the holidays. As I received question after question, I realized that I needed to roll up my sleeves and learn everything I possibly could around these vaccines to provide my community with answers. So I reached out to Meenakshi Bewtra, MD, MPH, an assistant professor of medicine at the Hospital of the University of Pennsylvania in Philadelphia, and an assistant professor of epidemiology in biostatistics and epidemiology, for answers. So when SARS-CoV-2 began decimating parts of Europe and Asia early in 2020, scientists from around the world came together to work on developing a vaccine. In the United States specifically, Operation Warp Speed pulled together the Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services (HHS), and pharmaceutical companies to pivot their strategy and focus on vaccine development. This brought production to scale. “Vaccine development was not sped up,” says Bewtra. “All these agencies and companies were focused on one worldwide emergency and poured unlimited resources into it from an existing technology. Their collaboration was a real testament to human intelligence and scientific rigor.” There were robust randomized clinical trials done in large populations of approximately 30,000 diverse participants. And the results were clear: The vaccines had 90 to 95 percent efficacy rates. These rates are higher than almost every other vaccine developed besides the measles vaccine. And because they are not 100 percent effective, Bewtra says we must continue to practice other precautions, such as masking up and maintaining social distance, until we achieve herd immunity.
Why the mRNA Vaccines Are Safe for IBD Patients
Studies are still needed to confirm the efficacy of the mRNA vaccines in IBD patients, according to Bewtra, but “there is strong reason to believe that these vaccines are efficacious in IBD patients based on comparisons to data in other vaccines, including the vaccines for shingles and pneumonia.” According to GI physicians, all IBD patients, including individuals on biologics, immunosuppression drugs, or with J-pouches or ostomies, should be receiving this vaccine. The vaccines are not live and only use 1 of the 25 proteins involved in this virus, so there is no chance of developing the SARS-CoV-2 from them. Still, people with IBD might be concerned that the vaccine will worsen symptoms of Crohn’s or ulcerative colitis. Bewtra says that there is no evidence that these vaccines cause IBD flares or result in an increased risk of autoimmune conditions. She advises people with IBD to get vaccinated with whichever one is available first since both Pfizer’s and Moderna’s vaccines have similar efficacy rates. And Bewtra says to stick to the same type of vaccine for both shots: The efficacy and safety has only been evaluated in patients getting the same type of vaccine. The only people in the IBD community who should not get vaccinated are those that are currently infected with the SARS-CoV-2 virus or patients who have been recently exposed to SAR-CoV-2. Exposed and infected patients should quarantine for two weeks and make sure they are fully asymptomatic, and then get vaccinated.
What We Know About Timing the Vaccines Around IBD Meds
Many IBD patients are often concerned about how to time their vaccinations around IBD medications or other vaccinations. But Bewtra says there is no need for this and timing your IBD injections or infusions around this can do more harm than good. “It’s always better not to risk a disease flare-up,” she says. Additionally, if you are receiving other vaccinations, she recommends that patients wait 14 days between each. “There is likely no adverse event between vaccinations, but it’s important for your doctors and the CDC to know what reactions, if any, you may have to the COVID-19 vaccine versus other vaccines,” she says.
How Herd Immunity Helps IBD Patients
By getting vaccinated, we are all contributing to the development of herd immunity, IBD patients included. In an article published December 24 in The New York Times, Anthony Fauci, MD, the nation’s top infectious disease expert, said that we need up to 90 percent of Americans to get vaccinated to achieve herd immunity against COVID-19. Herd immunity means that enough of the population is vaccinated against the disease to prevent the disease from spreading. For the immunocompromised IBD population, this concept is key because if you are on immunosuppressant agents, you may not have as robust a response to a vaccine as a person with an intact immune system, so we all have to do our part.
What Adverse Events Have Been Reported In IBD Patients?
The most common adverse events in the general population, including IBD patients, are as follows:
HeadacheFatigueNauseaDiarrheaPain, swelling, and redness at the vaccine site
There is, however, an ingredient in the vaccines called polyethylene glycol (PEG) that is also used in bowel preps for colonoscopies that some IBD patients might be allergic to. If you have a known sensitivity to this ingredient, it is recommended they either take the appropriate medication before getting vaccinated or carry an Epipen, whichever is suggested by your gastroenterologist. Bewtra, who experienced soreness in her arm after she received the first dose of the vaccine, said “adverse events are generally only observed short-term and that long-term considerations will be followed through [on] in the randomized clinical trials for several years.” Even though adverse events may be worse with the second dose (with flu-like symptoms being the primary concern), she emphasized that, “adverse events are not necessarily a bad thing as they indicate that the body is responding to the vaccine.” To report how you’re feeling after the vaccine, please visit the Crohn’s and Colitis Foundation’s site to sign up for IBD Partners. You can also download the V Safe app on your phone to send adverse events to the U.S. Food and Drug Administration (FDA) and CDC directly.
Vaccine Safety for Pregnant and Breastfeeding Women With IBD
Many women with IBD have been asking me if and how the vaccine can affect fertility or impact a pregnancy, or life postpartum. Bewtra assured me that these vaccines do not impair fertility and although there is no data yet on pregnant women, Bewtra says that “many physicians who are pregnant received the vaccine and have done well.” Bewtra adds, “We do know that contracting COVID-19 in pregnancy poses more severe risks to the mother and baby so it’s best for the mother to exercise caution and hunker down during this pandemic.” Every woman with IBD who is pregnant or is thinking about becoming pregnant should be having this conversation with her ob-gyn and gastroenterologist. While it is not clear at this time whether or not the vaccine passes into breast milk, Bewtra did say that early studies have shown that women appear to be able to safely breastfeed. If you are still unsure, Bewtra says, “It is very reasonable for women to wait until after pregnancy to get the COVID-19 vaccine or to decide to delay conception until after the mother receives the vaccine.”
Moving Forward Into 2021
There are still some unknowns about the vaccine regarding how long immunity will last or if it will cover viral mutations. But even though we do not have all of the answers just yet, Bewtra’s original message still stands: All IBD patients should get vaccinated as soon as we can. As a patient advocate and a woman of color, I feel that it’s my duty to educate and inform other people living with IBD about these vaccines. We have to keep including people of diverse backgrounds in clinical trials and we need to keep listening to their concerns and sharing the best information possible to ensure everyone’s safety. Bewtra, who is also a woman of color, described the evening after she received her first dose of the vaccine as “absolutely the best night’s sleep [she’s] had since March.” She was relieved knowing that this can be the beginning of the end of this virus if we all take the steps to protect ourselves. I take comfort in that too, and will do my part to continue to share scientific evidence and information to my community so we can return to normalcy and put this pandemic behind us. So, own your Crohn’s, own your ulcerative colitis, and take a stand for public health and well-being this new year! For additional information, please refer to the Doctors for America COVID-19 Vaccine Toolkit, which Dr. Bewtra has been contributing to regularly to share timely and credible updates on the vaccines.
