TABLE 1.
Summary of existing Covid‐19 vaccination recommendations in special populations and in patients with existing comorbidities
| Vaccine platform | ||
|---|---|---|
| mRNA | Adenoviral vector | |
| Most common side effects | Fatigue, headache, chills, muscle pain, fever. Worsen after the second dose. | Injection site pain, fever, muscle aches, headache, fatigue. Worsen after the second dose. |
| Who should not be vaccinated | People with a history of allergic reactions to vaccine ingredients, including polyethylene glycol, and anyone with a history of allergic reactions to polysorbate. a | Anyone with a severe allergic reaction to an ingredient in the vaccine. a |
| Significant side effects (rare) | Pfizer/BioNTech and Moderna: Anaphylaxis, Bell's palsy, autoimmune hepatitis, myocarditis, pericarditis | Janssen: VITT, demyelinatingOxford/AstraZeneca: VITT, transverse myelitis, demyelinating |
| Rheumatologic and autoimmune diseases | • Corticosteroids: Taper to <10 mg/day prior to vaccination. | • Corticosteroids: Taper to <10 mg/day prior to vaccination. |
| • MTX: Withhold 2 weeks before and after vaccination. | • MTX: Withhold 2 weeks before and after vaccination. | |
| • Anti‐TNF and IL‐17 medications: No specific dose reduction is required. | • Anti‐TNF and IL‐17: No specific dose reduction is required. | |
| • Anti‐IL‐6 medications: Vaccination should be 12 weeks before/after TCZ administration. | • Anti‐IL‐6: Vaccination should be 12 weeks before/after TCZ administration. | |
| • JAK inhibitors: Withhold 1–2 weeks before and after vaccination. | • JAK inhibitors: Withhold 1–2 weeks before and after vaccination. | |
| • Anti‐CD20 medications: Withhold 4 weeks before until 6 months after vaccination. | • Anti‐CD20 medications: Withhold 4 weeks before until 6 months after vaccination. | |
| • ABA: Data are not yet available. | • ABA: Data are not yet available. | |
| Cancer | • Anti‐CD20 or cytotoxic therapies inactivate the mRNA vaccine.• Cytotoxic chemotherapy: Start chemotherapy courses 2 weeks after vaccination. | • Cytotoxic chemotherapy: 2 weeks after vaccination• If chemotherapy has already been given, vaccination should be given between courses of chemotherapy. |
| • If chemotherapy is already initiated, vaccination should be given between courses of chemotherapy.• Lymphocyte or plasma cell‐depleting regimens: Vaccination should be 2 weeks before or 3 months after the end of treatment. | • Lymphocyte or plasma cell‐depleting regimens: Vaccination should be 2 weeks before or 3 months after the end of treatment. | |
| Transplant patients | • Vaccination is recommended early in the course of the underlying disease. | • Vaccination is recommended early in the course of the underlying disease. |
| • After transplantation, postpone vaccination for 3–6 months. | • After transplantation, postpone vaccination for 3–6 months. | |
| • If the first dose is received before the transplantation, the second dose should be administered at least 4 weeks after transplantation | • If the first dose is received before the transplantation, the second dose should be administered at least 4 weeks after transplantation | |
| • A third dose may be warranted for optimal immunity. | • A third dose may be warranted for optimal immunity. | |
| CLD | • Recommended, with priority given to patients with higher MELD scores. | • Recommended, with priority given to patients with higher MELD scores. |
| • Vaccination of patients with CLD undergoing treatment for HBV, HCV, PBC, and autoimmune hepatitis should be performed without discontinuing their therapy. | • Vaccination of patients with CLD undergoing treatment for HBV, HCV, PBC, and autoimmune hepatitis should be performed without discontinuing their therapy. | |
| • Vaccination is safe and recommended for patients with HCC. | • Vaccination is safe and recommended for patients with HCC. | |
| • Patients on the transplant list should receive two doses of the vaccine before the transplant. | • Patients on the transplant list should receive two doses of the vaccine before the transplant. | |
| • If the patient received the first dose before the transplant, the next dose could be given to him/her at 6 weeks to 3 months after the transplant. | • If the patient received the first dose before the transplant, the next dose could be given to him/her at 6 weeks to 3 months after the transplant. | |
| • Vaccination should be withheld in liver transplant recipients with active ACR or those receiving high‐dose corticosteroids until the condition is resolved. | • Vaccination should be withheld in liver transplant recipients with active ACR or those receiving high‐dose corticosteroids until the condition is resolved. | |
| ESRD | • Taper steroid doses below 20 mg prednisone equivalent daily before vaccination. | • Taper steroid doses below 20 mg prednisone equivalent daily before vaccination. |
| • If the patient received anti‐CD20 medication, vaccination should be delayed for at least 6 months after the last dose of the therapy. | • If the patient received anti‐CD20 medication, vaccination should be delayed for at least 6 months after the last dose of the therapy. | |
| • If an active underlying disease is present in these patients, immunosuppressive therapy is prioritised over vaccination. | • If an active underlying disease is present in these patients, immunosuppressive therapy is prioritised over vaccination. | |
| Neurologic disorders | • Vaccination is recommended for MS patients. | • Vaccination is recommended for MS patients. |
| • MS patients receiving ocrelizumab can receive the vaccine 4–6 weeks before starting the treatment or 4–6 months after ending the treatment. | • MS patients receiving ocrelizumab can receive the vaccine 4–6 weeks before starting the treatment or 4–6 months after ending the treatment. | |
| • DMTs for MS can reduce the antibody response of vaccines. | • DMTs for MS can reduce the antibody response of vaccines. | |
| • Patients receiving IRT, including alemtuzumab, rituximab, and ocrelizumab, can be vaccinated 6 months after the treatment. | • Patients receiving IRT, including alemtuzumab, rituximab, and ocrelizumab, can be vaccinated 6 months after the treatment. | |
| • In high‐dose or long‐term treatments with corticosteroids, vaccination is allowed 4–6 weeks after cessation of the treatment. | • In high‐dose or long‐term treatments with corticosteroids, vaccination 4 to 6 weeks after cessation of treatment | |
| • CDC recommended mRNA vaccines for GBS patients. | • For GBS patients, data are not yet available. | |
| Psychiatric disorders | • Recommended, but no studies have been performed solely on the Covid‐19 vaccines and neuropsychiatric disorders. | • Recommended, but no studies have been performed solely on the Covid‐19 vaccines and neuropsychiatric disorders. |
| • Antipsychotic agents suppress vaccine‐induced antibody formation. | • Antipsychotic agents suppress vaccine‐induced antibody formation. | |
| • Antidepressant therapy would normalise the vaccine‐induced immune response. | • Antidepressant therapy would normalise the vaccine‐induced immune response. | |
| DM | Recommended. Patients with DMT2 are prioritised higher than patients with DMT1. | Recommended. Patients with DMT2 are prioritised higher than patients with DMT1. |
| Obesity | Recommended | Recommended |
| CVD | Recommended | Recommended |
| HIV | Recommended | Data not yet available. |
| COPD | Recommended | Recommended |
| Current smokers | Recommended | Recommended |
| Pregnancy and breastfeeding | Recommended | Janssen: Individualised risk/benefit assessment should be performed before vaccination. |
| Oxford/AstraZeneca: Data are not yet available. | ||
| Elderly | Recommended | Recommended |
| Children | Pfizer/BioNTech: FDA recommends this vaccine for adolescents 12–18 years of age. | Data is not yet available. |
| Moderna: Data are not yet available. | ||
| Allergic diseases | Recommended unless a prior history of allergy to PEG or positive skin test for this agent is present. | Recommended unless a prior history of allergy to polysorbate or positive skin test for this agent is present. |
Abbreviations: ABA, abatacept; ACR, acute cellular rejection; CDC, Centers for Disease Control and Prevention; CLD, chronic liver disease; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular diseases; DMT1, diabetes mellitus type 1; DMT2, diabetes mellitus type 2; DMT, disease‐modifying therapy; ESRD, end‐stage renal disease; FDA, Food and Drug Administration; GBS, Guillain‐Barré syndrome; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; HIV, human immunodeficiency virus; IRAEs, immune‐related adverse events; IRT, immune‐reconstitution therapies; MELD, model for end‐stage liver disease; MS, multiple sclerosis; PBC, primary biliary cholangitis; PEG, polyethylene glycol; SLE, systemic lupus erythematosus; VITT, vaccine‐induced immune thrombotic thrombocytopenia.
a
For more information about vaccine ingredients, please see: CDC.gov.