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COVID19 / Coronavirus

NASS have advice and guidance on COVID-19 for people living with axial SpA (AS)

Updated 7 April 2021

Since the start of the COVID19 pandemic NASS has carefully monitored the situation for people living with axial SpA (AS). This page includes the answers to your most frequently asked questions. If you have a question which we haven’t covered below please contact the NASS Helpline on 0208 741 1515 between 10:00 and 16:00 Monday to Friday. You can also email asknass@nass.co.uk.

Vaccine

This section gives information about the COVID-19 vaccines which have been approved for use in the UK. 

Our information will be updated regularly over the coming weeks and months as new information about this vaccine and others that have been developed becomes available. Please check back frequently. Dr Antoni Chan, Consultant Rheumatologist at the Royal Berkshire NHS Foundation Trust has written an article on the COVID-19 vaccines which you may find interesting to download. 

More detailed information on the COVId-19 vaccination programme can be found in the Greenbook.

What are vaccines?

Vaccines are material that contain weakened or inactive parts of a particular organism such as virus or bacteria and it triggers an immune response within the body. Vaccines will be one of the important ways to control the COVID-19 pandemic.

Why vaccinate?

When a person is vaccinated, they are very likely to be protected against the bacteria or virus by production of antibodies or activation of immune cells. However, there is no vaccine that provides 100% protection. In addition, not everyone can be vaccinated. There are certain conditions where a vaccine is not suitable for a person. For example, people who have severe allergies to some vaccine components may not be able to receive certain vaccines.

These people may still be protected if they live amongst others who are vaccinated. When a significant number of people in the population are vaccinated, it becomes more difficult for the infection to be passed around. This is known as herd immunity and those who are unable to be vaccinated will receive substantial (but not full) protection against the infection.

So vaccination provides protection both for the person receiving it and also for those in the population are unable to be vaccinated. This is why if you are eligible and able to, you should receive the vaccine.

Can I get COVID-19 from the vaccine?

You cannot get COVID-19 from the vaccine.

All vaccines that are presently under development specifically for COVID-19 are non-live vaccines that cannot give you the disease.

Which COVID-19 vaccines are available in the UK?

The genetic sequence of SARS-CoV-2 was published on 11 January 2020, and was followed by the rapid research and development of vaccines. At the end of 2020, there were over 60 COVID-19 vaccines in human clinical trials.

It is important to have a range of different vaccines available as manufacturing has to be scaled up to meet the race against time to supply vaccines for the global population.

The vaccines have been given rapid approval with government funding and early review of the data. People who are hesitant to get a COVID-19 vaccine should be reassured that the approval process has been independent and robust.

There are currently three types of COVID-19 vaccines that have completed or are soon to start Phase 3 clinical trials.

mRNA vaccines

These vaccines contain genetic code for the virus that gives instruction to our cells to make proteins that resemble part of the virus, in this case the S (spike) protein of the SARS-CoV-2.  It is not made up of any part of the COVID-19 pathogen (live or dead).

The genetic code is called messenger ribonucleic acid (mRNA) and uses this new technology that is different from other vaccines we had before. The mRNA is not integrated into the host DNA. The genetic code from the vaccine is destroyed when the proteins are made.

The harmless protein produced is recognised by immune cells (B and T cells) and protection is developed against future infection from COVID-19. The vaccine shows the body’s immune system what the virus looks like so it can remember the next time it’s infected.

Viral vectors

These vaccines contain the genetic material of SARS-CoV-2 and are inserted into a weakened version of a non-related virus. This is called a viral vector. When the viral vector is inside our cells, the genetic material instructs cells to make proteins that stimulate an immune response from B and T cells that will remember how to react against the virus if we get infected in the future.

Protein subunits

These vaccines contain proteins from the virus that cause COVID-19. These harmless proteins cannot cause the infection and are given as a vaccine. Once inside cells, the immune cells recognise the proteins and begin making antibodies and T-cells. These immune cells will confer protection against future infection with COVID-19.

The list of COVID-19 vaccines available in the UK are:

AstraZeneca / Oxford University

Approved by MHRA for use in the UK on December 29, 2020. This is a viral vector vaccine. The  vaccine uses a vector from a common cold virus (adenovirus) from a chimpanzee. It is harmless and has been genetically changed so cannot grow inside human cells. This replication-deficient chimpanzee adenoviral vector vaccine contains the full-length SARS-CoV2 spike protein genetic sequence.

It delivers into the host cells the surface glycoprotein antigen (spike protein) gene. The gene (DNA) is shuttled into cells and makes the cell produce proteins that will prime the immune system. It elicits antibodies to attack the SARS-CoV-2 virus if it later infects the body. It is more stable and can be stored with refrigeration. It is given as 2 injections, 28 days apart.

 Pfizer, BioNTech

This vaccine is a mRNA vaccine that encodes the SARS-CoV-2 receptor-binding domain antigen.

The mRNA molecule is unstable and this is why it needs to be stored at very low temperatures, otherwise the molecule can break down. It is stored ultra-cold at -70ºC. Once thawed it can be kept refrigerated for up to 5 days. The vaccine comes in a liquid injection and is given as 2 injections, 21 days apart.

The vaccine contains natural tiny oily particles called lipid nanoparticles and these microscopic spheres contain the mRNA molecule. The small droplets are the same structure as the cell membranes, so they can fuse with the membrane allowing the mRNA to enter the cells. The lipids also stabilise the mRNA molecule. Once inside the cells, the mRNA produces the spike (S) protein. The immune system then recognises this as a foreign entity and attacks it using antibodies and T-cells. The immune system learns and remembers how to destroy the spike protein, so if the virus enters the body, it will recognise and destroy it.

Moderna

Approved by MHRA for use in the UK on January 8, 2021. This is also an mRNA vaccine. It is a lipid-nanoparticle-encapsulated mRNA vaccine expressing the prefusion-stabilised spike glycoprotein. This vaccine encodes the S-2P antigen.

There are some differences compared to the Pfizer/BioNTech vaccine in the composition of the lipid spheres. There are four types of lipid nanoparticles used to hold the mRNA. The ratios of these lipids, as well as whether they are positively or negatively charged, is what differentiates the mRNA vaccines. This also means they require different storage conditions. The vaccine is stored at -20°C. Once thawed it can be stored in the refrigerator (2-8°C) for 30 days. It is given as 2 injections, 28 days apart.

When might I be offered the vaccine?

The NHS has started the COVID19 vaccination programme. You can read more about The Joint Committee on Vaccination and Immunisation (JCVI) advice on this issue. Their priority list is as follows:

1. Residents in a care home for older adults and their carers.
2. All those 80 years of age and over and frontline health and social care workers.
3. All those 75 years of age and over.
4. All those 70 years of age and over and ‘clinically extremely vulnerable’ individuals.
5. All those 65 years of age and over.
6. All those aged 16 to 64 years with health conditions putting them at higher risk of serious disease/mortality.
7. All those 60 years of age and over.
8. All those 55 years of age and over.
9. All those 50 years of age and over.

You would know if you fall into category 4 as you would have received a letter during the autumn / winter asking you to shield.

Category 6 covers a broad range of conditions. Axial SpA (AS) is not specifically mentioned but some of the medications used to treat the conditon are specified. So, if you are on a biologic therapy such as anti TNF or anti IL 17A or are taking oral steroids you should be vaccinated as part of category 6.

You can read in more detail about who would fall into category 6 on page 10-11 of The Green Book.

On 29 March the Joint Committee on Vaccination and Immunisation (JCVI) advised the government to prioritise people for the COVID-19 vaccine who are over 16 and living with adults who have weakened immune systems, such as those on treatments such as anti TNF or anti IL 17A therapy. This new recommendation has been made in the light of growing evidence that the COVID-19 vaccines may reduce the chance of someone who has been vaccinated passing the virus on. This move will help limit the spread of the virus to immunosuppressed adults.

Should I receive the COVID-19 vaccine if I am on immunosuppressants?

The approved COVID-19 vaccines are recommended by the JCVI for immunosuppressed patients. This includes people on medications including anti-TNF, anti IL 17A , and individuals treated with steroid-sparing agents such as cyclophosphamide and mycophenolate mofetil. This group also includes individuals treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day.

People on these medications may have a diminished immune response to the vaccines.

Should I stop or pause my treatment to receive the COVID-19 vaccine?

There is currently no evidence to stop or pause your anti TNF, anti IL 17A or  steroid treatment to receive the vaccine. However, further guidance from the JCVI will be given so this advice may be updated.

Vaccinations should preferably be given when the disease is in a quiet phase and it is also preferred to vaccinate before planned immunosuppression if possible. For patients receiving Rituximab, where clinically possible, COVID-19 vaccines should be given four weeks or more before the treatment.

Which vaccine should I receive?

The first one you are offered.

Are there any contraindications to having the vaccine?

The vaccine should be avoided in those who have had a previous systemic allergic reaction (including immediate-onset anaphylaxis) to a previous dose of the same COVID-19 vaccine or any component (excipient) of the COVID-19 vaccine. The excipients are available for review prior to receiving the vaccine.

Do I still need the vaccine if I have had COVID-19?

Yes. Experts recommend getting vaccinated even if you have had COVID-19 in the past.

People who get COVID-19 do develop antibodies that likely provide some protection against getting infected again. But it is not known exactly how long antibodies last after a person recovers.

What if I am pregnant?

Although the available data do not indicate any safety concern or harm to pregnancy, there is insufficient evidence to recommend routine use of COVID-19 vaccines during pregnancy.

Can I breastfeed after receiving the vaccine?

Yes, you can. There is no known risk associated with giving non-live vaccines whilst breastfeeding.

Will I need a booster after the initial 2 vaccine doses?

This is not recommended at the moment as further research is needed to know if it is needed and the timing of boosters has not yet been determined.

If I get the vaccine, can I stop social distancing and wearing a mask?

Even though vaccines work very well to prevent COVID-19, it is still possible to get the infection. It will also take some time to learn exactly how long immunity lasts after a person gets a vaccine. Experts also need to learn more about how many people are getting vaccinated and how this is affecting the spread of COVID-19. Until this is known, it is recommended that social distancing, hand washing and wearing a mask continues after being vaccinated.

Regional differences across the devolved nations

Each of the devolved nations has its own approach to handling the COVID-19 crisis.

England

People who are clinically extremely vulnerable no longer have to shield from April 1 in England.

Letters containing updated guidance were sent out setting out practical steps you can follow to reduce your risk of catching the virus, including continuing to maintain strict social distancing and to keep your overall social contacts at low levels, such as working from home where possible. If you are unable to work from home, employers are required by law to take steps to make workplaces COVID-19 secure and should discuss this with their employees. If people have already registered for priority access to supermarket delivery slots, they will continue to be able to access these until 21 June 2021.

From 29 March, the ‘stay at home’ rule ends and up to 6 people or 2 households can meet outside. Find out more information about what you can and cannot do during lockdown.

Northern Ireland

Lockdown restrictions are in place in Northern Ireland. Read a summary of these restrictions.

On Monday 22 March children from P4 to P7 were able to return to the classroom. From Monday 1 April people can meet outside for exercise in groups of up to 10 people from two households, golf and other sporting activities can return and up to 6 people from two households can meet in private gardens.

Scotland

Some of the rules in Scotland have been relaxed. Now up to 4 adults from up to 2 households can meet outdoors, although the advice is still to stay as close to home as possible. Additionally, adults can take part in outdoor non-contact sport and organised group exercise in groups of up to 15 people.

For the latest information on what you can and cannot do, check the guidance on Gov Scot website.

The Scottish government is recommending that the clinically vulnerable follow the guidance for clinically extremely vulnerable to help protect yourself and others. For more details on the risk groups and protection levels, read the Gov Scot website information on the highest risk group.

Wales

From the 27 March, the stay local restrictions have been lifted, self-contained accommodation can re-open, outdoor children’s activities can take place and 6 people from 2 households can meet outdoors, socially distanced.

Shielding for clinically extremely vulnerable people was paused on 1 April.

Will I see my rheumatologist and physiotherapist as usual?

There may be delays to planned appointments as staff in rheumatology departments were redeployed during COVID19. To keep everyone safe, a lot of appointments are being carried out over the phone or online. NASS has produced a short video to help you make the most of remote appointments.

When will my NASS branch get started again?

A lot of our NASS branches have moved to offering online sessions so you can exercise safely from your home. These session are led by physiotherapists and still enable you to have a chat with others living with axial SpA (AS). You can find your local NASS branch by putting your postcode in the search box on this page.

How can I safely exercise?

NASS have a whole range of exercise resources for you and we’ve been working with physiotherapists, yoga teachers and Pilates teachers to put together some short stretch sessions you can use.

What research is being carried out into COVID19 and axial SpA (AS)?

In order to understand how COVID19 might impact on people living with rheumatological conditions like axial SpA (AS) a Global Rheumatology Alliance was established. Its aim is to increase our knowledge and understanding of how COVID19 both affects people with rheumatic conditions and if the medications people commonly take changes their risk. It is a database and clinicians from around the world are registering details of patients with rheumatic conditions who have contracted COVID19.

Research papers are already being produced based on the results. One paper based on over 600 patients from 40 different countries indicated only those taking more than 10mg of oral steroids were at greater risk of being hospitalised for COVID19. No other drugs increased the risk of hospitalisation and anti TNF appeared to decrease the risk.

Can I help by taking part in any research?

We’ve put together a list of studies taking part around the world and here in the UK looking at the impact of COVID19. You can find out more here.

Looking after your emotional wellbeing

It’s important to look after your emotional wellbeing. Visit our wellbeing page for advice and support, including specific advice for managing anxiety.

You can also download the coping with lockdown workbook provided by Anxiety UK.