Should lupus patients receive the 4th shot (2nd booster) now versus waiting for the Moderna bivalent vaccine?
We know that the BA.4 and BA.5 are starting to circulate in Canada. These variants are even more contagious than previous omicron variants, and as a result, some regions of Canada are already seeing another wave. While it is unclear how effective a booster with the current vaccines will work against these variants, it is expected that they will still provide protection against severe disease.
The National Advisory Committee on Immunization (NACI) recommends an interval of 3-6 months from the last dose of COVID-19 vaccine, based on several factors, including maximizing vaccine effectiveness and minimizing health risks. Some people with lupus have extra risks like immunosuppressive medications, or heart or lung disease, etc. For people with extra risks, especially if someone lives in an area with increasing COVID, or has a high risk of exposure to COVID, a 4th dose should be considered, especially if 6 or more months from the last dose.
A new vaccine that is likely more effective against Omicron subvariants is currently being reviewed by Health Canada and could be authorized for use before fall. Receiving a booster dose now could delay being eligible to receive the new vaccine because of NACI’s recommended minimum interval of 3-6 months between doses. BUT, we do not know for sure when or if the new vaccine will become available, how effective it will be, how much vaccine stock Canada will get and what the roll out will look like (who will be eligible first). So if choosing to delay a booster, in the hopes of getting the new vaccine, it may be wise to reassess frequently to see if there have been any changes in either COVID levels or updates on availability of the new vaccine.
It is recommended to wait 3 months after a COVID infection before getting a booster.
Christine A. Peschken MD MSc FRCPC
Professor of Medicine and Community Health Sciences
Rady Faculty of Health Sciences
Head, Section of Rheumatology
University of Manitoba
Chair, Canadian Network for Improved Outcomes in Systematic Lupus Erythematosus
Immune-compromised Canadians and COVID-19 – Patient-Oriented Resources
On April 14, Evusheld – the only pre-exposure long-acting monoclonal antibody for COVID-19 prevention – was authorized by Health Canada and recently supported with broad recommendations for use in immune-compromised Canadians by the Canadian Agency for Drugs and Technologies in Health and Institut national d’excellence en santé et en services sociaux.
Provinces and territories are currently releasing their own jurisdictional guidance on who is eligible and how to access Evusheld. To support you and the patients you represent, the Canadian Public Health Association has a developed an online resource centre with up-to-date information for patients and healthcare providers on preventive long-acting monoclonal antibodies, including:
- Links to the most recent provincial/territorial guidance on who can receive Evusheld and how;
- Resources for immune-compromised Canadians, including information about long-acting monoclonal antibodies;
- Information for health professionals to support decision-making discussions with patients.
Please visit https://www.cpha.ca/laab to learn more and check back often as content will be updated and added as new information becomes available.
Lupus Canada is pleased to share that Health Canada has approved Evusheld for pre-exposure prophylaxis of COVID-19 in immune-compromised individuals.
Evusheld is now approved for use in adults and children (12 years of age and older, weighing at least 40 kg) who are not currently infected with COVID-19 and have not had recent known contact with someone infected with COVID-19, and:
- who are immune compromised and unlikely to mount an adequate immune response to COVID‐19 vaccination; or,
- for whom COVID-19 vaccination is not recommended
To review the Health Statement please visit:
Canadian Rheumatology Association Position Statement on COVID-19 Vaccination
Government of Canada signs new COVID-19 antibody therapy agreement
In July 2021, GSK received authorization under Health Canada’s Interim Order for Sotrovimab for Injection to treat COVID-19 in high-risk adults and adolescents. To read more please visit https://ca.gsk.com/en-ca/media/press-releases/gsk-receives-authorization-under-health-canada-s-interim-order-for-sotrovimab-for-injection-to-treat-covid-19-in-high-risk-adults-and-adolescents/
GSK also announced on January 6th that the Government of Canada has purchased additional doses: https://ca.gsk.com/en-ca/media/press-releases/gsk-announces-additional-purchase-agreements-with-the-government-of-canada-for-covid-19-monoclonal-antibody-therapy-sotrovimab/
Ontario individuals who are immunocompromised can get a fourth dose (booster) three months (84 days) after completion of the three-dose primary series. Please visit https://covid-19.ontario.ca/getting-covid-19-vaccine for more information.
If you’re moderately to severely immunocompromised due to disease or treatment, you may have a lower immune response to COVID-19 vaccination. NACI recommends you get an additional mRNA vaccine dose following your 1- or 2-dose vaccine series. The additional dose should be given at least 28 days after the second dose. A booster dose may be recommended at least 6 months after the third dose. For more information on COVID-19 vaccines and dosage, consult a health care provider about what’s best for you.
Please visit https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19/vaccines/how-vaccinated.html for more details.
NATIONAL ADVISORY COMMITTEE OF IMMUNIZATION (NACI) RAPID RESPONSE: ADDITIONAL DOSE OF COVID-19 VACCINE IN IMMUNOCOMPROMISED INDIVIDUALS FOLLOWING 1- OR 2- DOSE PRIMARY SERIES
Please visit https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/statement-september-10-2021-additional-dose-covid-19-vaccine-immunocompromised-following-1-2-dose-series.html for details.
COVID-19: PROOF OF VACCINATION
Vaccination records or receipts are issued by your province or territory. Current COVID-19 vaccination documents aren’t standardized for international travel.
- Some provinces and territories have created a secure proof of vaccination document for non-essential services within their province or Canada.
- This proof may be used for activities like going to restaurants and sporting events.
- You may be able to use these secure documents if you need to travel outside the country.
- Each foreign country determines what it will accept at its border. Check your destination country’s rules and make sure your documents, including proof of vaccination, meet their requirements.
Visit your province or territory’s website to get a record.
- British Columbia
- New Brunswick
- Newfoundland and Labrador
- Northwest Territories
- Nova Scotia
- Prince Edward Island
For more information, please visit https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19/vaccines/life-after-vaccination/vaccine-proof.html
LUPUS AND COVID-19 VACCINATION WAIT TIMES
May 6, 2021
Christine A. Peschken MD MSc FRCPC
Head, Section of Rheumatology
Acting Head, Section of Allergy and Immunology
Professor of Medicine and Community Health Sciences
Max Rady College of Medicine, Rady Faculty of Health Sciences
University of Manitoba
Chair, Canadian Network for Improved Outcomes in Systemic Lupus Erythematosus
The intervals in the clinical trials for the different vaccines: 3 weeks for Pfizer, 4 weeks for Moderna and 4-12 weeks for AstraZeneca’s. However, after studying immune response after the first dose of vaccinations the National Advisory Committee on Immunization (NACI) recommended delaying the second dose for up to four months. The rationale was to allow as many as people as possible to receive at least a single dose, thereby providing greater overall protection to the population, and hopefully ending or at least dampening down the third wave sooner.
Several studies have shown that the mRNA vaccines are at least 90% effective following the first dose (although it is not known how long this will last) and there are also studies showing that the AstraZeneca vaccine is more effective if the second dose is delayed to 12 weeks versus four.
All provinces have followed NACI’s recommendations, but all are watching carefully to see if there is a resurgence in COVID-19 infection in people where the second dose is delayed. This is all in the setting of a vaccine shortage, ideally of course all provinces would like to offer both doses to all adults as soon as possible.
There is growing concern that people with lupus or other autoimmune disease, or those taking immunosuppressive medications will not mount the same response to the vaccine, therefore will have less protection, and greater need for an urgent second dose, as well as even possibly “booster” doses in the future.
Each province, as well as NACI, is currently trying to figure out how best to manage the vaccine rollout with all of the competing priorities. Each province has done things a little bit differently in terms of which population groups are prioritized. One of the current subjects for discussion is prioritizing second doses for high risk groups.
Apparently vaccine supply and shipment are expected to steadily increase in May. We are therefore hopeful that this will allow people with lupus to get a timely first and second dose for maximal protection. It needs to be stated though that even after the second dose protection may not be optimal for some immune compromised people. For that reason, following all of the public health restrictions currently in place is more important than ever in the next few weeks as we hopefully begin to see light at the end of this very long tunnel.
We look to our health care professionals to help advocate for priority first dose and priority second doses for people with lupus and other high risk conditions.
Six Bio-Ethicists on Ontario Government’s “Bioethics Table” Confirm Ongoing Concerns Raised by Disability Organizations regarding the Discriminatory and Secret Plans for the Triaging of Critical Care
Dr. Samir Gupta explains how the four COVID-19 vaccines now approved in Canada work and why efficacy rates aren’t the most important number to look at.
AZD1222 US Phase III trial met primary efficacy endpoint in preventing COVID-19 at interim analysis
COVID-19 VACCINE ROLLOUT
As provincial governments begin their rollout plans for the COVID-19 vaccine we encourage you to speak with your healthcare team or visit https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks/covid-19-vaccine-treatment/vaccine-rollout.html#a3o to determine when you are eligible to receive your vaccine.
VACCINES FOR COVID-19 AND LUPUS
Lupus, and some of the medications used to treat lupus, lowers the immune system’s ability to fight infections, including COVID-19. This means people with lupus may be at higher risk of severe illness from COVID-19. For this reason, current recommendations are for adults with lupus to be immunized against COVID-19 when it becomes available. (The vaccines have not yet been tested or approved in children or pregnant women).
The vaccines for COVID-19 help protect against COVID-19 by imitating an infection and allowing you to safely develop immunity to the virus. The vaccine causes the immune system to produce cells that will learn and remember how to fight that disease when you are exposed to it in the future.
Because the vaccine imitates a very mild version of an infection, but rarely causes illness, sometimes you might get minor symptoms such as a fever. This is a sign that the body is building up immunity to the disease. Like any medication, vaccines can cause side effects, but serious side effects are very rare. For most people, side effects are mild such as soreness at the spot where a shot was given.
“Live” vaccines are contraindicated in some lupus patients; none of the vaccines currently approved or in development for COVID-19 are live vaccines.
The vaccines that have been approved for COVID-19 have been tested in thousands of people, and their safety and effectiveness has been carefully evaluated by Health Canada, the FDA, and other national oversight bodies. Long term monitoring will continue to detect any long-term safety concerns. So far, there are no serious safety concerns for these two recently approved vaccines for COVID-19. While we don’t yet have a lot of information about the safety and effectiveness of these vaccines in lupus patients, so far there do not appear to be any specific concerns. This will be carefully watched and studied in the coming months and years.
For additional information on the COVID-19 vaccine please visit:
COVID-19 Prevention and Risks
How coronavirus spreads
Human coronaviruses cause infections of the nose, throat and lungs. They are most commonly spread from an infected person through:
- respiratory droplets generated when you cough or sneeze
- close, prolonged personal contact, such as touching or shaking hands
- touching something with the virus on it, then touching your mouth, nose or eyes before washing your hands
Current evidence suggests person-to-person spread is efficient when there is close contact.
Difference between quarantine (self-isolate) and isolate
Quarantine for 14 days if you have no symptoms and any of the following apply:
- you are returning from travel outside of Canada (mandatory quarantine)
- you had close contact with someone who has or is suspected to have COVID-19
- you have been told by the public health authority that you may have been exposed and need to quarantine
You must isolate if any of the following apply:
- you have been diagnosed with COVID-19, or are waiting to hear the results of a lab test for COVID-19
- you have symptoms of COVID-19, even if mild
- you have been in contact with a suspected, probable or confirmed case of COVID-19
- you have been told by public health that you may have been exposed to COVID-19
- you have returned from travel outside Canada with symptoms of COVID-19 (mandatory)
Quebec pharmacists to begin refilling hydroxychloroquine prescriptions again on Friday May 1
On the Friday April 24th edition of Arthritis at Home, Arthritis Consumer Experts interviewed Dr. Carter Thorne to get the latest information about patient access to hydroxychloroquine in Canada during the COVID-19 pandemic. https://arthritisathome.jointhealth.org/
New Enhanced Survey – Help Lupus Canada track the accessibility of Hydroxychloroquine
Media speculations around Hydroxychloroquine (HcQ) as a potential medication in the fight against COVID-19 have created tensions in the supply chain for this drug. Lupus Canada continues to advocate to ensure lupus patients have access to their medications, most specifically Hydroxychloroquine (HcQ). We have prepared an enhanced version of our previous survey to help us better understand the current situation and evolution Hydroxychloroquine availability in Canada.
Please share this survey with everyone you know that currently takes Hydroxychloroquine and ask them to take part so that we can best address this issue. Thank you
COVID-19: Canada secures order for five million pills of anti-malaria medication eyed by U.S. as treatment
Living Through COVID-19 With A Weakened Immune System
“Hydroxychloroquine has long been a standard treatment for lupus and rheumatoid arthritis patients. But many of them have reported having trouble obtaining it, said Leanne Mielczarek, executive director of Lupus Canada. ‘They are experiencing difficulty,’ she said. ‘In some cases, patients have to go to multiple pharmacies to fill their prescriptions.’” https://nationalpost.com/health/canadian-prescriptions-for-malaria-drug-with-covid-19-potential-surge-some-for-doctors-own-use?video_autoplay=true
Canadian lupus patients missing critical drug after claims it treats coronavirus. To read the full story visit https://globalnews.ca/news/6761222/hydroxychloroquine-lupus-coronavirus-drug
The Canadian Rheumatology Association has released their position statement on COVID-19 and Hydroxychloroquine Supply
Canadian Rheumatology Association Position Statement on COVID-19 and Hydroxychloroquine Supply The Canadian Rheumatology Association (CRA) is committed to supporting its members in their efforts to continue to deliver optimal care for their patients with rheumatic diseases. At the same time, the CRA acknowledges the gravity of the situation with the COVID-19 pandemic and the importance of identifying effective treatments in a timely and scientific manner. The identification of hydroxychloroquine (HCQ) as a possible treatment for COVID-19 has led to significant off-label use, which now threatens access for patients with lupus and other types of inflammatory rheumatic disease who are reliant on this medication for disease control.
To read the full statement visit https://rheum.ca/wp-content/uploads/2020/04/CRA-Statement-and-FAQ-on-HCQ-supply-and-COVID-19-EN.pdf
Lupus Canada hosted a Facebook Live Q&A with Dr. Matsos on Tuesday, March 31. Dr. Matsos answered questions specific to COVID-19 and its impact on lupus.
COVID-19 AND YOUR EMPLOYMENT RIGHTS
While the global coronavirus pandemic escalates. it’s understandable that many employees are nervous about heading into work every day – particularly those with lupus or other autoimmune conditions.
Employers have a positive obligation to take reasonable care to protect the health and safety of employees under occupational health and safety legislation. If an employee has reason to believe that there is a dangerous condition in the workplace, the employee may be able to refuse to attend work or perform certain duties. Occupational health and safety legislation states that employers cannot dismiss, discipline, or intimidate employees for properly exercising a health and safety right.
In the context of COVID-19 pandemic, work refusals could be based on
- a confirmed or presumptive case of COVID-19 in the workplace
- a confirmed case of COVID-19 in an employee’s immediate family
- the risk of potential exposure to COVID-19 from people at work – other employees, clients, customers
- concerns from employees who are particularly vulnerable (over age 65, compromised immune system, other medical condition) not wishing to report to work
In the event of a work refusal, the employer must respond in accordance with occupational health and safety legislation. An investigation will be made into the concerns and, if appropriate, measures to eliminate or reduce the workplace danger will be adopted. If the employee disagrees with the employer’s decision or measures to eliminate the danger, they can contact a health and safety officer who will then investigate the concern. The employer may also contact the HSO if the employee maintains their refusal to perform the work.
An employee who exercises a right of refusal must still be paid until the situation is resolved with the employer, or until the health and safety officer renders a decision. The worker may be assigned alternative duties by the employer in the interim.
If the employer cannot make work adjustments to eliminate the danger, then the employee could be placed on alternate duties. If that’s not possible, then they’d likely explore options like unpaid leave. In this situation, the person would still be employed and not eligible for EI. So this is one of the situations that the new emergency benefit is intended for.
We’ve heard you – Canadians living with lupus are having problems filling their prescriptions of hydroxychloroquine. Take a read of the issue in CTV’s article and spread the word.
Potential treatment for COVID-19 should not harm Canadians living with lupus
March 23, 2020 – Lupus Canada and the Canadian Network for Improved Outcomes in Systemic Lupus Erythematosus (CaNIOS) are calling on the Government of Canada to ensure critical supply of hydroxychloroquine for Canadians living with lupus.
“Like all Canadians, we are eagerly awaiting a treatment for COVID-19, to help end this extraordinary pandemic,” said Tanya Carlton, Volunteer President of Lupus Canada. “We at Lupus Canada, as well as researchers and medical professionals at CaNIOS, are aware of increased efforts of using hydroxychloroquine as a treatment for COVID-19. Let us be clear. While we share in the optimism that hydroxychloroquine may be a viable treatment for COVID-19, this must not impact the supply for Canadians living with lupus.”
Anti-malarial medication like hydroxychloroquine plays a critical role for people living with systemic lupus erythematosus – the most common form of lupus. For those living with lupus, hydroxychloroquine is proven to reduce mortality by 50%, prevent disease flares, reduce the need for hospitalization and potentially harmful immunosuppressive drugs, as well as prevent cardiovascular complications and infections.
“While we welcome clinical trials, and applaud pharmaceutical companies who have donated the drug for these trials, in an attempt to find a treatment for and slow the spread of COVID-19, we are greatly concerned about irresponsible messaging, suggesting that ‘everyone’ should take this drug in the face of very little evidence,” said Dr. Christine Peschkin, Chair of CaNIOS and Head, Section of Rheumatology at the University of Manitoba. “As a result, we are concerned at the difficulty Canadians living with lupus are having filling their prescriptions of hydroxychloroquine.”
Without access to medication such as hydroxychloroquine, this will lead to a further burden on Canada’s healthcare system, at such a precarious time. Lupus Canada and CaNIOS have been working with Canadians living with lupus and physicians to raise awareness in this anxious time.
“Because those living with lupus are already immune-compromised, they are at a high risk for COVID-19. We cannot compromise on the safety of those living with lupus,” said Carlton.
Lupus Canada and CaNIOS are urgently calling on the Government of Canada to ensure that vulnerable patients, like those living with lupus, have access to this critical medication throughout the COVID-19 pandemic.
About Lupus Canada
Lupus Canada is a national voluntary organization dedicated to improving the lives of people affected by lupus through research, public awareness, advocacy, and education.
Lupus is a chronic autoimmune disease that has no specific treatment or a known cure. It is often called “the disease of a thousand faces” because of its many symptoms. Lupus presents itself differently in everyone and this makes it difficult to diagnose. It can cause constant pain, immobility, organ failure – even death.
One in every 1,000 Canadians is living with lupus. For Canadians living with lupus, disabling pain and fatigue can prevent them from being active members of society – it can prevent them from getting a full education, from working to their full potential, and enjoying culture and recreation activities.
For more information, please contact:
905-251-9869 | email@example.com
Lupus and COVID-19
This is an anxious time across Canada and all over the world; keep in mind that most people who become infected have mild or even no symptoms. The main goal of all current recommendations is to slow the spread of the virus.
People with lupus may ask:
- What precautions should I take against COVID-19?
The Public Health Agency of Canada website states:
Protective self-separation is recommended for a person who is at high-risk for severe illness from COVID-19 (e.g., older adults, those with chronic underlying medical conditions or immunocompromised) when the virus is circulating in their community.
This means avoiding exposure to public spaces and crowds where possible and practicing social distancing if not. For some, this may include workspaces. Many businesses and places of work are making efforts to allow employees to work from home. Many clinics and hospitals are conducting patient appointments by telephone or video, except in essential cases. Check with your doctor before attending a routine appointment.
- What will happen if I get infected with COVID-19, especially if I am taking prednisone or other immunosuppressive agents?
Currently, there is no specific information on how severe COVID-19 usually is, or how long it lasts, in patients with rheumatologic disease or immunosuppression.
- Should I stop taking my prednisone or my immunosuppressive medications?
All patients should talk to their rheumatologist or other lupus doctor before stopping any of their medications. There is no information on the influence of these medications on COVID-19. If you become infected with the virus, let healthcare providers know immediately about all your medications so the best decisions can be made.
Stay home. Wash your hands often. Don’t touch your face. Cover your cough.
If you develop a fever or a cough, check your local sources to find out where and how to get tested, and what to do next.