Here are my thoughts and a few updates about #SARSCoV2 vaccines, and also about implications for our #IBD patients.
A tweetorial in 20 parts.
1) Development of multiple #SARSCoV2 vaccines in the timeframe we have seen is a monumental scientific achievement.
Necessity literally bred invention.
2) The @pfizer and @moderna_tx vaccines are messenger RNA vaccines. They use genetic material to trigger the body’s immune system to make antibodies against the spike proteins on the surface of #SARSCoV2. They DO NOT contain actual viral particles and can't cause infection.
3) Two doses are required with these vaccines. This is not uncommon for vaccines. The first exposes the immune system to the antigen, the second will activate memory cells, so your body will remember how to protect you if it gets exposed to #SARSCoV2.
4) The reason for the cold temperature is to stabilize the messenger RNA so it maintains its structural integrity and then can do its job in your body. This is a well-described but surmountable logistical challenge.
The vaccines will come with temperature monitors so you will know if it has been kept at the right temp during transport.
5) I am told that the @US_FDA is reviewing the @pfizer vaccine on 10 Dec and the @moderna_tx on 13 Dec. The @CDCgov has committed to rapid review and updated recommendations within 24 hours of the FDA decisions.
6) First in line for the vaccine will be front line healthcare workers. Also key will be residents of long term care facilities. The @CDCgov Advisory Committee on Immunization Practices (ACIP) voted today on this stratification.
7) The @CDCgov Advisory Committee on Immunization Practices (ACIP) has previously outlined plans for vaccination. Technically, our #IBD folks will be in the second tranche under the category of “use of immune weakening medicines”. But please read on 🔽
Reminder that #IBD pts have not been at increased risk for #SARSCoV2 infection or #COVID, and that the immune therapies used in #IBD (except steroids) have not been associated with worse outcomes. There may even be some protection while on these meds.
8) Key questions: Will #IBD patients on immune therapies be less likely to develop immunity? Does it matter which therapy you are receiving whether you will develop immunity? MAYBE?
There are some data that older vaccines like for pneumococcal pneumonia (PSV-23) or influenza are less likely to result in immunity if patients are on combined anti-TNF and immunomodulators (azathioprine or 6-MP).
But it's variable! Some patients are more immunogenic than others. With vaccines, being immunogenic is a good thing (you are more likely to respond to the vaccine). With monoclonal antibodies, being immunogenic is not a good thing (you become "immune" to the therapy).
So what about this messenger RNA vaccine? I’ve discussed a bit with experts here. Seems that anti-TNF (inflix, adalim) and anti-IL12/23 (ustekinumab) and possibly JAKinib (tofacitinib) will not impair immunity to these new vaccines.
Unclear whether cellular trafficking inhibitors (vedolizumab) may impair since they may affect lymphocytes ability to respond to the virus in the gut. Thiopurines (azathioprine, 6-MP) (which affect lymphocytes) may impair immunity.
5-ASAs (mesalamine), antibiotics will not affect immunity to the vaccine.
▶️ But also important is the potency and “immunogenicity” of the vaccine itself, which may overcome any effect of these therapies and be effective anyway… MORE 🔽
Example is the modern herpes zoster (shingles) recombinant vaccine (Shingrix) which is quite potent and effective at inducing immunity even in patients who are receiving chemotherapy. If you want to read more, look at this great study:
I believe that these vaccines against #SARSCoV2 will be appropriate and safe for our patients who are on immune therapies. I do not know that they will be AS effective at inducing immunity, but I suspect based on descriptions that they will come very close to being so.
There will be 3 years of f/u from the current vaccine trials. There will be post-marketing surveillance in the general population and the ACIP will adjust their recommendations.
But it is clear that we need as a society to work together with good leadership to get this done.
I will get vaccinated. I will work hard to get my patients vaccinated. In the mean time, everyone please stay safe and be vigilant.
Protect each other.❤️
20/ fin

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More from @IBDMD

7 Apr
I've created a thread that summarizes the statements from the #IOIBD global expert panel about management of #IBD during #COVID19. This is because the meeting summary of _appropriateness_ statements is being a bit misunderstood.…
Read on ⬇️⬇️
First, a disclaimer! The statements by this expert panel are not meant to replace conversations between a patient and their healthcare providers, nor are they set in stone. As we learn more, there will be modifications provided.
▶️IOIBD is holding weekly calls about #COVID19.
A RAND panel is a formal assessment of specific given statements when decision making is complex and data are limited.
The #IOIBD panel included 66 #IBD experts from 26 countries who voted on the "appropriateness" of specific statements using a 9 point scale. Example ⬇️
Read 21 tweets
28 Mar
Improvements in testing for #SARSCoV2 and #COVID19 and how they will transform what we are doing (a Tweetorial):
1) FASTER VIRAL TESTS for SARSCoV2 (the virus). Several companies have adapted existing point-of-care tests that can provide results in MINUTES.
Read on ⬇️⬇️⬇️
Faster tests for #SARSCoV2 may be less sensitive or specific for detecting the virus but we can figure this out.
Less sensitive means more false negative results (you actually have the virus, but the result says you don't).
Less specific means more false positive results.
How do you enhance interpretation of a test with less sensitivity and specificity? You add other information, like the clinical scenario (fever, resp symptoms), known exposures (close contact with #COVID19, being a healthcare worker), and repeating the test after a bit.
Read 16 tweets
16 Mar
Update 15 March #COVID19 and #IBD. Due to the active communication of colleagues around the globe, we are now aware of several worldwide cases of #COVID19 in patients who have IBD, including one child.
Reports that the #IBD adults are in Italy, Austria and US (NJ), the child is in Madrid, Spain.
The child has #Crohns receives Humira + 6MP. She presented with fever and cough, was not hospitalized, and is doing well.
I do not have more details on the adults yet. #COVID19
It was expected that we would see #COVID19 affect our patients with #IBD, as it is affecting the general population too, and it is great that we have systems in place to capture and to learn from these cases in real time. The international collaboration is extraordinary.
Read 5 tweets
9 Mar
Brief update on #COVID19 for inflammatory bowel disease (#IBD) patients as of 9 March 2020.
See the updated #IOIBD COVID19 recommendations on the website.
The #IOIBD site now includes this statement: "It is prudent that IBD patients on immunosuppressants and/or biologics limit unnecessary travel and large gatherings." (and spells out these therapies) However, please know that we still recommend staying on treatment. Read on. 🔽
In a global email exchange among #IBD experts over the last few days, the consistent recommendation is to stay on therapy for IBD, recognizing that IBD relapse or needing steroids is higher risk for the patient. There are similar recommendations from rheumatology experts.
Read 6 tweets
27 Feb
A Tweetorial on #coronavirus (and #IBD):
Coronaviruses are a family of viruses that can cause illness from the common cold to more severe diseases. The novel strain of #coronavirus named #SARSCoV2 was first detected in Wuhan, China and causes coronavirus disease #COVID19. 1/
How is #coronavirus transmitted?
Via respiratory droplets produced when an infected person sneezes or coughs and can infect people in close contact (within 6 feet). Touching contaminated surfaces before touching your eyes/nose/mouth might also lead to infection. 2/
How does #COVID19 compare with seasonal #influenza?
Both are infectious respiratory illnesses that present with symptoms such as fever, cough, and shortness of breath. Both can lead to serious illness especially in older people and those with prior medical conditions. 3/
Read 9 tweets
15 Dec 19
We are developing and studying biosensors as tools to predict #IBD activity (a thread in 5 parts).
In press: we show the correlation between standard instruments of PAIN, QUALITY of LIFE and SLEEP QUALITY and simplified Visual Analog Scales. #RubinLab 1/… ImageImage
We demonstrated high correlation between daily single "click" and "swipe" rating by a patient of their global health and sleep quality and the standardized validated and more cumbersome survey instruments that require recall of prior days/weeks. #RubinLab @UChicagoIBD 2/
One finding: patient-reported quality of life is very related to pain using the Wong-Baker Faces of Pain scale (WBS). Red dots are patients who also have active #IBD, black are those in remission. We are building pain assessment into our future dz monitoring tools. 3/ Image
Read 5 tweets

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