Concerned about the #COVID19 vaccines and autoimmune disease?

Both the #Moderna and #Pfizer vaccines do not contain an attenuated virus or instructions (via mRNA) to make viral particles that could replicate in vaccine recipients. (1/n)
I have psoriatic arthritis (on #methotrexate for about a decade) and had no hesitation to receive the vaccine @sloan_kettering. I am fortunate and was able to stop methotrexate for one month prior - this is atypical for most patients with autoimmune diseases - and will (2/n)
resume the medication a month after the second shot. I stress that this is not a medical recommendation for other patients with psoriatic arthritis or any other autoimmune disease. Patients should discuss how treatments for autoimmune conditions may impact vaccine immunity (3/n)
with their healthcare provider. I made a conscious choice to receive the vaccine and have had no significant side effects beyond the expected sore left arm for one day. I disagree with national authorities that discourage #COVID19 vaccine use in individuals with (4/n)
autoimmunity, for example in #Canada. There was no safety signal in trials in patients with defined damage to the immune system (e.g., stable HIV infection) and autoimmune diseases do not appear to aggravate #COVID19 severity.…
It is strange that we are correctly trying to prioritize vaccination of individuals with co-morbidities such as diabetes mellitus, which in many instances arises from autoimmunity (but is typically not classified as an autoimmune disease in the medical literature). (6/n)
There is an important knowledge gap - how long will vaccine immunity last in individuals with specific autoimmune diseases and on specific immune modulatory agents? Frankly, we do not know how long vaccine immunity will last in immune competent individuals (7/n)
beyond the 3-4 month period studied in vaccine trials. In my opinion, this is not a reason to recommend withholding vaccine from humans with autoimmune diseases. Rather, it is an opportunity to study vaccine immunity in this population. I am happy that #CDC interim (8/n)
guidelines state that "persons with autoimmune conditions who have no contraindications to vaccination may receive an mRNA COVID-19 vaccine". For this individual, receiving the vaccine was an easy choice (9/9). @GermHunterMD #VaccineStrategy #VaccinesWork…

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More from @tmhohl71

5 Apr 20
1/n Much will be made about this case report. I am very pleased that the patient did well and survived #COVID19 after a difficult course. On the heels of tweeting about anti IL-6 therapy (tocilizumab) I'm taking a stab at this case report.…
2/n It is a purely correlative, observational study. The title is misleading though. An alternate, equally valid title would be: First case of COVID-19 in a patient with multiple myeloma successfully treated with methylprednisolone. The patient received corticosteroid (MP)
3/n therapy on five consecutive days (day +2 to day +6). On day +9 the patient received tocilizumab. He continued to improve and was released from the hospital 10 days later. Did tocilizumab cause this improvement? It is impossible to tell. However, I conclude that it is safe to
Read 8 tweets
5 Apr 20
1/n I am thinking about the various modes of #COVID19 transmission. Although not common, gastrointestinal symptoms are routinely reported by COVID patients. In humans, the SARS-CoV2 receptor ACE2 is not only found in alveolar epithelial cells (lung), but also in cells that line
2/n the small intestine, among other sites (heart and kidneys). Humans shed high levels of #COVID19 in the stool, a finding that raised the question whether fecal-oral transmission may occur. This would be very relevant for measures to limit the spread of disease.
3/n The concern for fecal-oral transmission is clearly outlined in this review.…
Read 11 tweets
2 Apr 20
1/n I am asked on a daily basis about IL-6 blockade in #COVID19 patients @sloan_kettering . The truth is that I don't know if this intervention is helpful, neutral, or harmful. Colleagues point to the role of IL-6 blockade in treating CAR T cell toxicities and its cytokine storm.
2/n In the CAR T cell setting, IL-6 is clearly pathological and the IL-6 levels observed are typically far higher (10x or more) than those in critically ill COVID19 patients. It is not at clear to me that this concept is applicable to COVID. Why? There are important differences
3/n between a viral infection and genetically engineered T cells that causes a sterile inflammation. First, your immune system needs IL-6 to stimulate T follicular helper cells to foster Ab responses. This is likely to be important in generating sterilizing humoral (Ab-mediated)
Read 6 tweets
2 Apr 20
1/n One of the most challenging things about the #COVID19 outbreak in NYC is having to act both fast and slow. What do I mean by this? On one hand, as an ID physician, I am in state of perpetual impatience. I want to do the best possible thing for the one patient under my care at
2/n any particular moment. I want the instant gratification of feeling I did something important and relevant for this particular human being. So my heart wants to tear open a package of hydroxychloroquine and offer a tablet, to set up the IV for an infusion of convalescent
3/n serum, to block cytokines that are elevated in a patient's serum, to provide medications to ease a cough. That's the fast. On the other hand, my mind knows that hydroxychloroquine has not shown antiviral activity against any human viral disease in the clinic (the jury is out
Read 13 tweets

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