Immunity and Infection
Fighting Infection
Many of the medications used to treat vasculitis are immunosuppressive, meaning they restrain or lessen your body’s immune response. When you are being treated for vasculitis, you are usually considered immunocompromised. This means your immune system is weakened. A weakened immune system cannot as effectively fight organisms that cause infection. People who are immunocompromised are:
- More likely to get an infection.
- Less able to fight off an infection once infected.
- More likely to experience complications from infections.
Preventing Infection
- Practice good hand hygiene. Many infections are spread by bacteria or viruses that we pick up on our hands. Wash your hands frequently with soap and water (for 20 seconds), and use hand sanitizer when hand washing is not practical.
- Avoid touching your eyes, nose, and mouth. Your eyes, nose, and mouth are frequently the route by which viruses and bacteria enter your body.
- Use disinfectant wipes to clean high touch surfaces. High touch surfaces are areas that people touch frequently. Examples include doorknobs; light switches; stair rails; handles on faucets, refrigerators, cabinets, coffee pots, and microwave ovens; and elevator buttons.
- Avoid contact with people who are sick. When your immune system is weakened infections that are mild for others, such as colds, can be dangerous for you.
- Wear a mask when you can’t avoid crowds.
- Physically distance yourself from others if possible.
- Visit outside or in well-ventilated spaces.
- Limit the length of time you are in enclosed spaces with others.
Knowing how to set boundaries with others is an important skill for everyone, but it is especially important when you are living with a weakened immune system.
Check out A Guide to Setting Boundaries if You’re a People Pleaser from our friends at the Global Healthy Living Foundation.
- Shower and bathe regularly. This helps reduce the number of viruses and bacteria on your skin.
- Brush your teeth and keep up with dental visits. Bacteria in your mouth can spread to other parts of your body.
- Eat a nutritious diet. Provide your body with the building blocks it needs to function effectively. Eat a wide variety of foods that are naturally rich in nutrients and vitamins such as fruits and vegetables and whole grains.
- Exercise as tolerated. Physical movement, including gentle stretching, has been linked to lower rates of some types of infection and improved immune system response.
- Get adequate sleep. This can help to restore your immune system and improve infection outcomes.
- Get vaccinated as recommended by your healthcare provider. Vaccines help your body produce a type of immune system memory cell called B-cells. B-cells are long lasting cells that remember previous infections and can help your immune system quickly mount a defense if you encounter that virus or bacteria again.
- If you are immunocompromised, you will most likely be told to not receive any live vaccines. Vaccines are made from either dead or weakened viruses and bacteria. Since your immune system is not as strong when you are immunocompromised, you will most likely be advised not to receive vaccines that are made from live, weakened viruses and bacteria. This includes vaccines for measles, mumps, rubella, varicella, and yellow fever.
- When you are being treated for vasculitis, certain medications may prevent your immune system from reacting appropriately to vaccines. This means that you may not produce the immune cells that can help to protect you. Depending on what medications you are on and what stage of your vasculitis treatment you are in, your healthcare provider may recommend that you wait to receive certain vaccinations or that you stop certain treatments for a few weeks before and after vaccinations. The American College of Rheumatology offers vaccination guidelines that can help guide you and your healthcare provider in determining the vaccination schedule that is best for you.
COVID-19 Fast Facts
- Keep a supply of rapid home tests for COVID on hand.
- Test yourself right away, and if negative, consider testing yourself again 24-48 hours later. It can take time for the viral load to be large enough for the test to detect.
- Contact your healthcare provider if you test positive. The treatments that can reduce your risk of COVID progressing to a severe disease need to be started early (within the first 5-7 days of onset of symptoms) to be effective.
- Begin treatment with an oral antiviral medication such as paxlovid or molnupiravir OR receive an infusion of monoclonal antibodies such as bebtelovimab.
- Consult with your healthcare provider on the timing of vaccines. It is preferable to wait as long as possible after your last rituximab/cyclophosphamide dose before being vaccinated. No matter how you space your rituximab/cyclophosphamide and your vaccines, you are unlikely to have a robust immune system response to vaccines.
- In some cases, you can hold rituximab to allow the vaccine time to work. This is a very individualized decision and there are a number of factors you and your healthcare provider need to consider.
- One guideline that may be helpful when making decisions about holding medications and the spacing of treatments and vaccines is to make decisions about your vasculitis first and vaccines second. Treating your vasculitis is your first priority.
You can, but in most cases it is not helpful. There is currently no medical consensus on what level of antibodies is enough for protection. About all the test can tell you is if you have produced no antibodies or some antibodies (which may or may not be enough).
It can be hard to pinpoint what exactly leads to a vasculitis flare. There have been some reports of people experiencing a vasculitis flare after receving a vaccine including the COVID-19 vaccine. However, there have also been some reports of people experiencing a vasculitis flare after an illness, including after becoming ill with COVID-19.
In most cases, the benefits of being vaccinated outweigh the slight risk of a vasculitis flare. This is a great conversation to have with your healthcare provider.
Information adapted from May 2022 VF Webinar: 2022 COVID Update featuring Dr. Cassandra Calabrese, DO and Dr. Leonard Calabrese, DO.
Two recent research studies seemed to indicate that having COVID-19 increased a person’s risk of developing some autoimmune diseases.
In one study, a previous COVID-19 infection was most strongly linked to an increased risk of developing arteritis temporalis vasculitis, auto-immune driven thyroid problems, and psoriasis.
In the other study, a previous COVID-19 infection was most strongly linked to an increased risk of developing alopecia, ANCA-associated vasculitis, Crohn disease, and sarcoidosis.
When evaluating the results of these studies, there are a few important points to keep in mind.
- These studies show an association between COVID-19 infection and increased risk for some autoimmune disease not causality; meaning there is not yet enough evidence to say that a COVID-19 infection triggered the autoimmune disease.
- In the results of one study, while having COVID-19 seemed to increase the risk of some autoimmune diseases it seemed to reduce the risk of other autoimmune diseases.
- More research needs to be done to better understand how COVID-19 infections impact autoimmune disease risk.
Read the Studies
Additional COVID Resources
Covid-19 Help
Research Studies
- Efficacy of covid-19 vaccines in immunocompromised patients: systematic review and meta-analysis
- Plain Language Summaries of COVID-19 Global Rheumatology Alliance Research.
- Effectiveness of COVID-19 boosters in preventing hospitalization in patients taking immunosuppressive drugs.
- One study looked at the risk of severe COVID-19 for people with vasculitis.
- SARS-CoV-2 Vaccination in the Immunocompromised Host
Articles
- Creaky Joints Article: Three doses of the Moderna or Pfizer COVID-19 vaccines found to prevent hospitalization in people taking immunosuppressive drugs.
- Study on effectiveness of COVID vaccine at preventing hospitalization in immunosuppressed individuals
- Efficacy Study of Paxlovid and Molnupiravir in Real World Settings
- If You Take Rituximab, Here’s How a Third COVID-19 Vaccine Dose Boosts Your Immune Response.
