Coronavirus Vaccinations and LAM

24th of November 2020

When reading these notes, please note the date they were written as this is a rapidly changing situation.  The latest advice is available on the Department of Health website here and also here.

This is general advice, so please discuss any specific questions or concerns with your doctor.

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In the last few days there has been the news that three separate vaccinations produced by Pfizer/BioNTech, Moderna and Oxford/AstraZeneca against SARS-2 Corona virus which causes COVID 19 provide a good level of protection against infection. This is great news for everyone, suggesting that vaccines protecting people against COVID 19 can be used to reduce the impact of the pandemic including for people with LAM. These are the first successful Corona virus vaccines and the speed with which this has happened is an amazing achievement for the scientific community. Although the government has suggested that vaccinations could start before the end of the year, none of the three vaccines are yet approved for use outside clinical trials and there remain significant logistical issues with mass vaccination programs.

The new vaccine technologies used and how quickly they have been developed has led to a number of questions around safety and effectiveness, particularly for people with lung conditions including LAM.

 

Questions people have been asking include:

How effective are the vaccines?

At present it looks like all three vaccines give a similar level of protection, reducing every 100 potential infections to only 10 (90% protection) when compared with an ineffective “placebo” vaccine. Additionally, even though some people vaccinated went on to get infections, these were not severe. Although the vaccine greatly reduces the chances of becoming ill, it is not yet known if the vaccines also stop people passing on the infections, but we will discover this over the next few weeks. Safe vaccines with efficacy above 50% are likely to be approved for COVID-19.

Is one vaccine better than another?

At present the three vaccines seem equally effective and all are likely to be used. Other vaccines are also likely to become available. How quickly they can be manufactured and distributed is most likely to determine which one you will be offered.

Can the vaccines cause COVID if my immune system is weakened?

No, none of the vaccines are ‘live’ and don’t contain the virus but use different methods to induce protective antibodies and T-cells against the Corona virus. Although you may get a mild fever or chills, this is a normal vaccine reaction and not an infection.

Are the vaccines safe, including for people with LAM?

Although the vaccine trials have been short, there have been many tens of thousands of doses used and there have been no severe side effects reported. Most side effects related to vaccines occur shortly after treatment so it is unlikely this will change. Safety studies, including in people with long-term health conditions are still running at the present time.

Are the vaccines still safe if I am taking rapamycin?

Taking rapamycin will not make you more vulnerable to side effects from the vaccine.

Will the vaccines be effective if I am taking rapamycin (Sirolimus)?

Whilst many people call rapamycin an ‘immune suppressant’ rapamycin has a complex interaction with the immune system. Studies have shown that people using other vaccines including influenza can still generate a protective immune response when taking rapamycin. There are even studies suggesting that as rapamycin effects memory T-cell development it may actually enhance the vaccine response and low dose rapamycin for LAM is not therefore the same as other immune suppressing treatments. Whilst this is theoretical at present it is still important to get vaccinated if you take rapamycin.

Do RNA vaccines affect my genes or genetic make up?

RNA vaccines use a messenger molecule to make the body generate an immune response against the Corona virus. RNA and DNA are different molecules and the vaccine can’t get into your DNA (genes) or be passed on.

When will people with LAM be offered a vaccination?

Details on this are not clear however, it is likely that people with respiratory conditions including LAM will be given priority over younger people with no health problems. Although not officially announced it is likely front-line care workers and residents of nursing homes will be offered the vaccine first, with other at risk groups following them.

Are the vaccines still safe if I’ve had a lung transplant due to LAM?

A number of studies have examined vaccine response after lung transplant and in most cases protective immunity was obtained. You will have to speak to your transplant team about your particular circumstances.

 

Author: Simon Johnson, Professor of Respiratory Medicine, UK LAM Centre, Queens Medical Centre, Nottingham