Moderna COVID-19 Vaccine

The Moderna COVID-19 vaccine is administered as an intramuscular injection on day 0 and again 1 month later.  The full benefit from the vaccine occurs 2 weeks after the second injection. It provides a 95.6% reduction in risk of COVID-19 in people aged 18-64 and 86.4% reduction in patients aged 65 and up.

 

This vaccine is not a live virus vaccine and can be given to immunocompromised patients, including patients on immunosuppressant therapy (examples include prednisone, methotrexate, and biologic DMARDs).  However, currently available data does not establish safety and efficacy in immunocompromised patients.  It is possible that the vaccine may not be as effective in immunocompromised patients.  I recommend that my patients receive this COVID-19 vaccination when it is available locally, but continue to practice social distancing, wearing masks, and frequent hand washing.

 

It is contraindicated (cannot be given to) patients with a history of severe allergic reaction (anaphylactic shock and angioedema) to any of the compenents of the vaccine.  Each dose of the Moderna COVID-19 Vaccine also includes the following ingredients: 

100mcg mRNA encoding the SARS-CoV 2 spike protein

A total lipid content of 1.93 mg (SM-102, polyethylene glycol [PEG] 2000 dimyristoyl glycerol [DMG], cholesterol, and 1,2-distearoyl-sn-glycero-3-phosphocholine [DSPC]), 0.31 mg tromethamine, 1.18 mg tromethamine hydrochloride, 0.043 mg acetic acid, 0.12 mg sodium acetate, and 43.5 mg sucrose.

Note that there are no avian proteins.  I expect patients with egg and feather allergies to be able to take this vaccine.

Hypersensitivity reactions including hives and rash occurred in 1.5% of patients in the clinical trials.

 

The side effect profile of this vaccine is as follows:

Pain at the injection site (92%)

Fatigue (70%)

Headache (64.7%)

Muscle pain (61.5%)

Chills (45.4%)

Joint pain (46.4%)

Fever (15.5%)

Injection site swelling (14.7%)

Injection site redness (10%)

Axillary swelling (19.8%)

Lymphadenopathy (1.1%)

It is ok to take acetaminophen, ibuprofen or naproxen to manage these side effects (unless you have conditions that preclude the use of these medications). 

 

For pateints who have had COVID-19 already, the chance of reinfection is very low in the first 90 days after initial infection.  They should receive vaccination after their COVID-19 symptoms have resolved and their quarantine period has ended.  It is ok to delay the vaccine for 90 days after infection.

 

As more vaccines are approved, it is important to note that this vaccine is not interchangeable with other COVID-19 vaccines.  Patients who get the first vaccine with the Moderna product, should receive the second Moderna vaccine injection.

 

The CDC recommends that this vaccine should be administered alone with a minimum interval of 14 days between this and other vaccines (such as influenza, pneumovax, etc.).  

At Rheumatology Solutions, we have begun administration of the Moderna Vaccine to our staff and patients.  In my experience thus far, the Moderna Vaccine does not appear to cause sustained flare ups of autoimmune disease.  The side effects in my patients with Lupus, Rheumatoid Arthritis, Psoriatic Arthritis, Systemic Sclerosis, Sjogren's Syndrome, Ankylosing Spondylitis, and Vasculitis are similar to the volunteers in the published clinical trials.  

My personal experience with the Moderna Vaccine is as follows:

The first injection:  I had fatigue the day of the vaccine and went to bed at 8 pm.  The next day I had normal energy levels, but did have mild arm soreness at the injection site for 3 days.  

The second injection:  I received injection number two at 3 pm.  At 3 am the next morning, I awoke with shaking chills and bone pain.  I had difficulty returning to sleep.  I continued to feel cold and feverish (I did not take my temperature) as well has have body aches and fatigue the rest of the day.  The most troublesome symptom was the fatigue.  It made seeing patients difficult.  I went to sleep at 9 pm and woke up the following morning 100% back to normal with no residual symptoms. 

Having experienced the vaccine for myself, and having observed hundreds of patients receive the vaccine, has only increased my confidence in our COVID-19 vaccination options.  Having flu like symtpoms for 1-2 days is a very small price to pay for the level of protection provided against COVID-19.  I do recommend that you take the day after the second vaccine off of work (in case you experience the flu like symptoms that tend to follow the second vaccine injection).

 

Author
Jeffrey Feinstein, MD

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