Why Covid Long-Haulers Should Be Careful About Vaccines
Understanding who might be at risk for post-vaccine autoimmunity, including mRNA-based vaccines.
In 2011, Yehuda Shoenfeld, MD, a world-leading autoimmunity professor with over 1,700 peer-reviewed publications, coined the term ASIA: Autoimmune/inflammatory Syndrome Induced by Adjuvants. It’s also called Shoenfeld’s syndrome or post-vaccination autoimmunity. Here comes a predicament: Should people at risk for ASIA, such as those with autoimmune conditions like Covid-19 long-haulers, get a vaccine?
A backdrop on ASIA
Adjuvant, the second A in ASIA, means to aid in Latin. In medicine, an adjuvant is a substance that boosts immune responses to a vaccine. Common adjuvants include alum, squalene, killed bacterial products, and mineral oil. Adjuvants can also be found elsewhere, such as silicone breast implants or cosmetic fillers.
While the biomolecular mechanisms of ASIA are complex and variable, the simple reason is that the immune system of some may be frailer to stimulation than others, leading to more chaotic immune responses.
Evidently, persons with these traits are already prone to autoimmune diseases, and the adjuvant in vaccines might have pulled the final trigger.
ASIA has been recorded following most vaccine types, including the flu shot, according to a 2013 research review of Prof. Shoenfeld. “Reports on autoimmune reactions after vaccination would constitute probably less than 0.01% of all vaccinations performed worldwide, although this rate may be biased by under-reporting,” the review further stated. “In addition, many of those reactions are mild and self-limited.” Symptoms of ASIA include muscle weakness, arthritis, chronic fatigue, sleep disturbances, memory and concentration difficulties, fever, and dry mouth.
ASIA patients typically had auto-antibodies — antibodies the immune system makes to neutralize pathogens, but end up attacking human cells for reasons such as molecular mimicry or defective antibodies — in their blood.
People at risk for ASIA
In a 2015 research review, Prof. Shoenfeld and his team scoured the literature for information on ASIA risk factors. Drawing on case reports, case series, autopsies, and cohort studies, they identified a few indications on who tended to develop ASIA:
- People with a history of post-vaccination autoimmune phenomena.
- People with a history of allergy.
- People with autoimmune conditions or disorders.
- People at risk for autoimmunity. They include those with a family history of autoimmune diseases, pre-existing auto-antibodies, smoking habits, and sub-par hormonal regulation.
Evidently, persons with these traits are already prone to autoimmune diseases, and the adjuvant in vaccines might have pulled the final trigger. One caveat is that risks of ASIA were not quantified due to a lack of studies with a proper control or comparison group and adequate sample size, which is expected since ASIA only affects a rare subset of the population.
“The rarity of the adverse manifestations strongly suggests that the benefits of the vaccines largely overwhelm the risks,” the team wrote, and instead advocated for “the development of safer and personalized vaccines.”
Prof. Shoenfeld also led a 2017 study that provides further insights into who might be susceptible to ASIA. This study used an international ASIA registry that contains inputs from published reports and unpublished physician’s diagnoses of ASIA cases. As of December 2016, the registry recorded 300 ASIA cases, and analyses revealed that:
- The overwhelming majority of cases (86.7%) were females.
- The average age of diagnosis was 37.6 years, ranging from 4 to 82 years.
- 20.3% of cases had a personal or family history of autoimmune diseases.
- 76.6% of cases received vaccines in the past decade, usually the hepatitis B virus (54.8%), human papillomavirus (20.8%), influenza (13.9%), and other vaccines (10.5%). The other 23.4% of cases had adjuvant exposure via other means, such as cosmetic fillers (e.g., mineral oil, hyaluronic acid, polyalkylimide, and collagen) or silicone breast implants.
From these analyses, it’s evident that factors predisposing people to ASIA also include female sex, personal or family history of autoimmune diseases, and hepatitis B vaccine.
But such results must also be interpreted in light of the study limitations, as the authors pointed out. One issue is underreporting, as only qualified rheumatologists can send their data into the ASIA registry. Cases in the registry are also not sampled randomly, so some bias may be present, making the results less generalizable to a broader population.
Finally, Prof. Shoenfel asserted that vaccines are important life-saving tools. “The rarity of the adverse manifestations strongly suggests that the benefits of the vaccines largely overwhelm the risks,” the team wrote, and instead advocated for “the development of safer and personalized vaccines.”
Should Covid-19 long-haulers take a vaccine?
Covid-19 long-haulers suffer symptoms — such as fatigue, brain fog, and shortest of breath — for up to three months and counting. Probable causes of long-Covid are unresolved inflammation or auto-antibodies. For this reason, SARS-CoV-2 has been called an ‘autoimmune virus.’ A newer study published this month reveals that 13.1% of patients with mild-to-moderate Covid-19— without any pre-existing thyroid condition — suffered thyroid damage, which might lead to thyroid-related autoimmune diseases.
“A possible concern could be that some mRNA-based vaccine platforms induce potent type I interferon responses, which have been associated not only with inflammation but also potentially with autoimmunity.”
As Covid-19 long-haulers may qualify as persons with autoimmune conditions, they fit the criteria for persons at risk for ASIA. This begs the question: Will a vaccine worsen or re-trigger long-Covid symptoms?
While a vaccine would hypothetically increase the risk of a long-hauler developing ASIA, the risks of not taking a vaccine should also be considered. Since infections can induce autoimmunity, avoiding risks of post-vaccine autoimmunity (or ASIA) comes with risks of post-infection autoimmunity. According to a research review of three immunologist professors in the Lancet, the latter's risks are much higher.
Thus, the European League Against Vaccination (EULAR) advised that people with an autoimmune condition should still take a vaccine, but with a personalized plan, to prevent the greater complications infections can cause. For instance, live vaccines should be avoided, and vaccines should be taken when the autoimmune condition is stable. The CDC also has a webpage on “Who Should NOT Get Vaccinated with these Vaccines?” which include people with a history of autoimmune diseases or post-vaccination autoimmunity that should consult a healthcare provider for a customized vaccination plan.
Even for the leading Pfizer's mRNA vaccine with over 90% efficacy (unpublished data), the risk of ASIA should not be neglected. “A possible concern could be that some mRNA-based vaccine platforms induce potent type I interferon responses, which have been associated not only with inflammation but also potentially with autoimmunity,” stated a 2018 paper in Nature Reviews Drug Discovery. “Thus, identification of individuals at an increased risk of autoimmune reactions before mRNA vaccination may allow reasonable precautions to be taken.”
Autoimmune/inflammatory Syndrome Induced by Adjuvants (ASIA) or post-vaccine autoimmunity was only coined less than a decade ago. Adjuvants are usually used in vaccines and, to a lesser extent, in cosmetic fillers or silicone breast implants. ASIA typically affects those with autoimmune conditions or with a family or personal history of it. And long-Covid can be considered as an autoimmune condition. Thus, it’s advised that Covid long-haulers be careful and seek medical advice before getting a vaccine.
Thanks to Mad Mockingbird