Latest: Coronavirus vaccine for people with Crohn’s or Colitis

09 July 2021

The COVID-19 vaccine is low risk, and is the best way to protect yourself and others against coronavirus. It's important to consider getting the vaccine when it is offered to you, especially if you are at increased risk of complications from the virus.

Any newly created medicine or vaccine can raise lots of questions - we're here to support you. Hear IBD healthcare professionals' thoughts on the vaccine by watching our live event on COVID-19 vaccines and IBD. You can also read the British Society of Gastroenterology's statement on the coronavirus vaccine for people with Crohn's and Colitis.

Visit the NHS website for general information about the vaccine and how it will be delivered. Our information is specific to Crohn's and Colitis - if you have other health conditions or feel there is another reason why the vaccine may not be right for you, speak to your healthcare professional.

Can people with Crohn's or Colitis have the COVID-19 vaccine?
Can children and young people have the vaccine?
I've heard that immunosuppressed people cannot have the vaccine?
Which coronavirus vaccine is best for people with Crohn's or Colitis?
Oxford AstraZeneca vaccine in people under 40
Has the vaccine been tested in people with Crohn's or Colitis?
Will the COVID-19 vaccine work?
Can I get the COVID-19 booster (third dose) vaccine?
When can I have the vaccine and how can I book?
Can people I live with have the vaccine?
Will the vaccine cause my Crohn's or Colitis to flare?
Should I take (or avoid taking) the vaccine at certain times?
Can I have the vaccine if I've had an allergic reaction before?
Do I need the vaccine if I've had coronavirus already?
Should I be concerned about the length of time between vaccines?
Can I have an antibody test after my vaccine
Are the needs of people with Crohn's and Colitis being considered?


I will take the vaccine and I will strongly encourage all my patients [with Crohn's or Colitis] to take the vaccine.

There is lots of information on the Crohn's & Colitis UK website. We will be there to fight your corner right through this for you.

Professor Shaji Sebastian
Consultant Specialist in IBD/Gastroenterology

Can people with Crohn's or Colitis have the COVID-19 vaccine?

Having Crohn's or Colitis, or taking any medicine to treat your condition, will not stop you from being able to have the COVID-19 vaccine. All of the available vaccines are suitable for people taking biologics, steroids or immunosuppressants, as well as people who have a stoma or J-pouch. You don't need to leave a gap between your vaccine and when you take your biologic medicine - they can both be taken on the same day if needed. Your vaccine will still be just as safe and just as effective if taken at the same time as your biologic medicine. You may wish to show your IBD Team our information for nurses if you are receiving different advice. 

I’ve had my first dose of the coronavirus vaccine. As far as my experience so far goes, it's been okay. Nothing too exciting to write home about so far! I'm prepared to take what I view as a positive risk, for the possible chance of regaining some normality, getting back to work and, most importantly, spending quality time with my loved ones (with hugs!).

 

Heather
Living with Crohn's

As with any medicine or vaccine, there is a small risk of side effects, which you can find out more about on the NHS website. There is no evidence to suggest that having Crohn's or Colitis, or taking any medicine to treat your condition, increases your risk of side effects. When weighing up the risk of side effects of the vaccine, it's also important to also consider the risks of complications from COVID-19 if you were to catch the virus. If you feel you have had a side effect from the COVID-19 vaccine, you can report it via the MHRA Yellow Card reporting site.

Read our Blog I've received the coronavirus vaccine by Heather, living with Crohn's.

Being on an immunosuppressant medicine for your Crohn's or Colitis does not mean that you don't have an immune system.
Your immune system is still able to fight off infections, just not quite as well as other people. Therefore you are still able to have vaccines that are not 'live' vaccines, no matter what medicine you take for your Crohn's or Colitis. None of the COVID-19 vaccines are classed as live - including the vaccine made by Oxford, as it has been altered so that it can't replicate.

You will be able to have the coronavirus vaccine if you are immunosuppressed; you need the coronavirus vaccine if you are immunosuppressed; and you will be prioritised because you are immunosuppressed.

Dr Nick Powell
Clinical Reader and Consultant in Gastroenterology


Can children and young people have the vaccine?

Children and young people aged 12 to 15 years old who are more at risk of serious illness from COVID-19 will now be offered the COVID-19 vaccine. This is based on the recommendations from the Joint Committee on Vaccination and Immunisation (JCVI). Young people aged 16 and 17 years old who are at increased risk of serious illness from COVID-19 should have already been offered the vaccine in the current vaccination programme. 

The COVID-19 vaccine will also be offered to children aged 12 to17 years old who live with an adult who is immunosuppressed and all teenagers within three months of their 18th birthday.  

Vaccination of children and young people who are not in these three specific groups is not currently recommended, as they are generally at very low risk of severe illness from COVID-19.  

How safe is the vaccine for children and young people? 

At the moment, the only COVID-19 vaccine approved for 12 to 17 year olds is the Pfizer-BioNTech vaccine. This vaccine has been tested on a group of 12 to 15 year olds in a US trial, with generally only mild side effects reported. The vaccine was given to just over 1000 adolescents aged 12 to 15 years old.  The main side effects reported were injection site pain, fatigue and headache. Around 1 in 5 (20%) experienced fevers after the second dose. No serious side effects or deaths were reported.  

It is important to note that the trial participants were all healthy, or had a stable health condition. Those with immunosuppressive disorders or taking systemic immunosuppressants (like prednisolone) were excluded from the trial. However, this is quite a common thing to happen in medical trials. This is because complex health conditions can sometimes make it hard to interpret the data. For example, was a serious side effect due to the vaccine, or because the person had an active serious health condition? 

There have been rare reports of pericarditis and myocarditis (inflammation of the heart and lining of the heart) after the Pfizer-BioNTech vaccine, particularly in young men, and more commonly after the second dose. However, this is still extremely rare (just over 100 reports in UK out of millions of vaccines given). Most cases have been mild and improved with anti-inflammatories and rest. 

The JCVI has said a ‘precautionary approach is preferred’. They stated that they will keep vaccine recommendations under review as more data becomes available.  

The vast majority of children and young people are at very low risk of severe illness from COVID-19. In the first 12 months of the pandemic, under 30 children died due to COVID-19.  

Which 12 to 17 year olds are now eligible to receive the vaccine? 

Those eligible from the 19th July 2021 include: 

  • Vulnerable children, aged 12 to 15, with: 

           - Severe neurodisability 

           - Down's syndrome 

           - Immunosuppression (This may include some young people with Crohn’s or Colitis. For clarification, speak to your child’s GP or IBD team) 

           - Profound and multiple learning difficulties. 

  • Young people aged 12 to 17 who live with somebody with a weak immune system. This is to help limit the spread of the virus to immunosuppressed adults who are at higher risk of serious illness from COVID-19. 
  • Teenagers within three months of their 18th birthday. The aim is to protect people leaving school before they start work or university. 

How do I know my what my child’s risk level is? 

The British Society for Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) has put together specific guidance on the risk categories for children with Crohn's or Colitis. We've used this information to create a decision tree for the risk in children. 

Children aged 16 to 19 years old should ask their IBD Team whether they should follow the risk guidance for children or adults. 

Can children I live with have the vaccine? 

If you are immunosuppressed, your immune system is still able to fight off infections, just not quite as well as other people. You may be at increased risk of severe illness from COVID-19. Some of the medications commonly used to manage Crohn’s and Colitis may also make the vaccine work less well.   

The JCVI recommends that children and young people aged 12 to 17 who live with an immunosuppressed person should be offered the vaccine. Your risk of catching COVID-19 can be lowered if the people you live with are also fully vaccinated.  

Visit our Treatments page to see if the medicine you take is an immunosuppressant - most medicines for Crohn's and Colitis are, except 5-ASAs like Mesalazine and Pentasa.  

We will update this information once we know more about eligibility and how to book. 


I've heard that immunosuppressed people cannot have the vaccine?

People with Crohn's and Colitis who take medicines that weaken their immune systems should not have vaccines that are 'live' vaccines. None of the COVID-19 vaccines ordered by the UK government are classed as live vaccines. This means that you can have whichever vaccine you are offered.

The Oxford vaccine is originally based off of a live vaccine, but the final product is not considered 'live' as it has been made safe enough for people on immunosuppressants to take. The vaccine is made by taking a common cold virus that normally infects chimpanzees, and altering it so that it looks a lot more like coronavirus. The virus has been changed so that it cannot multiply inside humans. This means that you can't get COVID-19 from taking it. So even though the Oxford vaccine is originally based on a live virus, it has been altered to make it safe enough for people on immunosuppressant medicines to take.

You may have seen conflicting messages elsewhere about whether you can have the Oxford vaccine. We recommend that you refer your healthcare professional to the following resources which state that you are able to have the vaccine:

  • Page 14 of the Green Book on the official gov.uk website states that "Although [Oxford] AstraZeneca COVID-19 vaccine contains a live adenovirus vector, this virus is not replicating and is considered safe in immunosuppressed people." The Green Book has the latest information on vaccines and vaccination procedures for vaccine preventable infectious diseases in the UK.
  • Public Health England's guidance for healthcare professionals does not list immunosuppression as a reason not to have any of the vaccines.
  • The British Society for Immunology state that "All three of the COVID-19 vaccines (Pfizer/BioNTech; AstraZeneca/Oxford; Moderna) that have currently been approved for use in the UK are safe to use for people who are immunocompromised or immunosuppressed."
  • The British Society of Gastroenterology state that "We strongly support SARS-CoV2 vaccination for patients with IBD. We recommend that IBD patients accept whichever approved SARS-CoV2 vaccination is offered to them."

People with other medical needs may not be able to have any of the COVID-19 vaccines - such as people going through transplants - as they take very high dose of immunosuppressant medicines. This does not apply to people with Crohn's and Colitis, as the doses given do not severely weaken the immune system. You are not considered 'severely' immunocompromised by taking medicines to treat your Crohn's or Colitis.

I would recommend everyone with Crohn's or Colitis to have the coronavirus vaccine as I recently had mine. I feel it is important especially for those who are immunosuppressed – we are all here to fight it together with the support and guidance from Crohn's & Colitis UK, who can provide you with more advice and information.

Daljit Chohan
IBD Specialist Nurse

Which coronavirus vaccine is best for people with Crohn's or Colitis?

All of the available coronavirus vaccines are considered suitable for people with Crohn's or Colitis, as they are not live vaccines. Therefore having Crohn's or Colitis, or taking medicine to treat your condition, will not affect which coronavirus vaccine is best for you. You should have whichever vaccine you are offered.

The vaccines approved by the UK so far are the ones made by Pfizer/BioNTech (over 12s), Moderna (over 18s), Oxford/AstraZeneca (over 18s but preferred for over 40s), and Janssen (over 18s). All of these vaccines are considered suitable for people with Crohn's or Colitis to take, including people who take immunosuppressant medicines. 

How are the vaccines different?
The Pfizer and Moderna vaccines are completely synthetic - meaning made in a lab. They are not live vaccines. The Oxford and Janssen vaccines are different, as they are made by taking a common cold virus that normally infects chimpanzees, and altering it so that it looks a lot more like coronavirus. However, the virus has been changed so that it cannot multiply inside humans. This means that you can't get COVID-19 from taking it. So even though the Oxford and Janssen vaccines are originally based on a live virus, they have been altered to make it safe enough for people on immunosuppressant medicines to take.

We understand that you may have seen conflicting messages elsewhere about whether you can have the Oxford vaccine. We recommend that you refer your healthcare professional to Page 14 of the Green Book on the official gov.uk website, which states that "Although [Oxford] AstraZeneca COVID-19 vaccine contains a live adenovirus vector, this virus is not replicating and is considered safe in immunosuppressed people." The Green Book has the latest information on vaccines and vaccination procedures for vaccine preventable infectious diseases in the UK.

In their official statement, the British Society of Gastroenterology (BSG) have stated that "We recommend that IBD patients accept whichever approved SARS-CoV2 vaccination is offered to them, in accordance with UK Department of Health and Social Care and the Medicines and Healthcare products Regulatory Agency (MHRA)."


Oxford AstraZeneca vaccine in people under 40

The JCVI have issued new recommendations for use of the Oxford AstraZeneca vaccine in healthy people aged 18-39. This is due to a possible, very rare, risk of blood clots after the first Oxford vaccine dose. The risk of blood clots is extremely rare - around 4 people develop this condition for every million doses of Oxford AstraZeneca vaccine given. This works out at a risk of one in 250,000, or 0.0004%.

If you have concerns or are unsure about whether to have the Oxford vaccine, contact your medical team for advice. When weighing up the risks and benefits, you should also consider that clotting problems are a common complication of COVID-19 infection. Deep vein thrombosis (DVT), or clotting in the legs, occurs in 11.2% of people who have COVID-19. Pulmonary embolism, or clotting on the lungs, occurs in 7.8% of people who have COVID-19. 

You should be offered an alternative to the Oxford vaccine, such as Pfizer or Moderna, if:

  • You are under 40 and do NOT have a health condition that puts you at higher risk of severe illness from coronavirus (i.e. you are in the low risk group for coronavirus). However you may still choose to have the Oxford vaccine if it means you can have your vaccine sooner, or if you have decided the benefits outweigh the risks. 
  • You have a blood clotting disorder, or have ever experienced major thrombosis with thrombocytopaenia (including heparin induced thrombocytopaenia).
  • You are currently pregnant

If offered, you should have the Oxford vaccine if:

  • You are over 40 years old (in any risk group).
  • You are in the moderate or high risk group for coronavirus (in any age group over 18). This is because the benefits of having the vaccine outweigh the very small risk for you. 
  • You have already had your first dose of the Oxford vaccine (in any risk group) and not experienced any severe side effects.

Not everyone with Crohn's or Colitis is at higher risk of severe illness from coronavirus - check your risk.

Does my Crohn's or Colitis increase my risk of blood clots?
Crohn's and Colitis are not blood clotting disorders. However, they may slightly increase your risk of blood clots. You're more at risk during a flare-up or if you're confined to bed, for example in hospital. You can reduce your risk by not smoking, keeping active, drinking plenty of fluids, and wearing support stockings. 

The risk of blood clots in Crohn's and Colitis should not stop you from having the Oxford AstraZeneca vaccine. This is because the blood clots after the vaccine appear to have happened randomly, and no risk factors have been identified. However you may wish to seek advice from your medical team if you have a history of thrombosis, are pregnant, or are taking the medicine tofacitinib

Why is this advice being given to under 40s?
In people under 40, the risk of severe illness from coronavirus is lower, so the potential risk of blood clots may outweigh the benefit of the vaccine. However, in people who are at higher risk of severe illness from coronavirus, the risk of coronavirus far outweighs the potential risk of a blood clot.

If you're under 40 and have already had your first Oxford dose you should have still have your second dose of the Oxford vaccine - the benefits of vaccination strongly outweigh the risk of potential blood clots. It's important to remember that the risk of blood clots after vaccination is incredibly rare. 

This is an emerging area of research, and we will continue updating our information as more details come to light. 

What symptoms should I look out for?
Seek medical help immediately if you have any symptoms of blood clotting between four days and four weeks after vaccination. The symptoms are:

  • a severe or ongoing headache, blurred vision, confusion or seizures
  • shortness of breath, chest pain, leg swelling or ongoing abdominal pain
  • unusual skin bruising or pinpoint round spots beyond the injection site

Has the vaccine been tested in people with Crohn's or Colitis?

Many people with Crohn's and Colitis have now safely had the COVID-19 vaccine in the UK. We spoke to our supporters Heather, Carl and Donna about their experiences. 

The CLARITY trial is looking at antibody responses after coronavirus vaccination in people taking infliximab and vedolizumab - and in people taking these medicines in combination with an immunomodulator (such as azathioprine or methotrexate). Find out what this research has found so far.

The coronavirus vaccine has been extensively tested, and trials have involved people with varied chronic underlying conditions and broad age ranges, including many older people. The data on how people with Crohn's and Colitis have coped with coronavirus and vaccines, even those taking medicines that affect their immune system, is reassuring, and shows no significant differences from the general population.

All the data we have from other vaccines shows us that people with Crohn's and Colitis are not at any increased risk of side effects. Delaying your vaccine could lead to you having worse complications if you catch coronavirus. 

Every medicine that IBD patients take outside of their usual IBD medicines - for example paracetamol for your headache, or insulin for diabetes, blood pressure medicines - none of those medicines have been tested specifically in clinical trials of IBD patients. But this doesn't mean that these medicines are risky for IBD patients. It's the same for all other vaccines that we use in routine practice, they were never tested in IBD patients prior to their approval for the general population. Accordingly, we should consider these new vaccines low risk in IBD patients.

We will of course continue to monitor how these vaccines perform as they are rolled out. Balancing risk is an important consideration for all medicines. The one thing we know for certain is that coronavirus infection itself is definitely high risk, and can cause serious problems and even death in some patients. 

Dr Nick Powell
Clinical Reader and Consultant in Gastroenterology

Will the COVID-19 vaccine work?

Having Crohn's or Colitis does not make the vaccine any less effective for you. If you are on a 5-ASA medication, or no medication at all, you can expect the vaccine to work just as well as it would for someone like you who doesn't have Crohn's or Colitis. It is important to remember though that no vaccine is 100% effective and there is no guarantee that it will give complete protection.

If you take an immunosuppressant medicine, the vaccine may be slightly less effective. Crohn's & Colitis UK are supporting the research study CLARITY, which is looking at antibodies in people on infliximab and vedolizumab. The study found that people on infliximab produced fewer antibodies after one vaccine, but most people produced a good number of antibodies after the second vaccine. Read the full results on CLARITY

This does not mean you should stop your treatment. Stopping treatment can lead to a flare of your Crohn's or Colitis, which puts you at greater risk from serious complications of COVID-19. Even if the COVID-19 vaccine works slightly less well for you, it will still offer greater protection than not having the vaccine.

As is the case with other vaccines, no coronavirus vaccine will be 100% effective for everyone, and there is no guarantee that it will give complete protection. To compare, flu jabs are around 50% effective on average for the general population, yet are still effective in reducing the amount of hospitalisations and serious complications from flu. If you do catch COVID-19 after being vaccinated, it is likely that the virus will be less severe and you will recover faster than if you had not had the vaccine. Having the vaccine will reduce your risk of being hospitalised with coronavirus. Being vaccinated may also stop you spreading the virus to other people. 

Find out more about coronavirus research in people with Crohn's and Colitis.

New variants
It's not a surprise that new variants of the coronavirus have developed. As viruses spread, they mutate. There are now a number of different coronavirus variants in the UK and it is not clear if the vaccines will give protection from them all. The data so far looks promising but scientists are closely monitoring the situation.

No vaccine is ever 100% effective. Having your two coronavirus vaccine doses when you're invited will still offer you the best protection possible against the different coronavirus variants in the UK.

Some of the commonly used vaccines are a bit less effective in people taking immunosuppressants. If you look at the flu vaccine, we see some reduction in antibody formation in patients on anti-TNF medication. However, this doesn't mean that it won't provide some protection.

For the COVID-19 vaccines, the protection is around 95%, so these are probably much better vaccines than the flu vaccine, where protection is more like 50-60%. So, the starting level at which you're protected from coronavirus is much higher to start with, even if your medicine may make the vaccine slightly less effective. It is worth remembering that without vaccination, IBD patients will have no protection whatsoever from this dangerous virus.

Dr Nick Powell
Clinical Reader and Consultant in Gastroenterology

When can I have the vaccine and how can I book?

 

The vaccine is now available for all adults over 18 years old, and for some children and young people. 

How to book a vaccine

(It is yet to be announced how children and young people, if eligible, will be able to book their vaccines. We will update the page when more guidance is released.)

England
You can book a slot via your GP, on the NHS booking site, or by calling 119. 

Wales
See the advice for your local health board.

Scotland
Contact your health board.

Northern Ireland
Book online through the COVID-19 Vaccine Service for NI or call 0300 200 7813.

All nations
If you are aged 16 or 17 years old and taking an immunosuppressant but are being told you are not eligible for the vaccine, we have created a letter of support for you to share with your GP. 

Can I get the COVID-19 booster (third dose) vaccine?

The Joint Committee on Vaccine and Immunisation (JCVI) has published interim guidance on who should be prioritised for a third booster dose of the COVID-19 vaccine. The guidance recommends offering a booster vaccine dose to people in specified priority groups from September in two stages.

The interim guidance prioritises adults over the age of 16 years who are immunosuppressed and the clinically extremely vulnerable in the first stage. ‘At risk’ groups and adults who live with immunosuppressed people may be offered the booster in the second stage.

This means most adults with Crohn’s and Colitis could be offered a third vaccine dose in stage 1 or 2. This will depend on factors such as your age, the medication(s) you take, how well controlled your Crohn’s or Colitis is and any other health conditions you may have. If you take an immunosuppressant such as a biologic or thiopurine, you might be prioritised in stage 1. Remember, risk levels can change, so use our decision tree to find out what your current risk is.

The JCVI, made up of clinicians, scientists and public health experts, advises UK health departments on immunisation. The addition of a booster is intended to make sure that the protection from the first and second dose is maintained. As well as protect against new variants of COVID-19. Whether the booster jab is given alongside the annual influenza (flu) vaccination or with a gap between the two is still something to be considered by the JCVI based on data currently being collected.

The interim guidance is based on learnings about emerging variants and how the vaccine works in different groups of people. It’s important to note that plans across the UK have not yet been finalised. The JCVI will want to continue looking at the data from now until September, until they announce the final booster programme plans.

Stage 1: The following people should be offered a third dose COVID-19 booster vaccine and the annual flu vaccine, as soon as possible from September 2021:

  • adults aged 16 years and over who are immunosuppressed;
  • those living in residential care homes for older adults;
  • all adults aged 70 years or over;
  • adults aged 16 years and over who are considered clinically extremely vulnerable;
  • frontline health and social care workers.

Stage 2: The following people should be offered a third COVID-19 booster vaccine as soon as practical after Stage 1, and the flu vaccine if they’re eligible:

  • all adults aged 50 years and over;
  • all adults aged 16 – 49 years who are in an flu or COVID-19 at-risk group as outlined in the Green Book;
  • People who live with someone who is immunosuppressed.

The available vaccines are safe for people with Crohn’s and Colitis and offer the best protection against coronavirus. There are several studies looking at the effectiveness of the vaccine in people with Crohn’s and Colitis, including CLARITY and VIP studies.

The final JCVI guidance will be issued at a future date. We will continue to monitor this issue and find out more details. We’ll engage with the British Society of Gastroenterologists (BSG), Department of Health and Social Care and JCVI to ensure that the final guidance and how it's implemented takes into account the needs of people with Crohn’s and Colitis.

Working in partnership with other charities, we recently wrote an open letter to employers calling for more workplace awareness and support for people who may be at increased risk of severe illness from COVID-19.

Can people I live with have the vaccine?

If you are immunosuppressed it is even more important that you are fully vaccinated to lower your risk of serious illness from COVID-19. Your risk of catching COVID-19 can also be lowered if the people you live with are also fully vaccinated.

As all adults aged 18 years and over are eligible for the vaccine, they do not need to say why they are getting it. Those aged 12 to 17 years old are also eligible for the vaccine if they live with an adult who is immunosuppressed. 

If you live in Wales: People aged 16 or over who live with a severely immunosuppressed adult can complete a self referral form on the NHS website to book their vaccine.

Visit our Treatments page to see if the medicine you take is an immunosuppressant - most medicines for Crohn's and Colitis are, except 5-ASAs like Mesalazine and Pentasa. 

Communicating concerns about your risk level can be difficult. As restrictions ease, people may see risk very differently and you may find it hard to talk about why you're worried about doing certain things.

We are currently working on creating information to help you with this issue. In the meantime, you could try looking at our 'It Takes Guts' resources. These can help you with talking to other people about your condition and what it means for you.

Please note that while JCVI recommendations apply to the whole of the UK, the process of booking a vaccine may be different in the devolved nations.


Will the vaccine cause my Crohn's or Colitis to flare?

There is no evidence to suggest that the COVID-19 vaccine would cause a flare-up of your condition. There is also no evidence that the vaccine would stop your medicine from working properly. If you do have a flare-up after receiving the vaccine, this is likely to be a coincidence, as Crohn's and Colitis flares can happen unexpectedly. It's common for periods of stress to trigger a flare-up, so this might also be responsible. Tummy pain, nausea, vomiting, diarrhoea, fever, fatigue and decreased appetite can all be side effects of the vaccine, so it may be that if you are experiencing these, it is a temporary side effect rather than the start of a Crohn's or Colitis flare-up.

If you feel you have had a side effect from the COVID-19 vaccine, you can report it via the MHRA Yellow Card reporting site, and speak to your IBD Team.

If you look at the history of vaccinations in people with immune problems like Crohn's and Colitis, there has been no evidence that commonly used vaccinations trigger a flare in your disease.

The COVID-19 vaccine particles are unlikely to live in your body forever. Your body will probably eliminate the particles in about ten days [from what we have seen from mice studies] and then it's gone forever. You generate an immune response against them. Your immune system is smart and has an excellent memory. It will remember the viral components present in the vaccine, and if it ever sees the coronavirus itself in the future, it will recall the encounter and rapidly generate antibodies that neutralize the virus, or protective immune cells called T-cells.

Your immune system is also highly specific. The immune cells triggered to generate a response to the coronavirus vaccine, are completely different to the immune cells likely to be involved in damaging the gut IBD. Therefore, it is unlikely that immune activation stimulated by the vaccine would be misdirected and make your IBD worse. We certainly haven't seen this happen with any other the other commonly used vaccines.

Dr Nick Powell
Clinical Reader and Consultant in Gastroenterology

When weighing up the risk of side effects of the vaccine, it's also important to also consider the risks of complications from COVID-19 if you were to catch the virus. Complications from the virus can be life-threatening, especially if you are at increased risk, and some people have reported that testing positive for coronavirus has led them to develop a flare-up. It is safer to receive protection from coronavirus rather than risk infection.

My experience with coronavirus felt no different to when I have a bad flare up. It started with abdominal pain, nausea, aching followed by a fever and high output from my stoma. I was also very fatigued throughout this and it continued for seven days. On day 6, I was admitted for to hospital and placed on IV antibiotics and fluids.

Emma
Living with Colitis

Should I take (or avoid taking) the vaccine at certain times?

The coronavirus vaccine is suitable to take in most circumstances, including when you are in a Crohn's or Colitis flare-up. You do not need to leave a gap between your vaccine and when you take your biologic medicine - they can both be taken on the same day if needed. Your IBD Team may recommend that you leave a gap between the two if you are likely to experience side effects, but your vaccine will still be just as safe and just as effective if taken at the same time as your biologic medicine.

This advice is based on expert opinion from the British Society of Gastroenterology, who state that "Neither IBD disease activity, nor the timing of subcutaneous/intravenous IBD medications should delay vaccination. There is some evidence with annual influenza vaccination that the timing of anti-TNF administration does not significantly impact on vaccination immunogenicity". Immunogenicity is your body's ability to respond to the vaccine effectively. You may wish to show your IBD Team our information for nurses if you are receiving different advice. 

There are some exceptions to this, when you should delay either your vaccine or medicine. These are:

  • If you feel very unwell on the day of your appointment (for example if you have a high fever or symptoms of coronavirus), your vaccine may be postponed until you have fully recovered.
  • If you're scheduled for another vaccine. You should ideally wait 7 days between the coronavirus vaccine and any other vaccination, such as the flu jab. This is because in the very rare circumstance that you have an allergic reaction, it will be important to tell which vaccine has caused it. This does not apply to biologic injections, as they are not vaccines - but seek advice from your IBD team if you are starting a new treatment in the same week as your COVID-19 vaccine.
  • If you're taking steroids. Your IBD Team may recommend that you've tapered down to a lower dose, or have finished your course of steroids, before you have the COVID-19 vaccine. This is because the vaccine will be more effective if you are not taking a higher dose of steroids. However, it is still safe to take the vaccine while on steroids.
  • If you're just about to start a new biologic or immunosuppressant medicine. Your IBD Team may recommend that you have both doses of the COVID-19 vaccine before you start your new medicine. This may mean that you have to delay starting your new medicine until you have had the vaccine. This is recommended because the vaccine may be less effective once you start a biologic or immunosuppressant. However, it is still safe to take the vaccine while on these medicines.

If you have Crohn's or Colitis it's better to be protected from flu as soon as possible, so if you are eligible for a flu jab and haven’t yet had it this winter, contact your GP or community pharmacy.


Can I have the vaccine if I've had an allergic reaction before?

In most cases, yes. If you've had an allergic reaction before, including a reaction to a medicine you take for your Crohn's or Colitis, you will usually still be able to have any of the available COVID-19 vaccines.

The exceptions to this are:

  • You have an allergy to any of the vaccine ingredients.
  • You've had a very severe form of allergic reaction called anaphylaxis to many different medicines.
  • You've had an anaphylactic reaction where your doctors couldn't explain why it happened.

If you have, then it is recommended that you do not have the Pfizer vaccine. You will still be able to have the Oxford/AstraZeneca vaccine. Anaphylaxis is a severe and potentially life-threatening reaction which usually develops suddenly and gets worse very quickly. Anaphylactic reactions are not common - if you have had an allergic reaction before, it is unlikely to have been anaphylaxis. You can ask your healthcare professional for advice when it is your turn to have the vaccine.


Do I need the vaccine if I've had coronavirus already?

Yes. It is not known how long immunity from coronavirus lasts, and it may be possible to get COVID-19 more than once. Therefore it is important to get the vaccine, even if you have had the virus already. 

If you've recently tested positive for coronavirus – even if you have no symptoms – contact your healthcare professional for advice. They may recommend that you wait for a certain period of time before getting the vaccine.


Should I be concerned about the length of time between vaccines?

The recommended gap between doses is now 8 weeks. This is based on research showing best vaccine response after this time. If you receive the second dose too soon it may not be as effective.  

However, if you are about to start immunosuppressant therapy, you may be advised to have your second dose sooner than 8 weeks after your first one. This is because your immune response to the vaccine may not be as good once you are immunosuppressed. In that case, the minimum interval would be at least 3-4 weeks. 


 Can I have an antibody test after my vaccine?

Antibody testing for coronavirus is not yet widely available for free on the NHS. This is because antibody tests currently cannot give a clear indication of how well you are protected from COVID-19.   

Antibodies are proteins made by your body to fight infection. An antibody test is a blood test that looks at antibodies to coronavirus. The test result may tell you your level of antibodies, or just a positive or negative result.  

An antibody test can help to see if you have been exposed to the virus before – whether that is from infection or a vaccination. However, it cannot tell you your overall level of immunity.   

This is for a few reasons. 

  • The body has many ways of fighting infection. For example, T cells have also been shown to be crucial in fighting coronavirus. However, T cells are much harder to test. An antibody test will not show your T cell response. 
  • There are lots of different types of antibodies that your body can produce, and an antibody test will not test them all. Even if it did, it cannot tell you how good quality these antibodies are, only the level in your blood. It is not clear yet whether high levels of antibodies equal high levels of protection from the virus.  
  • It’s not known how long antibodies stay in your body. People who produce antibodies may still be vulnerable to coronavirus later.  
  • You may get a negative result even if you do have antibodies in your blood. This may be because the level of antibodies is too low to be detected by the blood test, even though it is still high enough to be helpful in fighting infection.  

Another issue with antibody testing is that it may give people a false sense of security if their antibody levels are high. Or on the other hand, the test could make people think they are extremely high risk if the result is negative or very low, even if they actually have a good immune defence.   

There are a few groups that can get antibody tests for free.   

  • Those that are taking part in certain COVID-19 studies may be able to have antibody tests.  
  • Certain occupations can also make you eligible for antibody testing. See government advice for more information.

These results will not be able to tell you the likelihood of getting the virus in the future.  


Are the needs of people with Crohn's and Colitis being considered?

Many people with Crohn's and Colitis are at increased risk of complications from coronavirus - we're fighting to make sure that those most at risk are protected.

We've written to the JCVI, who advise UK health departments on immunisation, asking them to ensure that people with Crohn's or Colitis in both the moderate and high risk groups would be eligible for priority COVID-19 vaccination. We have also written to the relevant Ministers in all four UK nations and the Chief Medical Officers with the same ask. Find out more about how we're speaking up for you.

More coronavirus support and information