Update – Myasthenia Gravis and Coronavirus

Last reviewed May 17, 2021.

This page offers valuable resources for myasthenia gravis patients with regard to COVID-19.

MG and COVID-19 Vaccination

5/17/2021 Update

Individuals who have myasthenia gravis may be at increased risk for severe COVID-19 illness.  With this in mind, Conquer MG’s Medical Advisory Board continues to review recommendations issued by the Centers for Disease Control (CDC), and offers these general guidelines.

Please note this is not intended to be a substitute for professional medical advice. Be sure to consult with your physician to decide what’s appropriate for your specific situation.

  • Most MG patients should get vaccinated. Generally, we anticipate that the risks associated with the COVID-19 vaccine will be relatively small compared to the risk of contracting the disease itself.

As of 5/12/2021, the CDC states, “People with autoimmune conditions were eligible for enrollment in COVID-19 vaccine clinical trials. No imbalances were observed in the occurrence of symptoms consistent with autoimmune conditions or inflammatory disorders in clinical trial participants who received COVID-19 vaccine compared to placebo. People with autoimmune conditions may receive any FDA-authorized COVID-19 vaccine.”

  • If you have a condition such as myasthenia gravis, or are taking immunosuppressant medication (this includes common MG treatments such as prednisone, azathioprine, mycophenolate mofetil, and others), you may NOT be fully protected even if you are fully vaccinated. Talk to your healthcare provider. Even after vaccination, you may need to continue taking precautions such as wearing a mask, social distancing, and staying out of crowds.

Q: Is there a way to tell how effect how effective the COVID-19 vaccine is for me?

A: How well the vaccines work will depend upon your immunosuppression at the time of receiving the vaccine dose(s). This varies from person to person, and will depend on your overall health, age, and medication dose. The National Institutes for Health (NIH) is conducting research that examines the immune response to COVID-19 vaccination in people with different immune disorders or on immunosuppressive medications.

Q: I’m just taking pyridostigmine bromide to treat my MG. Does that reduce the effectiveness of my COVID-19 vaccine?

A: We don’t believe so. Pyridostigmine bromide does not work by suppressing the immune system.

  • It’s recommended that persons who have myasthenia avoid any vaccine made from a live or weakened virus. However, the COVID-19 vaccines approved for use in the U.S. (made by Moderna, Pfizer, and Janssen (Johnson & Johnson) do not contain a live or weakened COVID virus, though the Jannsen uses a viral vector as the delivery method.
  • More than one vaccine is being developed for COVID-19. There is not yet enough information to say which vaccine will be better for the MG population.
    • 5/12/2021 Note: On April 23, 2021, the CDC and FDA lifted a pause on use of the Janssen (Johnson & Johnson) COVID-19 vaccine. The CDC and FDA did so after investigating reports of a very rare condition called thrombosis with thrombocytopenia syndrome (TTS) (blood clotting with low blood platelet counts). A warning has been attached to the Johnson & Johnson vaccine noting rare clotting events might occur after vaccination, primarily among women aged 18-49 years, and that providers and patients alike should watch for signs of this condition so it can be treated promptly.
    • 4/7/2021 Note: Although not yet approved for use in the U.S., we continue to watch reports about the COVID-19 vaccine made by AstraZeneca. European regulatory agencies are reviewing rare cases of TTS while weighing benefits/risks associated with COVID-19.
  • Persons receiving monoclonal antibody therapy (such as rituximab or Soliris®) for myasthenia should discuss with their doctors how to time the COVID-19 vaccine so the vaccine is most effective. For rituximab, it’s suggested individuals get the first vaccine dose 6 weeks before rituximab treatment, and the second vaccine dose 4 weeks before another treatment.

COVID-19 and MG: Guidance You Can Trust

About COVID-19 

Like you, those of us at Conquer MG have been closely following news of the coronavirus. We recognize many individuals who have MG may be at risk for serious illness in the event they contract the virus. We wanted to share our current understanding of the illness with you.

About the Coronavirus

The strain of the coronavirus causing this illness is called COVID-19. The virus is thought to spread through respiratory droplets produced when an infected person coughs or sneezes. It may be possible to acquire the illness if you’re near someone who is ill, or by touching a contaminated surface.

Coronavirus symptoms range from mild cold-like illness to severe breathing difficulty.

What Information is Reliable?

The content on this page was created by expert doctors and researchers in the MG community. In addition, these sources – the Center for Disease Control (CDC) and the World Health Organization (WHO) – offer trustworthy information:

Below we share links from the CDC about people who are most at risk, and steps you can take to prevent becoming ill.

We hope to share more information that will be useful as the situation unfolds.

ADVICE FROM THE CDC

To protect yourself from exposure, the CDC recommends:

  • Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use hand sanitizer with at least 60% alcohol
  • Avoid close contact with people who are sick.
  • Put a distance of at least six feet between youself and others who don’t live in your household.
  • Cover your mouth and nose with a mask when around others.
  • Avoid touching your eyes, mouth, and nose with unwashed hands.
  • Stay home when you’re sick
  • Cover your mouth and nose when you sneeze or cough; throw used tissues in the trash
  • Clean and disinfect frequently touched objects and surfaces (for instance, your phone, TV remotes)

For more information, click these:

Who is at Risk for Serious Illness from COVID-19

The CDC notes those most at risk for serious illness from COVID-19 include older individuals and those who have serious chronic medical conditions. This includes people who are immunocompromised, such as people receiving immunosuppressant treatments for myasthenia gravis.

If you are at higher risk of getting very sick from COVID-19, you should:

  • Stock up on supplies.
  • Take everyday precautions to keep space between yourself and others.
  • When you go out in public, keep away from others who are sick, limit close contact and wash your hands often.
  • Avoid crowds as much as possible.
  • Avoid cruise travel and non-essential air travel.
  • During a COVID-19 outbreak in your community, stay home as much as possible to further reduce your risk of being exposed.