Vaccines and Adrenal Insufficiency

If you have Addison's Disease or another form of adrenal insufficiency, which vaccines should you have? Is it safe to be vaccinated? What do you need to know before you go for a jab?

Our medical trustees advise that vaccines are usually safe. There are lots of useful links and some helpful advice below to help you explore any particular concerns and understand what you need to consider.

Should people with Adrenal Insufficiency have the flu jab?

You’ll find the answer to this and more information about this vaccine in our Flu Jab Guide

Should people with Adrenal Insufficiency have the Pneumonia jab?

People with adrenal insufficiency who take daily steroids are not currently in an at risk group requiring a pneumonia jab. The pneumovax vaccination available from healthcare professionals and pharmacies does not protect against the viral pneumonia that can be caused by COVID-19. Recent studies have set out to prove definitively if those with adrenal insufficiency are at greater risk of bacterial Pneumonia than those without. There is yet to be any information to change the advice provided the the NHS. If you feel concerned about pneumonia, discuss it with your healthcare team who can advise on risks and vaccine requirements specific to your circumstances. Pneumonia vaccines are available to buy from some pharmacies. NHS advice on Pneumonia vaccines.

Which priority group are people with Addison’s or adrenal insufficiency in?

The information below is extracted from our "Coronavirus Vulnerable Adult Advice" statement, authored by members of the Addison's Clinical Advisory Panel (CAP) This statement contains more information on vaccine priority grouping for people with Addison's disease and adrenal insufficiency. The document also contains important information about hydrocortisone medication dosing for COVID-19 and hydrocortisone injection kits. Click here to read and download the full statement.

"The government has issued a list of people considered vulnerable - you can find more guidance about who should get a vaccine, and when from the Joint Committee on Vaccination and Immunisations (JCVI). 

Whilst adrenal insufficiency is not specifically mentioned in this guidance, the following criteria apply to people with adrenal insufficiency:

Category 6: “People aged 16 to 64 years with underlying health conditions which put them at higher risk of serious illness or death from coronavirus.”

This group includes people with all types of Addison’s disease and other causes of adrenal insufficiency. The individual may be in a higher category due to further health circumstances and any treatments they take. This decision will be based on the health care professional responsible for their care and category 6 should be taken as a minimum requirement.

Category 4: “Everyone 70 years old and above, and clinically extremely vulnerable individuals”

This group includes people with Autoimmune polyendocrine syndrome type 1 (APS-1) / Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) syndrome, a rare variant of autoimmune Addison’s disease.

Of course, you may be prioritised in a higher category for vaccination for other reasons, including because of your age, or another underlying health problem which makes you more vulnerable than the adrenal insufficiency/ steroid-dependence alone. If you believe you should be in a certain priority group, please discuss this with your healthcare professional (GP or hospital team). You'll receive an invitation to have the vaccine as soon as there is enough vaccine available."

We have co-authored this statement as a download to give you the information, should you need it, to send to your GP or healthcare professional to provide them with more information about the advice that those with Addison's disease and adrenal insufficiency should be in vaccine priority group 6 and the required hydrocortisone medication and injection replacements needed.

As a patient support group one of our main aims is patient safety - to be prepared and not scared. We understand, as people living with Addison's ourselves, everyone is very keen to be higher up the priority list. The government sets the rankings on likelihood of death from COVID-19 - and currently, as confirmed by our Medics working tirelessly in hospitals across the UK, people with other health conditions are currently at a greater risk than people with Addison's and adrenal insufficiency.

So if you are worried, please use other methods to stay safe while we wait - we are here to help you become an expert patient.

Should people with Adrenal Insufficiency have a COVID-19 vaccine?

 Read our Coronavirus Vulnerable Adult Advice statement - including information on Priority Groups, hydrocortisone medication & the hydrocortisone emergency injection kit.

 Read the full Society for Endocrinology statement on COVID-19 vaccines: Information for patients with endocrine conditions and diabetes mellitus.

There are different COVID-19 vaccines that are in the very early stages of being rolled out across the NHS in the UK. The ADSHG welcomes the latest approval of the Moderna vaccine following on from the Oxford AstraZenica and Pfizer/BioNTech vaccines roll-out. Full clinical trials are taking place and no safety elements have been rushed. As with all vaccines / medicines there will be ongoing checks. 

This is a rapidly changing situation and information will be updated by the government (see links under 'who will receive the vaccine and when?'). 

The European Medicines Agency has dedicated pages that are constantly updated with the latest news on the vaccines being developed and assessed.

Currently our medics are not aware of any specific side effects that would be unique to people with adrenal insufficiency having a COVID-19 vaccine, in the same way there are no specific concerns about other vaccines. According to a NewScientist.com article about the Pfizer Vaccine it has been "tested in people with “stable” pre-existing conditions – also known as comorbidities – including diabetes, cancer, hepatitis B, hepatitis C and well-managed HIV. Their response was as good as anyone else’s."

Each of the vaccines that are being developed have different potential side effects, information about which will be available on the government, NHS and EMA websites featured in this article. If you have concerns about a COVID-19 vaccination, check the NHS / HSE vaccine pages to see if your queries are answered. For any individual circumstances, for example any conditions you have alongside adrenal insufficiency you may need to talk to your GP.

NHS Coronavirus Vaccine pages

HSE Vaccination pages

Should anything change, this page will be updated once we have a clear view of any impacts you need to take into consideration.

Who will receive the COVID-19 vaccine and when?

This depends on which group you are in, and how quickly the largest vaccination programme in British history can be put in place. The independent Joint Committee on Vaccination and Immunisations (JCVI) has released guidance about who should get a vaccine, and when. Everyone in the UK will be split into nine priority groups to begin with. Group one will get the vaccine first, group two will follow and so on. 

The government hope to be able to offer everyone in the top four priority groups their first dose by mid-February 2021 and that all nine groups should receive their first dose by the spring. You'll receive an invitation to have the vaccine when it is available for you. 

We have listed below links to the latest government information so you remain up-to-date.

All of the approved vaccines are shown to be safe. There have been a very small number of reports of allergic reactions to the Pfizer/BioNTech vaccine. For the vast majority of people, there is no need to worry about these reports. You can have the vaccine even if you have a history of anaphylactic shock to other things - just let the person who is giving you the vaccine know beforehand. 

Please ensure you answer the questions on the vaccination check list accurately before going ahead with the vaccination.

Read the UK government Q&A about why you might have to wait for the vaccine

Some people are being asked to fill in a form before having the COVID-19 vaccine, why is this?

Just as for other vaccines, some centres offering vaccines use a form to help with checks for allergies, pregnancy and other risk factors before the vaccination goes ahead. Some vaccination providers vaccinate without a form. You can view the form being used for the COVID vaccination programme in England here as an example.

Can vaccines cause bad reactions?

We are all different and some people may have a reaction. They might have an allergy to the ingredients. Always ask your healthcare professionals to discuss the ingredients with you to make sure you are comfortable with the ingredients. If you are poorly you are advised to rearrange your vaccination until have recovered so that you avoid complications. You can find out more about reactions to vaccines and the Yellow Card scheme for reporting them on the NHS website.

Are people with Adrenal Insufficiency at greater risk of bad reactions to vaccines?

People with Adrenal Insufficiency are not at an increased risk of having bad reactions to vaccines. Lots of factors at the time of having the vaccine may make it appear it is related to the vaccine such as food poisoning or a stomach bug. As with all bouts of illness or physical stress on your body, you should follow the sick day rules. This year, we featured a study about and people with Addison's and their 'natural killer cells'. Read about the implications of this and immunity in people with Adrenal Insufficiency.

Fludrocortisone: some members have got to in touch concerned having read online that you should not have vaccinations if taking fludrocortisone. Our medics have confirmed these rumours are incorrect. When taking fludrocortisone as replacement therapy for Addison's or any form of adrenal insufficiency you should still receive vaccinations when offered by your healthcare professionals.

What about live vaccines?

Live vaccines contain a live version of the virus it is designed to protect you from. According to NICE people receiving immunosuppressive doses of corticosteroids should avoid live vaccines. People who have adrenal insufficiency alone usually take daily doses of steroids that are not immunosuppressive so are on replacement corticosteroids treatment - replacing what your body would naturally produce.

It’s important to check the latest advice about any other conditions you have in combination with adrenal insufficiency. The flu jab for adults is not a live vaccine. You can check the NHS website for more details about various types of vaccines.

Do the COVID-19 vaccines contain live viruses?

Vaccines work by producing a “spike” inside the body, so in the future, the immune system recognises the “spike” and responds to it. That means that if the body encounters the Covid-19 virus, the immune system will recognise it and act against the virus so it cannot develop into an illness.

The Pfizer/BioNTech vaccine is an mRNA (messenger RNA) vaccine. The vaccine does not contain any live virus.

For the Oxford vaccine - instead of mRNA, the Oxford vaccine uses a harmless, weakened adenovirus. It has been genetically changed so that it is impossible for it to cause an illness.

The most recent vaccine to be approved for use in the UK has been produced by Moderna. The Moderna vaccine is 94% effective. The government have ordered 17 million doses, which will start being delivered to the UK from Spring. The Moderna vaccine, works in a very similar way to the Pfizer/BioNTech vaccine. It uses mRNA to tell the body's cells to create the spikes that are on the surface of the coronavirus, so that the immune system can respond to them. It does not contain any live virus.

Last Updated 21/01/2020. 

Reviewed and approved by our trustee endocrinology professionals.