Last week, the Centers for Disease Control and Prevention (CDC) announced that fully vaccinated people can go without masks in most scenarios. The sudden shift in mask guidance sent shockwaves through everyone who had been carefully abiding CDC directives. While many people shed their masks for the first time this weekend, others remained cautious and opted to continue wearing a face covering. But there's one group of people the CDC has warned should keep their masks on, even once they're fully vaccinated: People taking immunosuppressive medications for autoimmune diseases may need to continue wearing a mask.
On May 13, the CDC announced that fully vaccinated people "can resume activities without wearing a mask or staying six feet apart, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance." However, the CDC noted that people who have an autoimmune condition or are taking medications that weaken the immune system should talk to a doctor before going without their mask.
"If you have a condition or are taking medications that weaken your immune system, you may NOT be fully protected even if you are fully vaccinated," the CDC guidance reads. "Even after vaccination, you may need to continue taking all precautions." The CDC says its researchers are still learning about how well the vaccines protect people with weakened immune systems, either from certain conditions or medications they're taking.
Studies have shown that people with an autoimmune disease who take medications that suppress their immune systems may have a weakened response to the vaccine. A pre-peer-reviewed study shared on medRxiv on March 29 found that regular infusions of infliximab (Remicade) can make the first dose of the Pfizer and AstraZeneca vaccines less effective. Remicade is commonly used to treat autoimmune disorders, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, plaque psoriasis, and ulcerative colitis. While many patients' immune response improved with the second dose, some never gained sufficient immunity.
The researchers noted that reduced efficacy of the vaccine is likely not only limited to Remicade. The study hypothesized that people prescribed other medications to stop inflammation could also have a diminished immune response to the vaccine. Besides Remicade, other commonly prescribed tumor necrosis factor (TNF) inhibitors include Enbrel (etanercept), Humira (adalimumab), Cimzia (certolizumab pegol), and Simponi (golimumab). Humira and Enbrel are two of the world's top-selling medications, according to ARY News.
CDC director Rochelle Walensky, MD, expanded on the guidance over the weekend. During an appearance on NBC's Meet the Press on May 16, Walensky said, "We know that—and there are emerging data to suggest—that if you don't have a fully competent immune system from chemotherapy, from transplants, from other immune-modulating agents, that the vaccine may not have worked as well for you. So, please, before you take off your mask, consult your physician."
Walensky also pointed out that just because the guidelines changed doesn't mean that everyone's behavior has to shift immediately. You should factor in your risk and how comfortable you feel going maskless. "Not everybody has to rip off their mask because our guidance changed on Thursday," Walensky said on CNN's State of the Union on May 16.