• Current guidelines recommend most people with Parkinson’s disease should get the COVID-19 vaccine.
• The COVID-19 vaccines currently approved in the U.S. do not contain a live virus and cannot replicate within the body, and the proteins they introduce break down over time.
• The COVID-19 vaccines should not have any impact on people with deep brain stimulators.

Ever since the U.S. Food and Drug Administration (FDA) authorized the first COVID-19 vaccines for emergency use in December 2020, people living with Parkinson’s disease have had questions about whether these inoculations will be safe and effective for them.

On February 27, the FDA approved the Johnson & Johnson COVID-19 vaccine, providing a third option to the Pfizer and Moderna COVID-19 vaccines. The Johnson & Johnson vaccine requires a single dose and works in a different way than the first two vaccines. Although the FDA paused the use of the Johnson & Johnson vaccine on April 13, the FDA and the Centers for Disease Control and Prevention (CDC) lifted that pause on April 23.

The Parkinson’s Foundation released guidance in January indicating that people living with Parkinson’s disease should get vaccinated if given the opportunity. However, many MyParkinsonsTeam members are still curious about whether they should get vaccinated.

To address these concerns, MyParkinsonsTeam sat down with Dr. Sarah O’Shea, assistant professor of neurology at Boston University, who specializes in the diagnosis and treatment of individuals who have Parkinson’s disease.

The COVID-19 vaccines are so new that there is not yet any specific data on results or side effects in people with Parkinson’s disease. How can we know whether the vaccines are safe and effective for this population?

It’s true that individuals living with Parkinson's disease (PD) were not specifically studied in the vaccine trials. However, from a pathobiological perspective, there’s no reason to believe that these vaccines would work any differently in patients with Parkinson’s disease compared to the general population.

To break down whether these vaccines would really be any different for individuals with PD versus those without it, it’s important to understand how the vaccines work.

The way the messenger RNA (mRNA) vaccines (like Pfizer and Moderna) work is by introducing a piece of mRNA (or coding) for the spike protein of the coronavirus into your immune cells, which prompts the cells to display this protein on the surface. So essentially, it convinces the body to launch an immune response to this protein so your body knows what to do. If you’re exposed to the virus, it now recognizes the virus.

For the Johnson & Johnson vaccine, genetic instructions for making this piece of virus are inserted into what we call a viral vector — basically a shell of an adenovirus — with genetic instructions for the common cold having been removed, so the body knows how to respond to the SARS-CoV-2 virus.

These mechanisms aren’t any different for people living with Parkinson's disease versus those who do not have the disease. Therefore, the efficacy shouldn't be any different for either population. In terms of safety, the side effects due to these immune responses should not be any different.

Can medications taken to treat Parkinson’s cause interactions or impact the effectiveness of the vaccination? For instance, dopaminergic drugs like Sinemet (levodopa/carbidopa), dopamine agonists like Apokyn (apomorphine), or anticholinergics such as trihexyphenidyl?

No, medications to treat Parkinson's disease — whether that involves levodopa-containing or dopamine agonists or anticholinergic medications — don't impact the effectiveness of the vaccinations. On the flip side, the vaccines don't impact the effectiveness of the medications.

There have been some concerns about one of the medications that some patients take for orthostatic hypotension, called Florinef (fludrocortisone). This may cause a reduction in immune response to the vaccine, per some package inserts. And the reason for this is that fludrocortisone is a type of steroid molecule, and some steroids can attenuate, or reduce, the effectiveness of an immune response. However, Florinef is much less likely to do this compared to other steroids that are usually used more for immunosuppressive purposes rather than blood pressure purposes. So we're not concerned about it when it does come up with patients.

For people who have deep brain stimulators, are there concerns about getting vaccinated?

None at all. There are no concerns for patients undergoing deep brain stimulator (DBS) surgery or having a DBS implanted in terms of getting vaccinated against COVID-19.

If someone experienced a bad reaction following a flu vaccine in the past, should they also be cautious about getting the COVID-19 vaccine?

It’s very important to differentiate a reaction from an allergy.

A reaction — such as fevers, chills, or malaise — following a vaccine is a normal response, which indicates that your body is appropriately responding to the vaccine.

Allergic reactions, however, include anaphylaxis, trouble breathing, or hives. In general, people who have a history of severe allergic reactions, especially to any vaccine, need to let their physician and anyone administering the vaccine know about this allergy.

Sometimes, such patients will need to talk to an allergist prior to receiving the vaccine as well. In some cases, it means that they need to receive pretreatment medications prior to getting the vaccine to prevent a reaction. And it should also be noted that everyone needs to be there for 15 minutes after the vaccine administration, and that those with severe allergies, anaphylaxis, or any allergic reaction in the past to vaccines are monitored for 30 minutes following vaccination.

Some of our members have expressed worry about how quickly the COVID-19 vaccines were developed. Do you have similar concerns about the speed or nature with which the vaccines were developed? And if not, why not?

No, I'm not concerned about the speed or nature in which the vaccines were developed. All three of the vaccines that are available in the U.S. were subject to vigorous studies to demonstrate their efficacy and safety. Additionally, these companies and research teams were very transparent about their data and methodologies, which is very reassuring to both doctors and patients alike.

I do want to note that the effects of the vaccines were studied for about two to three months after vaccine administration. Usually, side effects from vaccines — anything that would cause any harm to patients — generally occur within the first few days to a month following vaccination, so overall, these vaccines were studied long enough to get a good idea of the efficacy and safety.

What is the most important thing for people with Parkinson’s disease to know about COVID-19 vaccines, in your opinion?

It's very important that individuals living with Parkinson's disease receive the vaccine, given the risks associated with contracting the virus. The global movement disorder community agrees on this recommendation, but please do talk to your doctor first, as of course there are always exceptions.

Another recommendation is that even if you received the vaccine, the risk of contracting the virus is still not zero. So keep up with hand-washing hygiene, social distancing, and wearing masks, despite getting the vaccine.

“Looking Forward To Adventures in 2021!”

Some members of MyParkinsonsTeam say they are excited about the opportunity to get vaccinated. “I am happy that I just got an appointment to get my COVID-19 vaccine,” one member wrote. “Looking forward to adventures in 2021! Need that vaccine!” another said.

Other MyParkinsonsTeam members are cautiously optimistic about what the promise of a vaccine could mean for the Parkinson’s community. “We are not anti-vaccine people, but I was wondering if anyone with Parkinson’s has taken the COVID-19 vaccine — if so, did you have any severe side effects?” one member asked. “I am good with getting the vaccine, but I worry about my wife, who has Parkinson’s.”

Talk With Others Who Understand

MyParkinsonsTeam is the social network for people with Parkinson’s disease and their loved ones. On MyParkinsonsTeam, more than 75,000 members come together to ask questions, give advice, and share their stories with others who understand life with Parkinson’s.

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