EXPLAINER: Who are exempted from getting Covid-19 vaccines?
MANILA, Philippines — The national government has announced that it is already prepared for the expected rollout of Covid-19 vaccines in the country this month.
The government has also recently approved and ratified its plan for mass immunization against Covid-19. The detailed list of the priority population for the scheduled inoculation has also been released last week.
While it seems like everything is underway for the country’s vaccination program, several doctors and medical experts clarified that there is a certain group of individuals who are not advised to receive jabs of Covid-19 vaccines.
Who should not receive shots of the Covid-19 vaccine?
According to Dr. Anna Ong-Lim, a pediatric infectious disease expert and Department of Health (DOH) technical advisory group member, there is currently only one contraindication to Covid-19 vaccination.
“Currently yung nag-iisang contraindication is yung anaphylaxis or a severe allergy to a previous dose,” Lim said in an online briefing on Monday, explaining that those who will experience this contraindication will not be allowed to take further doses of Covid-19 vaccine.
(Currently, the only contraindication is anaphylaxis or a severe allergy to a previous dose of Covid-19 vaccine.)
The guidelines set by the Philippine Society of Allergy, Asthma, and Immunology (PSAAI) stated that: “Patients who have experienced an immediate allergic reaction, whether mild (e.g.rashes) or severe (e. g. anaphylaxis) to Covid-19 vaccine after the first dose should not receive the second dose.”
“Patients who have a history of allergic reaction or anaphylaxis to certain vaccine excipients such as polyethylene glycol (PEG) (which can also be found in colonoscopy preparation, or laxatives) or to polysorbate (which can be found in vascular graft materials, surgical gels, PEGylated medications) should not receive the Covid-19 vaccines.”
The persons mentioned by PSAAI, according to the Centers for Disease Control and Prevention (CDC), should not receive vaccine shots either from Pfizer-BioNTech or Moderna, since PEG is a component of the mRNA (messenger RNA) vaccine.
The patients are also advised by PSAAI to be referred to an allergist for further evaluation.
“Patients who have experienced an immediate allergic reaction, such as urticaria, angioedema, difficulty of breathing, regardless of severity, to any OTHER vaccine or
injected therapy must be evaluated by an allergist to assess possible allergic reactions to PEG or polysorbate. All vaccinated patients should be observed for at least 30 minutes after vaccination,” PSAAI added.
“Wala pa naman tayong nababakunahan so di natin masasabi,” said Dr. Carmela Kasala of the Philippine Pediatric Society, adding that it is crucial to monitor for any adverse effects following the first round of Covdi-19 vaccination in the country.
(We have yet to start vaccinating people so it is hard to say.)
“Yung mga on the second round natin kung nag react siya sa unang vaccine na binigay sa kanya, ‘di na po pwede ibigay yung pangalawang shot kasi baka maging fatal pa yung mangyari but this is very rare,” Kasala added.
(During the second round of vaccination, if the person severely reacted to the first dose, he/she can not get the second dose or shot because it might become fatal — although that kind of situation is very rare.)
Meanwhile, the World Health Organization (WHO) enumerated the following conditions that may disqualify a person from getting the coronavirus vaccine, specifically the Pfizer-BioNTech product:
- extreme allergic reactions
- pregnant and breastfeeding women
Can immunocompromised persons get Covid-19 vaccines?
Health Secretary Francisco Duque III on Friday said that immunocompromised individuals cannot receive jabs of Covid-19 vaccine due to adverse effects.
“‘Yong mga immunocompromised, ‘yong kanilang immune system na mahina o may tama, ay hindi natin pwedeng bigyan ng bakuna,” he told reporters in an ambush interview.
(Immunocompromised individuals, those whose immune systems are either weak or have taken a hit we cannot give them vaccines.)
Duque cited previous reports that some elderly people with underlying health conditions in Norway have died after getting inoculated with vaccine from the PfizerBioNTech.
However, according to the Global Advisory Committee on Vaccine Safety (GACVS), a committee which acts as a scientific and clinical advisory body to the WHO, there is no evidence yet linking the reported deaths of elderly people and PfizerBioNTech’s Covid-19 vaccine.
“The current reports do not suggest any unexpected or untoward increase in fatalities in frail, elderly individuals or any unusual characteristics of adverse events following administration of BNT162b2,” GACVS said in a statement last month.
“Reports are in line with the expected, all-cause mortality rates and causes of death in the sub-population of frail, elderly individuals, and the available information does not confirm a contributory role for the vaccine in the reported fatal events,” the committee added.
Health reform advocate Dr. Tony Leachon and kidney specialist Dr. Carlo Trinidad also disputed what they described as an “irresponsible” and “misleading” statement by Duque.
“Sec. Duque should rectify and qualify this misleading information. We will deprive the people who will surely benefit from vaccination,” Leachon said in a Twitter post on Friday.
Duque: Immunocompromised persons can’t get Covid-19 vaccines | Inquirer News
— Tony Leachon MD (@DrTonyLeachon) February 7, 2021
“I think [Duque is] confused or tired. Perhaps he must consult his vaccine expert panel. As long as these are not live attenuated vaccines, they hold no specific risk to an immunocompromised patient, other than any factors specific to the individual that could be a contraindication,” Leachon said in a separate Tweet.
I think he’s confused or tired. Perhaps he must consult his vaccine expert panel. As long as these are not live attenuated vaccines, they hold no specific risk to an immunocompromised patient, other than any factors specific to the individual that could be a contraindication.
— Tony Leachon MD (@DrTonyLeachon) February 5, 2021
Meanwhile, according to Trinidad, “Pfizer trials included patients with baseline comorbidities such as those with CANCER, AIDS, DIABETES, LEUKEMIA, LIVER DISEASE.”
The Pfizer trials included patients with baseline comorbidities such as those with CANCER, AIDS, DIABETES, LEUKEMIA, LIVER DISEASE. In my opinion, this is an irresponsible motherhood statement. https://t.co/fZkRSwBAAYhttps://t.co/nHCSpNGlug
— Carlo Trinidad, MD (@hellokidneyMD) February 5, 2021
Based on the Infectious Diseases Society of America (IDSA), Covid-19 vaccines that use mRNAs such as PfizerBioNTech and Moderna’s vaccines are “unlikely to pose a safety risk” for transplant patients since it is not a live vaccine.
“[B]ecause immunocompromised people may be at risk for severe COVID-19, CDC recommends these groups may still receive the vaccine if there are no contraindications,” the US-based medical association explained on its website.
“Transplant recipients should be counseled that the effectiveness and safety profile of these vaccines for them are not currently known,” IDSA added.
On the other hand, oncology patients, which IDSA said “many of whom are immunocompromised either by virtue of their disease of cancer or their treatment, e.g., chemotherapy, radiation, stem cell transplant,” can also get Covid-19 vaccines if they have no contraindications to vaccination.
However, since there are still limited data on the vaccines’ safety profile and efficacy in immunocompromised populations, IDSA suggested counseling patients before taking vaccine shots for Covid-19.
IDSA likewise clarified that patients with autoimmune diseases can be inoculated against Covid-19.
“Autoimmune disease is not a contraindication for the mRNA vaccines. The study populations for both mRNA vaccine trials included participants with autoimmune disease.”
“No imbalances were observed in the occurrence of symptoms consistent with autoimmune conditions or inflammatory disorders in clinical trial participants who received an mRNA Covid-19 vaccine compared to placebo.”
What about other allergic reactions and conditions?
CDC said those who have a food allergy, pet allergy, environmental allergies, and allergies to oral medications (including the oral equivalents of injectable medications) can and should get Covid-19 vaccine shots.
The agency explained that allergic reactions “not related to vaccines, injectable therapies, components of mRNA Covid-19 vaccines (including PEG), or polysorbates” are not considered a contraindication or precaution to Covid-19 vaccination.
“Hindi po totoo na contraindication kung may mag allergies kayo o asthma o may food allergy or drug allergy, hindi po totoo na hindi niyo pwedeng ma-receive ang bakuna. Pwede po [kayo mabakunahan],” Kasala emphasized.
(It is not true that yous should not get Covid-19 vaccine if you have allergies, asthma, food allergy, or drug allergy. You can still get vaccinated.)
“‘Wag po matakot. Isipin natin mas maraming benepisyo sa paglagay sa bakuna kesa sa wala tayong bakuna,” she added.
(Do not be afraid. Just think about it, there are more benefits in receiving Covid-19 vaccines than having none.)
Also included in PSAAI’s “special group” who can receive Covid-19 vaccines are:
- Patients with allergic reactions (of any severity) to food, inhalant/environmental allergens, insects, latex, oral medications, not related to vaccines and their components, can receive Covid-19 vaccines.
- Patients with immunodeficiency and autoimmune disease (e.g. Guillain-Barre Syndrome, Bell’s palsy) may also get vaccinated but they should be informed that there is still not enough data available to establish vaccine safety and efficacy in these conditions.
- Patients with well-controlled asthma and on inhaled corticosteroids, and those with allergic rhinitis on intranasal corticosteroids can receive the Covid-19 vaccine.
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