Can I choose what vaccine I get? What if I have allergies or side-effects? Key COVID vaccine rollout questions answered


Marc Pellegrini, Walter and Eliza Hall Institute

Australia’s keenly awaited COVID vaccine rollout begins today, with the ultimate goal of vaccinating all Australians by October.

Here are the answers to some key questions.

Can I choose which vaccine I get?

No, there won’t be a choice for the average person. The current initial rollout of the Pfizer vaccine isn’t enough doses to vaccinate all of Australia. So the first people vaccinated with the Pfizer vaccine will be frontline health-care workers, including aged care and hotel quarantine officers.

The AstraZeneca vaccine will be produced for the general public. It’s hoped that will be rolled out during March.

I can’t say how the logistics will run — that’s up to the government, presumably on a state-by-state basis. Most likely they will try to prioritise the highest-risk groups such as the elderly and people with chronic health conditions.

For most people it will be a case of waiting for further announcements as to when enough vaccine is available and it’s appropriate to make an appointment. Children are unlikely to be included in the vaccination program.

Infographic on COVID vaccine rollout

The Conversation, CC BY

How will I be monitored for side-effects?

As doctors, when we vaccinate people we generally like to look after them for about 15-30 minutes, just to check they haven’t had an adverse reaction. That should be the practice for the COVID jab, just the same as for any vaccine.

For those 15-30 minutes you will generally just be sitting in a waiting area at the clinic. You will be monitored to see if you develop any symptoms such as hives or a rash, or wheezing. In those cases you would be monitored even more carefully and staff would take your blood pressure and pulse rate.

If you experience any symptoms once you’ve gone home, it would be up to you to contact your local doctor. Obviously, when trying to vaccinate 25 million people, health authorities can’t follow up with every individual. It’s very much up to them to follow up with whoever gave them the vaccine — whether their GP clinic or other health service.




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Should I still have the vaccine if I have an allergy?

That needs to be a conversation between individuals and their doctor, who can advise on a case-by-case basis. But, generally speaking, there are no common allergies that should stop you having a COVID vaccine. If someone has a peanut allergy they can have the vaccine, and the same goes for shellfish, wheat, eggs or any other common allergies.

Some people are allergic to an ingredient called polyethylene glycol, or PEG, which is found in more than 1,000 different medications and is used in the Pfizer vaccine as a mechanism to help deliver the viral mRNA (genetic material) into your cells. In the US and UK vaccine rollouts, a very small proportion of people seemed to have an allergy to this compound: with a million doses you might see about ten people have this allergic reaction. It is rare, albeit less rare than allergic reactions to influenza vaccines.

But no one has yet died from being vaccinated against COVID, so these cases are being captured effectively and are generally detected within the initial observation period of 15-30 minutes. Severe reactions can be treated with an epipen; less severe cases are just monitored.

People might already know they’re allergic to PEG and they shouldn’t receive the Pfizer vaccine, but if they don’t know, there’s no way of knowing that in advance.




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The Oxford/AstraZeneca vaccine doesn’t contain PEG. It contains a related compound called polysorbate, which appears not to trigger the same allergy. If you have a known allergy to PEG you would probably be given the AstraZeneca vaccine.

It’s important to stress that these compounds are not preservatives — they are mechanisms to deliver the vaccines effectively.

Will I be fully protected? Do I still need to follow COVID restrictions?

The two vaccines have different efficacy rates — 95% for Pfizer, 62% for AstraZeneca — but these refer to their ability to prevent infection rather than disease. The fact is both are very good at preventing serious disease.

This means that, although you may still have a chance of being infected, you are much less likely to develop severe symptoms, and therefore less likely to infect others. Someone with severe COVID might be coughing and spluttering and spreading the virus more easily, while someone without symptoms might not.

Bear in mind there are two main reasons for the vaccine rollout. The first is to protect members of the public from getting very ill or dying.

The second aim is to provide a degree of immunity in the general population that will ultimately stop the virus circulating.

Of course, this second goal is much harder, which is why it’s still important that we follow any and all COVID precautions. But the hope is that over time we’ll see fewer and fewer people who are COVID-positive, and the risk of spread will fall.

Federal government information on the vaccine rollout.

Will the vaccine last forever or will I need to be revaccinated in future?

The current COVID vaccines require two doses, several weeks apart. It’s very tricky to say how long the resulting immunity will last, because globally we have only had these vaccines in use since December or so. It’s possible the immunity might last a year or longer, but at the moment it’s unclear. People might well have to be revaccinated at some stage.

We’ll start to get that data soon though. In fact we should have plenty more information by the time the AstraZeneca vaccine starts to be administered in high numbers in Australia around June or July.




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Will the vaccines work against mutant coronavirus strains?

In the fullness of time I expect we’ll start to see “escaped mutant” variants of the coronavirus that can evade the vaccine or make it less effective.

To an extent that’s happened already — the AstraZeneca vaccine looks to be less effective against the South African variant than against the other current variants. Having said that, although it’s not as effective at preventing infection, it still probably has a good chance of stopping you getting seriously sick.

Because we’re not vaccinating everyone in the world, there will always be a pool of people who can incubate new viral strains, potentially giving rise to new mutant variants.

There’s no doubt the vaccines will need to be updated from time to time to deal with this.

Thankfully this process will be relatively straightforward. mRNA vaccines such as Pfizer’s can be tweaked very quickly – virtually overnight – to accommodate new mutants. It’s a bit trickier with non-mRNA vaccines such as the AstraZeneca and Chinese vaccines, but it can still be done.

Will the vaccine rollout mean no more lockdowns?

The vaccine rollout should give us a much firmer handle on the spread of the virus. We can hope to stop seeing hotel quarantine workers being infected and spreading the virus outside, which is what has prompted the recent snap lockdowns in various Australian cities.

As for whether we’ll ever find ourselves in lockdown again, well, we’ll just have to wait and see. But if we’re still persisting with hotel quarantine and hosting arrivals from overseas, the vaccine program will hopefully mean we can afford to be much more liberal with opening our borders without fear that the virus will run rife.




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The Conversation


Marc Pellegrini, Researcher, Walter and Eliza Hall Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

If I have allergies, should I get the coronavirus vaccine? An expert answers this and other questions



Sandra Lindsay, left, a nurse at Long Island Jewish Medical Center, is inoculated with the COVID-19 vaccine by Dr. Michelle Chester.
Mark Lennihan/Pool via Getty Images

Mona Hanna-Attisha, Michigan State University

Editor’s Note: With a coronavirus vaccination effort now underway, you might have questions about what this means for you and your family. If you do, send them to The Conversation, and we will find a physician or researcher to answer them. Here, Dr. Mona Hanna-Attisha, a public health pediatrician whose research exposed the Flint, Michigan, water crisis, answers questions about the vaccine and allergies, and when kids might be able to get the vaccine.

If I have allergies, should I still get the vaccine?

If you have a history of allergies to food, pets, insects or other things, the Centers for Disease Control and Prevention recommends that you proceed with vaccination, with an observation period. If you have a history of severe allergic reaction, or what is called anaphylaxis, to another vaccine or injectable therapy, your doctor can do a risk assessment, defer your vaccination, or proceed and then observe you after vaccination. The only reason to avoid vaccination is a severe allergic reaction to any component of the COVID-19 vaccine. The CDC has specific recommendations for post-vaccine observation.

As the vaccine goes out to a broader population, how will adverse events be tracked?

The CDC and Food and Drug Administration encourage the public to report possible adverse events to the Vaccine Adverse Event Reporting System, or VAERS. This national system collects these data to look for adverse events that are unexpected, appear to happen more often than expected or have unusual patterns of occurrence. Anyone who has experienced an adverse event should report it to the system.

Reporting an adverse event is a crucial step to ensuring safety and to help the CDC monitor the vaccines. Safety is a top priority, and scientists and public health officials need to know about adverse reactions.

An adverse event is different in most cases from a typical vaccine side effect. Vaccines may cause a side effect, such as soreness at the injection site or redness. Adverse events are more serious and can sometimes be life-threatening. If you are unsure whether you have experienced a side effect or adverse event, you can still report the event.

Participants are given a fact sheet when they are vaccinated. Health care providers who vaccinate people will be required to report to VAERS certain adverse events following vaccination. In addition, under the terms of the emergency use authorization, health care providers also must follow any revised safety reporting requirements that may arise.

The CDC is also implementing a new smartphone-based tool called v-safe to check in on people’s health after they receive a COVID-19 vaccine. When you receive your vaccine, you should also receive an information sheet telling you how to enroll in v-safe. If you enroll, you will receive regular text messages directing you to surveys where you can report any problems or adverse reactions you have after receiving a COVID-19 vaccine.

Triage guidelines from CDC for administering the Pfizer-BioNTech COVID-19 vaccine.
Clinical guidelines from the Centers for Disease Control and Prevention for determining which patients should receive the Pfizer-BioNTech COVID-19 vaccination.
CDC

When might kids younger than 16 be vaccinated?

It is likely to be several months. The currently authorized Pfizer and soon-to-be-authorized Moderna vaccine are not applicable for children. More research and clinical trials need to be done to include younger children in COVID-19 vaccine trials.

According to the American Academy of Pediatrics, Pfizer has enrolled children down to age 12 and submitted a request for emergency use authorization for vaccination down to age 16. Moderna, whose vaccine is expected to receive emergency use authorization from the FDA any day, is about to start a similar study.

In the United Kingdom, AstraZeneca has approval to enroll children ages 5 to 12 in clinical trials, but the pharmaceutical company has not yet enrolled any children in trials in the U.S.The Conversation

Mona Hanna-Attisha, Professor of Medicine, Michigan State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

People with severe allergies warned off Pfizer COVID vaccine for now. But that may change as more details emerge


Giovanni Cancemi Shutterstock

Nicholas Wood, University of Sydney and Ketaki Sharma, University of Sydney

Two people in the United Kingdom have experienced an allergic reaction to the Pfizer/BioNTech COVID-19 vaccine. This led the UK medicines regulator to issue precautionary advice earlier this week that “people with a significant history of allergic reactions” should not be given this vaccine for now.

This is an appropriate cautious move. The advice may change once we understand more about what caused these reactions.

Both people reportedly had known allergies and carried adrenaline autoinjectors, suggesting they had a prior history of severe allergic reactions, such as anaphylaxis, a severe and rapid form of allergy.

At this stage, we do not have many further details about the reported allergic reactions to the vaccine.

An advisory panel to the United States Food and Drug Administration (FDA) has recommended the authorisation of the Pfizer/BioNTech vaccine for emergency use. If the FDA grants this approval, it would be the third country behind the UK and Canada to do so.

How common are these types of reactions?

Severe allergic reactions to vaccines are extremely rare, with anaphylaxis occurring after approximately one per million vaccine doses.

Most reactions reported as possible allergic reactions to vaccines are most likely not true allergies.

Regardless, every person is normally asked about their medical history by their immunisation provider, including whether they have any known allergies, especially to a vaccine or its ingredients, before being vaccinated.




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As almost all severe allergic reactions occur within 15 minutes of exposure to the trigger, it is common around the world to monitor patients for at least 15 minutes after vaccination.

In Australia, it is recommended that any facility where vaccinations are delivered is equipped with the equipment and trained staff to recognise and treat allergic reactions. This applies to all vaccines, including COVID-19 vaccines.

What types of allergens are we talking about?

People can be allergic to a wide range of substances (called allergens), including foods and medications. If someone has a known allergy to a vaccine ingredient, they may be advised not to have that vaccine.

The Pfizer/BioNTech COVID-19 vaccine does not contain any ingredients that commonly cause allergic reactions, and the full list of ingredients has been published by the UK medicines regulator.

It is likely the two people who may have had an allergic reaction after the Pfizer vaccine will be reviewed by an allergy/immunology specialist. If found that they truly had anaphylaxis they would be unlikely to be given the second dose of the vaccine.

However in some situations, people who have had allergic reactions after one dose may be able to receive further doses of the same vaccine using a specialised approach, such as graded dosing, which can avoid triggering a reaction. This approach has not yet been reported for any COVID-19 vaccine.




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Aren’t clinical trials supposed to pick up issues like this?

People with a history of severe allergic reaction to a vaccine or to any ingredient of the Pfizer/BioNTech vaccine were not included in the late phase clinical trial for this vaccine.

This is a precaution designed to protect the safety of the trial participants. Clinical trials usually focus on healthy people without underlying medical conditions, although the Pfizer phase 2/3 trial allowed enrolment of people with stable pre-existing chronic conditions.

Once the safety and effectiveness of a vaccine is well established in healthy people, it can then be offered to other populations, such as people with severe underlying medical conditions.

This trial includes more than 40,000 participants and has shown the vaccine to be safe and well tolerated, with no serious safety concerns. The incidence of allergic-type symptoms after vaccination was slightly higher in the vaccinated group at 0.63% compared with the placebo group at 0.51%, however it is not clear whether this slight difference is due to chance.




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What are the implications for people with significant allergies?

As to the implications of this latest news for people with significant allergies, it’s too early to tell. We still don’t know if these reports were true allergic reactions.

There is also no theoretical reason to suspect allergic reactions would be more common with COVID-19 vaccines than with other vaccines, even those using newer technologies.

As always, people should discuss their medical history with their vaccine provider, including any history of allergy.




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We still need ongoing monitoring

Given COVID-19 vaccines will be delivered to millions of people around the world, it’s inevitable some adverse events will be reported. There is potential for an adverse reaction with any medication or vaccine, and that’s why people are monitored after being given a vaccine. A consideration of the risks and benefits is always important when considering whether to have a vaccine.

More than 1.5 million people have died from COVID-19 so far, and thousands more are dying each day. The benefits of vaccination will far outweigh the risks, particularly for the priority population groups most vulnerable to COVID-19.

Ongoing monitoring of COVID-19 vaccine safety is also crucial and will allow us to detect side effects that may be very rare, or which may be related to an underlying medical condition.

In Australia, we’ll be doing this with a robust vaccine safety surveillance system, which will be used to monitor the safety of any licensed COVID-19 vaccines in near-real time, and which will provide publicly available updates.The Conversation

Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of Sydney and Ketaki Sharma, Clinical Lecturer, Discipline of Childhood and Adolescent Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Early exposure to infections doesn’t protect against allergies, but getting into nature might



Katya Shut/Shutterstock

Emily Johnston Flies, University of Tasmania and Philip Weinstein, University of Adelaide

Over the past few decades, allergies and asthma have become common childhood diseases, especially in developed countries. Almost 20% of Australians experience some kind of allergy, whether it’s to food, pollen, dust, housemites, mould or animals.

When people suffer from food allergies, hay fever or asthma, their immune system incorrectly believes the trigger substances are harmful and mounts a defence.

The response can range from mild symptoms, such as sneezing and a blocked nose (in the case of hay fever), to anaphylaxis (from severe food allergies or bee stings) and asthma attacks.




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We used to think the rise in allergic conditions was because we weren’t exposed to as many early infections as previous generations. But the science suggests that’s not the case.

However it seems being out in nature, and exposed to diverse (but not disease-causing) bacteria, fungi and other microorganisms may help protect against asthma and allergies.

Remind me, what’s the hygiene hypothesis?

In 1989, researcher David Strachan examined allergy patterns in more than 17,000 children in England. He noticed young siblings in large families were less likely to have hay fever than older siblings or children from small families.

He proposed that these younger siblings were exposed to more childhood illness at a younger age, as more bugs were circulating in these large families and the younger children were less likely to wash their hands and practise good hygiene.

Greater exposure to these childhood infections helped “train” their immune systems not to overreact to harmless things like pollen.

Strachan coined the term “hygiene hypothesis” to explain this phenomenon, and the idea has been appealing to our dirty side ever since.

Yes, it’s a good idea for kids to wash their hands regularly to avoid getting sick.
Wor Sang Jun/Shutterstock

Strachan wasn’t the first to notice exposure to “dirty environments” seemed to prevent allergic disease. A century earlier, in 1873, Charles Blackley noted hay fever was a disease of the “educated class”, and rarely occurred in farmers or people living in less sanitary conditions.

Ditching the hygiene hypothesis

However, Blackley and Strachan were wrong about one important thing: the association between sanitation and allergies is not due to reduced exposure to early childhood infections (or “pathogens”).

Large studies from Denmark, Finland, and the United Kingdom have found no association between the number of viral infections during childhood and allergic disease. In other words, exposure to disease-causing pathogens doesn’t appear to prevent allergies.

In fact, exposure to childhood viral infections, in addition to making a child sick, may contribute to the development of asthma in predisposed children.




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Many researchers now argue the term “hygiene hypothesis” is not only inaccurate but potentially dangerous, because it suggests avoiding infection is a bad thing. It’s not.

Good hygiene practices, such as hand washing, are critical for reducing the spread of infectious and potentially deadly diseases such as influenza and the Wuhan coronavirus.

What about ‘good’ exposure to bacteria?

For healthy immune function, we need exposure to a diverse range of bacteria, fungi and other bugs – known as microbes – in the environment that don’t make us sick.

We need exposure to a range of organisms found in nature.
caseyjadew/Shutterstock



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Within urban environments, recent research shows people who live closer to green, biodiverse ecosystems tend to be healthier, with less high blood pressure and lower rates of diabetes and premature death, among other things.

More specifically, research has found growing up on a farm or near forests, with exposure to more biodiverse ecosystems, reduces the likelihood of developing asthma and other allergies.




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This is potentially because exposure to a diversity of organisms, with a lower proportion of human pathogens, has “trained” the immune system not to overreact to harmless proteins in pollen, peanuts and other allergy triggers.

How can we get more ‘good’ exposure?

We can try to expose children to environments more like the ones in which humans, and our immune systems, evolved.

Most obviously, children need to have exposure to green space. Playing outdoors, having a garden, or living near green space (especially near a diverse range of native flowering plants) is likely to expose them to more diverse microbes and provide greater protection from allergic diseases.

Infants who are breastfed tend to have more diverse gut microbiomes (a larger variety of bacteria, fungi and other microscopic organisms that live in the gut), which makes them less likely to develop allergic diseases in childhood.




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Having a varied diet that includes fresh and fermented foods can help cultivate a healthy gut microbiome and reduce allergic disease. As can using antibiotics only when necessary, as they kill off good bacteria as well as the bad.

So keep washing your hands, especially in cities and airports, but don’t be afraid of getting a little dirty in biodiverse environments.

This article was co-authored by Chris Skelly, International Programme Director, Healthy Urban Microbiomes Initiative and Head of Programmes (Research and Intelligence), Public Health Dorset.The Conversation

Emily Johnston Flies, Postdoctoral Research Fellow (U.Tasmania), University of Tasmania and Philip Weinstein, Professorial Research Fellow, University of Adelaide

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Tough nuts: why peanuts trigger such powerful allergic reactions



The humble peanut. Tasty for most, treacherous for some.
Dr Dwan Price, Author provided

Dwan Price, Deakin University

Food allergens are the scourge of the modern school lunchbox. Many foods contain proteins that can set off an oversized immune reaction and one of the fiercest is the humble peanut.

Around 3% of children in Australia have a peanut allergy, and only 1 in 5 of them can expect to outgrow it. For these unlucky people, even trace amounts of peanut can trigger a fatal allergic reaction.

But what sets the peanut apart from other nuts? Why is it so good at being an allergen?

To answer this, we have to explore the pathway from allergen to allergy, and just what it is about an allergen that triggers a response from the immune system.




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How food gets to the immune system

Before coming into contact with the immune system, an allergen in food needs to overcome a series of obstacles. First it needs to pass through the food manufacturing process, and then survive the chemicals and enzymes of the human gut, as well as cross the physical barrier of the intestinal lining.

After achieving all of this, the allergen must still have the identifying features that trigger the immune system to respond.

Many food allergens successfully achieve this, some better than others. This helps us to understand why some food allergies are worse than others.

The most potent allergens – like peanuts – have many characteristics that successfully allow them to overcome these challenges, while other nuts display these traits to a lesser extent.

Strength in numbers

The first characteristic many allergenic foods have, especially peanuts, is strength in numbers. Both tree nuts and peanuts contain multiple different allergens. At last count, cashews contain three allergens, almonds have five, walnuts and hazelnuts have 11 each and peanuts are loaded with no less than 17.

Each allergen has a unique shape, so the immune system recognises each one differently. The more allergens contained in a single food, the higher the potency.
Additionally, many of these allergens also have numerous binding sites for both antibodies and specialised immune cells, further increasing their potency.

Stronger through scorching

The first hurdle for a food allergen is the food manufacturing process. Many nuts are roasted prior to consumption. For most foods, heating changes the structure of proteins in a way that destroys the parts that trigger an immune response. This makes them far less potent as allergens.

This is not the case for many tree nuts: allergens in almonds, cashews and hazelnuts survived roasting with no loss of potency.

And for the major peanut allergens, it’s even worse. Roasting actually makes them more potent.




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The gauntlet of the gut

From here, the allergen will have to survive destruction by both stomach acid and digestive enzymes within the human gut. Many nut allergens have the ability to evade digestion to some degree.

Some simply have a robust structure, but peanut allergens actively inhibit some of the digestive enzymes of the gut. This helps them safely reach the small intestine, where the allergens then need to cross the gut lining to have contact with the immune system.

This is where peanut allergens really stand apart from most other allergens. They have the ability to cross the intestinal cells that make up the gut lining. Given their relative sizes, this is like a bus squeezing itself through a cat flap.

Peanut allergens accomplish this remarkable feat by altering the bonds that hold the gut cells together. They can also cross the lining by hijacking the gut’s own ability to move substances. Once across, the allergens will gain access to the immune system, and from there an allergic response is triggered.

Peanut allergens attack the bonds that hold intestinal cells together.
Dr Dwan Price, Author provided

The combination of multiple allergens, numerous immune binding sites, heat stability, digestion stability, enzyme blocking, and the effect on the gut lining makes peanut a truly nasty nut.

Where to from here?

This leaves us with a nagging question: if peanuts are so potent, why doesn’t everyone develop a peanut allergy? We still don’t know.

Recently, a potential vaccine developed by researchers from the University of South Australia has shown promise in reprogramming the immune system of mice and blood taken from people with peanut allergy. Will this translate to a potential treatment for peanut allergy? We will have to wait and see.

For now, the more we learn about the action of allergens, and the more we understand their effects on our body, the more we can develop new ways to stop them. And eventually, we might outsmart these clever nuts for good.The Conversation

Dwan Price, Molecular Biologist and Postdoc @ Deakin AIRwatch pollen monitoring system., Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.