AstraZeneca, can the second dose be done with a different vaccine? What symptoms does thrombosis cause? –

How could the vaccination campaign change in the coming days?
The Vaxzevria vaccine (AstraZeneca) recommended for over 60s: this would be the line of the Technical Scientific Committee, confirming the opinions of the Ministry of Health and the Italian Medicines Agency. Young people would be excluded from the administration of the viral vector vaccine, after the rare cases of thrombosis that mainly affected young women. As advocated by several scientists, including the immunologist Alberto Mantovani. Instead, the debate on offering a different vaccine as a reminder to those under 60 who received the first dose of Vaxzevria is open. After the evaluation of the CTS, the final decision rests with the policy.

How many post-injection adverse reactions have been reported in Italy?
Pharmacovigilance has received reports of 45 cases of rare thrombosis on nearly nine million doses of Vaxzevria. According to the drug Agency’s fifth Covid vaccine surveillance report, there were 328 deaths in our country (data on May 26), of which 53 after Vaxzevria, 4 after Janssen (Johnson & Johnson) and 58 after Moderna. Most (213) have been reported with Comirnaty (BioNTech / Pfizer), the first vaccine authorized and used in greater quantities than the others. But no thrombotic events were observed with mRna vaccines. In Italy, in total, over 40 million doses have been administered.

How should someone who has received the first dose of Vaxzevria behave?
The vaccine mix is ​​not authorized by regulatory agencies, but several research groups are examining its effects. One of the hypothesized combinations includes the first dose of Vaxzevria and the second dose of Comirnaty. According to some recent studies, the vaccine mix could increase the immune response and stimulate the production of specific antibodies against Sars-CoV-2. But there are no conclusive data, because the number of people tested is still small. At the moment, therefore, those who have received the first dose of Vaxzevria without reporting serious side effects can booster with the same vaccine.

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What do we know about thrombosis related to viral vector vaccines?
According to European data, cerebral venous thrombosis or atypical sites concern, on average, one case for every 100,000 doses administered. They can affect, in rare cases, predominantly people under the age of 60 and have so far occurred almost exclusively after the first doses of Vaxzevria. For the other viral vector vaccine, Janssen, no conclusions can be drawn for the small amount of doses used. Ema, the European Medicines Agency, has recognized the existence of a possible link between Vaxzevria / Janssen and vaccine-induced immune thrombotic thrombocytopenia (Vitt, vaccine-induced immune thrombotic thrombocytopenia).

What are the symptoms and when do they appear? Are there effective therapies?
Symptoms of rare thrombosis can occur five days to three weeks after administration of the viral vector vaccine. Swelling in an arm or leg, abdominal pain that does not resolve, headache, blurred vision, dizziness, difficulty breathing, chest pain, rapid heartbeat, bleeding and bruising require an emergency alert. It is important that the disorder is treated quickly: the protocol provides for the administration of immunoglobulins and anticoagulants. Vitt is clinically very similar to heparin-induced autoimmune thrombocytopenia, which is why this drug cannot be used in post-vaccine thrombosis.

Are there categories of people more at risk for these events?
In April, the Italian Medicines Agency (Aifa) issued a non-stringent recommendation for the use of viral vector vaccines in people over 60 years of age. Initially Vaxzevria was recommended only for the under 55s. The autoimmunity more frequent in young women and the incidence of Vitt confirms this characteristic – says Pier Mannuccio Mannucci, hematologist and member of the Aifa commission for the evaluation of the risk of thrombosis associated with anti Covid -. Autoimmune diseases generally have two peaks, in juvenile and old age. In this case, however, except in rare cases, rare thrombosis does not affect the elderly.

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What happened in Great Britain, the first country to use Vaxzevria?
Over 34 million people have been vaccinated in the UK. The British government has chosen, in recent months, to delay the recalls beyond the scheduled schedule to increase coverage with the first doses, but now the infections are on the rise due to the Delta (Indian) variant. In recent weeks, the National Health Service (NHS), a public health body, has advised against the use of Vaxzevria in people under 40. Those who received the first dose of the AstraZeneca vaccine without suffering from significant side effects – said the NHS – can instead carry out the booster with the same vaccine, regardless of age and health conditions.

June 11, 2021 (change June 11, 2021 | 08:58)



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