When can the Covid-19 vaccine be postponed? The Italian Society of General Medicine and Primary Care (Simg) offers a detailed answer to this and other questions, which has produced a document, in collaboration with the Higher Institute of Health and the Ministry of Health, with all the information useful for family doctors and vaccinators, since – reads a note – “some questions remain on how to behave in the face of particular cases”. Cases on which the ministerial circulars of 4 and 5 August intervened concerning the issue of ‘anti-Covid-19 vaccination exemption certificates’.
With these circulars – explains Simg – the Ministry of Health has regulated the adoption and issue of exemption certificates for those who, due to specific and documented clinical conditions, cannot receive vaccination or complete the vaccination cycle and those who have received the Reithera vaccine, also in order to obtain the Covid-19 European green certification. Therefore, temporarily and until 30 September 2021, unless otherwise specified, the vaccination exclusion certificates already issued by the regional health services are valid on the national territory.
There are conditions – explains Simg (whose document can be consulted at the link https://www.simg.it/esesimo-da-vaccino-anti-covid-19-vademecum-operativo/) – in which it is preferable to postpone vaccination and are linked to the protection already guaranteed from infection: these are positive patients at least three months after the first positive swab and patients with Covid-19 who have received therapy with monoclonal antibodies where at least three months have not passed since treatment. There are also subjects in quarantine for close contact and subjects with suspected symptoms of Covid-19: in these cases the opportunity for vaccination will take place at the end of the quarantine or subsequently at the end of the diagnostic process. To these are added patients with severe non-deferrable acute disease (such as an acute cardiovascular event, acute hepatitis, acute nephritis, septic state or severe infection of any organ / tissue, major surgical condition, etc.).
In general – continues Simg – a vaccine should not be administered when there is a contraindication such that the risk of adverse reactions is greater than the benefits induced by vaccination. The presence of a contraindication to a specific vaccine does not exclude the possibility that other available vaccines can be administered. And as a specific contraindication to one or more of the vaccines currently used in Italy, Simg identifies hypersensitivity to the active ingredient or to any of the excipients. In case of a severe allergic reaction to the first dose of a Covid-19 vaccine, the possibility of using a different type of vaccine to complete the immunization may be considered.
Vaccination – the family doctors still remember – is not contraindicated in pregnancy. Guillain-Barré syndrome has been reported very rarely after administration of Vaxzevria and Janssen. And again: there are also some false contraindications, which as such do not give the right to an exemption certificate. Among the most common, breastfeeding is not a contraindication to vaccination; people with a history of Bell’s palsy and individuals with autoimmune diseases can receive any vaccine authorized by Ema, as well as immunocompromised patients and oncologists undergoing radio-chemotherapy, unless specific contraindications.
People with a history of severe allergic reactions unrelated to vaccines or injectable drugs, such as allergies to food, pets, insect venom, the environment or latex – Simg points out in the document – can be vaccinated, as can those with a history of allergies to oral medications or a family history of severe allergic reactions, or who may have a milder allergy to vaccines (no anaphylaxis).