The following is a summary of relevant content relating to the administration of the AstraZeneca COVID-19 vaccination in south east London, following updated advice by the JCVI on 7 May.
- Official statements on AztraZeneca COVID-19 vaccine 7 May 2021
- Summary of updated advice 7 May 2021
- Information for clinicians and staff
- Materials to support communications
- Managing suspected adverse effects in south east London
Official statements on AztraZeneca vaccine 7 May 2021
- Use of the AstraZeneca COVID-19 vaccine: JCVI statement, 7 May 2021
- MHRA Statement on the updated JCVI advice, 7 May 2021
- Government statement on the updated JCVI advice, 7 May 2021
Summary of updated advice
Summary points of updated advice on 7 May 2021:
- In addition to those aged under 30, unvaccinated adults aged 30 to 39 years who are not in a clinical priority group at higher risk of severe COVID-19 disease, should be offered an alternative to the AstraZeneca COVID-19 vaccine, where possible and only where no substantial delay or barrier in access to vaccination would arise.
- For those under 40 years who are of older age, male, obese (BMI above 30), from certain ethnic minority backgrounds or experiencing socio-economic deprivation, the risks of acquiring and/or suffering complications of COVID-19 are higher. Every effort should be made to remove barriers to accessing vaccination in those individuals.
- All those who have received a first dose of the AstraZeneca vaccine should continue to be offered a second dose of AstraZeneca vaccine, irrespective of age. The second dose will be important for longer lasting protection against COVID-19.
- The only individuals who should NOT have a second dose of AstraZeneca are patients who have experienced major venous and/or arterial thrombosis occurring with thrombocytopenia following vaccination with any COVID-19 vaccine should not receive a second dose of COVID-19 AstraZeneca vaccine.
- JCVI has also advised that everyone offered a COVID-19 vaccine should be fully informed about the benefits and risks of vaccination and give their consent accordingly.
Information for clinicians and staff
Information for healthcare workers on blood clotting (updated 7 May 2021) can be found on the PHE website along with a patient leaflet on blood clots (updated 7 May 2021) that explains the risks and benefits of the AstraZeneca vaccine for different age groups.
The SEL Referral Form for AstraZeneca alternative for patients and staff members who are eligible for COVID-19 vaccination and are within a patient group that has been specifically advised by the Joint Committee on Vaccination and Immunisation (JCVI) to be offered an alternative COVID-19 vaccine to the Oxford-AstraZeneca (AZ) vaccine (updated 10 May 2021)
Updated Patient Decision Aid – AstraZeneca (AZ) Covid-19 vaccine and the risk of blood clotting
Capillary leak syndrome is now included as a contraindication to the AZ vaccine, please see the SPC for further information. The patient decision aid (PDA) has subsequently been updated to reflect this change and is available here . The document also provides information on managing suspected adverse effects with the vaccine.
SEL has also put together a process for managing suspected adverse effects in South East London (updated April 2021)
Other useful documents include:
- FAQs: MHRA and JCVI guidance on AstraZeneca Covid-19 and very rare clotting disorders (updated 15 April 2021)
- Guidance for regulated healthcare professionals to use when talking to patients about vaccination and blood clotting (updated 23 April 2021)
- Regulatory approval of COVID-19 Vaccine AstraZeneca (updated 15 April 2021)
- National protocol for COVID-19 Vaccine AstraZeneca (ChAdOx1-S [recombinant]) (updated 27 April 2021)
Materials to support communications with patients
- Public-facing information leaflet from PHE in multiple languages.Winton Centre analysis on communicating the benefits and harms of the AZ vaccine
- Information for people who have had their first COVID-19 vaccination
- The NHS.uk coronavirus vaccination webpage has been updated to include details about vaccination and blood clotting.
Managing Suspected Adverse Effects with Oxford/Astra-Zeneca COVID-19 Vaccination in south east London
The MHRA have published new advice (April 2021):
The benefits of administering covid-19 vaccinations continue to outweigh the risks of potential side effects, however as a precautionary measure, anyone who has symptoms four days or more after vaccination is advised to seek prompt medical advice, such as:
- a new onset of severe or persistent headache, blurred vision, confusion or seizures
- develop shortness of breath, chest pain, leg swelling or persistent abdominal pain,
- unusual skin bruising or pinpoint round spots beyond the injection site
Referral pathways and action to take: The MHRA states that the reported clots following the first AZ Covid-19 vaccination dose have been associated with a low platelet count, so please check full blood count (FBC) in any patient with suspected adverse effects.
For a confirmed DVT and confirmed PE: Urgent referral to the thrombosis team (follow local pathways)
For a suspected CVST: If clinical signs are present such as a severe headache and neurological signs refer the patient to your local emergency department and for all suspected strokes dial 999. For mild to moderate headaches, please check FBC and, if platelets are low, please refer to your local emergency department.
Please continue to report anyone who suspects they have experienced a side effect linked with their COVID-19 vaccine to the Coronavirus Yellow Card website.
Local SEL anticoagulation contact emails if you require further advice: