Frequently Asked Questions Part 2: COVID-19 Vaccine
By Abhaya Trivedi, MD
To view “Frequently Asked Questions Part 1: COVID-19 Vaccine Products” by Shannon Rotolo, PharmD, BCPS, please click here.
As a pulmonary and critical care physician, I have been treating severely ill COVID patients for over 11 months. While the experience of taking care of thousands of COVID patients at our hospital and the data we have learned from studies have equipped us to provide better care for these patients, people still die from this disease. Vaccination represents the most effective means to prevent moderate to severe COVID and death due to COVID. As vaccines have become available, I have felt some hope that the medical community can finally prevent death. Many questions about vaccines remain prevalent, even in the medical community. At the beginning of the US vaccine rollout, I was eagerly awaiting my opportunity to schedule my first vaccine dose and remember being in a COVID patient room with two of our critical care nurses. Here are some of the questions they asked:
Q: Are you going to get the vaccine? Are you worried about any of the side effects?
A: Without hesitation my answer was a loud “YES.” As I was examining the patient in that room who was dependent on the ventilator due to complications of COVID, I knew that side effects that someone may experience from the vaccine would be minimal compared to the devastation caused by this disease. Shortly after, I was able to receive my first dose and only had minimal pain at the site of injection. Three weeks later, two of my colleagues described common symptoms of mild fever and chills after the second dose of the vaccine. Those symptoms resolved quickly and both of those doctors were at work in the intensive care unit the following morning. I received my second injection that morning and had no further symptoms other than pain at the site of injection. While some people do experience side effects, most symptoms resolve within 24 – 48 hours and they do not compare to contracting the virus itself. Serious allergic reaction, such as anaphylaxis can occur with both vaccines, but these events are rare and treatable. Initial reporting from the Vaccine Adverse Event Reporting System revealed 11 cases of anaphylaxis per million doses for the Pfizer vaccine and 2.5 cases per million doses for the Moderna vaccine. There were no reported cases of Guillain-Barre syndrome in those that participated in the trials.
Healthy, younger individuals may not be as concerned, but I have heard other members of specific vulnerable populations ask about safety of the vaccine – including those that are pregnant, immunocompromised, and elderly.
Q: Does the vaccine cause infertility? If I do get pregnant or am breastfeeding, should I get the vaccine?
A: There is no evidence to suggest the vaccine causes problems with fertility. Although pregnant and breastfeeding women were intentionally excluded from the trials, several women became pregnant during the course of the trial and did not have complications.
Initially, I was hesitant to recommend the vaccine to my friends that are pregnant. However, the following information we currently have about the vaccine is reassuring; the mRNA vaccine does not contain live particles, it does not alter the DNA of the recipient and cannot cause genetic changes. My thoughts on this continued to change as I reviewed the data on pregnancy outcomes in COVID positive women. Pregnant COVID patients are at increased risk for severe disease including increased risk of intensive care unit admission, need for the ventilator for respiratory support, and death compared to symptomatic non-pregnant COVID positive women. I was reminded of these risks last week when one of the new patients transferred to the ICU was a young, pregnant woman with COVID and all team members involved in her care were on heightened alert. Thankfully, she recovered and was safely discharged home, but I worried for a worse outcome for her initially. The vaccine can protect pregnant women like this patient from severe disease and is recommended by the American Colleague of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC). The World Health Organization (WHO) is also now recommending COVID vaccination for select groups of pregnant women who are at higher risk for severe illness.
I spent a lot of time of the first year of the pandemic pumping breast milk for my infant. I continued to do so despite high risk exposures because I knew that if I became ill with COVID, the medical community recommends that I should continue to provide breast milk. The body’s response to a COVID infection is to produce antibodies to the virus: these antibodies also pass through expressed milk to my baby. The vaccine works in a similar way. Infants of vaccinated mothers who breastfeed can benefit from antibodies against COVID-19.
Q: I am immunocompromised. Is the vaccine safe for me?
A: The trials for the currently available vaccines did not include large numbers of patients with compromised immune systems. However, immunocompromised patients including patients with cancer, organ or bone marrow transplants, HIV, and those receiving steroids or other medications to suppress the immune system such as Humira and other biologics are at increased risk for severe disease from COVID-19. Patients in these categories should discuss receiving the vaccine with their doctors and get vaccinated as long as there are no contraindications. As the vaccine is inactive, it does not cause dissemination of the virus. Based on the experience with other inactive vaccines (such as the Influenza vaccine), no unique or major side effects have been reported in patients that are immunocompromised. Because the vaccine works by relying on the host to produce an immune response, the vaccine may not be as effective in an immunocompromised person. For this reason, immunocompromised people must remain vigilant and follow all the other measures such as hand washing, wearing a mask, and social distancing even after receiving the vaccine.
Q: Is there a maximum age that it is safe to receive the vaccine?
A: The trials did not include frail elderly patients, as those enrolled had to be healthy enough to come in for ambulatory visits. Studies continue to show that increased age is a risk factor for severe disease and death from COVID-19. The CDC reported in August 2020 that patients between the age of 75-84 had 8 times the risk of hospitalization and 220 times the risk of death and those over 85 had 13 times the risk of hospitalization and 630 times the risk of death than the comparison group of those between the ages of 18-29 with COVID. While more data needs to be collected regarding the safety in this population, this group is at most risk for severe disease. The graph below, from the Illinois Department of Public Health, shows the exponential increase in death from COVID with increasing age in Illinois.
The currently available vaccines have been studied in tens of thousands of patients and have shown an excellent safety profile. While there are additional factors to contemplate if you are currently pregnant, immunocompromised, or elderly, the increased risk of severe illness in these groups is the major reason to consider vaccination. As I continue to care for critically ill patients with COVID, I know that the best way to prevent their ICU admission is by vaccination. If we want to prevent further deaths from this disease, we must get vaccinated and encourage others to do so.