By Elizabeth Sandel DO, Board Certified Family Physician
At one full year into the SARS COVID 19 worldwide pandemic, there is finally a morsel of hope. Historically speaking, to develop a safe and effective vaccine against a wild variant virus in this short period of time, is nothing short of groundbreaking. Unfortunately, that same speed has highlighted a long-standing vaccine skepticism amongst first-world citizens. It is understandable, given the amount of information the public is bombarded within 24-hour news cycles and social media circles. There has never been a time in history in which we have had so much information at our fingertips, yet very little education on how to interpret that data. The end result is a public that is drastically misinformed, confused, and overwhelmed.
At this juncture, our job as health care workers is also to be educators. To do this, I have been listening to the most commonly asked questions and most commonly voiced concerns about this new vaccine and will attempt to address them the best I can.
Messenger RNA vaccines have been in development for years and these mRNA Covid 19 vaccines are the first to be administered to the public.
Prior, there were two main types of vaccines; live attenuated and inactivated vaccines. Examples of live vaccines are the shingles vaccine, the MMR vaccine, the nasal flu mist, the rotavirus vaccine, and the chickenpox vaccines. The vaccine uses a weakened version of the virus itself, and as a result, can result in side effects that are symptoms of the viruses themselves, yet far less severe. The flu shot, hepatitis B vaccines, and almost all other vaccines are inactivated vaccines, meaning the virus or bacteria is not injected weakened but inactivated. The body still sees the structure as foreign and creates antibodies that promote an immune response to the injected bug.
The covid 19 vaccine is novel in that it is a RNA vaccine. Essentially, RNA vaccines were the first vaccines for SARS-CoV-2 to be produced and represent an entirely new vaccine approach. Once administered, the RNA is translated into the target protein, which is intended to produce a reliable immune response. The mRNA remains in the cell’s external structure and does not enter into the nucleus. In this way, mRNA vaccines do not interact with or integrate into the recipient’s DNA. The target of the vaccine is the spike protein on the surface of the virus. The hypothesis is that because of this, mutations in the virus should not reduce the vaccine’s efficacy. SARS-CoV-2 RNA vaccines are now available. These include the Phizer and Moderma vaccines. Both require a booster at 3 or 4 weeks, respectively.
SARS-CoV-2 infection might still occur despite vaccination, and the duration of protection is uncertain. After vaccination, it is still recommended that recipients continue other personal preventive measures to reduce SARS-CoV-2 transmission, such as masking and physical distancing.
However, the CDC allows waiving post-exposure quarantine requirements for asymptomatic individuals who have completed a full vaccination series at least two weeks before but no more than three months prior to the exposure. These interim recommendations limit the quarantine exemption to the three months following vaccination because the duration of vaccine-induced immunity is uncertain.
Vaccine recipients should be advised that side effects are common and include local and systemic reactions, including pain at the injection site, swelling of lymph nodes on the side of the vaccine, fever, fatigue, and headache. Although acetaminophen and ibuprofen can be taken if these reactions develop, we recommend avoiding these if possible because of the uncertain impact on the immune system’s response to vaccination.
Individuals with a severe allergic reaction, such as anaphylaxis, after a previous dose of an mRNA COVID-19 vaccine or to any of its components (including polyethylene glycol). If one has an existing allergy to polyethylene glycol, a common component in laxatives, this vaccine is not recommended. If this allergy is unknown, those individuals should not receive an mRNA COVID-19 vaccine unless they have been evaluated by an allergy expert who determines that it can be given safely. Components of the mRNA COVID-19 vaccines are listed on the CDC website.
After both sets of vaccines, recipients will be required to sit for at least 15 minutes.
They are to be monitored for an immediate vaccine reaction. Individuals who have a history of anaphylaxis due to any cause or a history of immediate allergic reaction of any severity to a vaccine or injectable therapy should be monitored for 30 minutes.
Following the first several million doses of mRNA COVID-19 vaccines administered in the United States, anaphylaxis was reported at approximate rates of 5 and 2.8 events per million doses for the Pfizer and Moderna vaccines, respectively. The vast majority of these events occurred in individuals with a history of allergic reactions and occurred within 30 minutes.
Late local reactions characterized by a well-demarcated area of redness appearing at the injection site about one week after vaccination has been administered. It is recommended that individuals who experience this reaction after the initial dose proceed with the second dose as scheduled.
Facial swelling in areas previously injected with cosmetic dermal fillers has also been rarely reported following vaccination. Dermal fillers are not a reason to not receive the COVID-19 mRNA vaccination, and no specific precautions are recommended. However, it is reasonable to be aware that if one has dermal fillers that the possibility of post-vaccination swelling exists.
Anticoagulation is not a contraindication to vaccination; excess bleeding is unlikely with intramuscular vaccines in patients taking blood thinners. Such patients can be instructed to hold pressure over the injection site to reduce the risk of hematoma.
Several COVID-19 vaccines have demonstrated efficacy in preventing symptomatic COVID-19. However, asymptomatic infection also contributes to the transmission of SARS-CoV-2, and the impact of vaccination on asymptomatic infection is uncertain. Limited data from some of the vaccine trials suggest that certain vaccines may reduce asymptomatic as well as symptomatic infection. Nevertheless, the lack of increase in asymptomatic cases in the vaccine group suggests that vaccination reduces SARS-CoV-2 infection overall. Until more data is available, continued personal and public health preventive measures are still recommended for individuals who have been vaccinated to reduce the risk of transmission.
It is exciting to see a light at the end of this long dark winter. Vaccination is the only way this pandemic can end quickly and as distribution increases, we are living through a historic victory that could only be accomplished via the power of science and humankind.
