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NACI recommends pause on use of AstraZeneca vaccine for those under 55

Last Updated Mar 29, 2021 at 6:29 pm PDT

Summary

Canada has received 500,000 AstraZeneca doses so far, supposed to receive 1.5 million from the U.S. this week

OTTAWA (NEWS 1130) – Canada’s National Advisory Committee on Immunization (NACI) is recommending a pause on AstraZeneca COVID-19 vaccinations for people under 55 due to concerns it may be linked to rare blood clots.

The NACI will advise provinces to stop giving the vaccine to anyone under that age group, following Prince Edward Island’s lead after they halted the shot for those aged 18 to 29 early on Monday. B.C. is moving to pause using the drug in people under the age of 55 for the next few days.

“Health Canada has issued what they call terms and conditions to obtain more information from AstraZeneca about the risk-benefit profile, and what this might mean to people here in British Columbia and in Canada,” provincial health officer Dr. Bonnie Henry explained.

“If you have received the AstraZeneca vaccine, and it’s more than 20 days since you’ve received it, there is no concerns,” Henry said. “If you have received the AstraZeneca vaccine and you develop symptoms that are concerning such as headaches or swelling, and we have a list of those symptoms on the BCCDC website. You can seek medical attention.”

She says it is a “very rare” condition and “it is unlikely we will see any cases here in British Columbia or in Canada, but it is also a condition that we have a test for.”

“We anticipate that we will have more information in the next two to three days. Health Canada is working closely with the European medicine agencies in the United States and the U.K. to understand what this means in those countries, and if there are implications for people here in British Columbia,” Henry said.

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Quebec is also suspending the use of the AstraZeneca COVID-19 vaccine for people under the age of 55. The province says in a news release that the decision was taken in conjunction with the Public Health Agency of Canada as well as provincial and federal vaccine advisory committees.

“NACI recommends that AstraZeneca COVID-19 vaccine should not be used in adults under 55 years of age at this time while the safety signal of Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) following vaccination with AstraZeneca COVID-19 vaccine is investigated further,” said NACI in a release.

NACI says cases identified have been primarily in women under the age of 55 years but note that cases in men have also been reported and have mostly occurred between 4 and 16 days after administration.

“This adverse event is being referred to as Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT).”

Based on the NACIs latest round of information, the case fatality of VIPIT is approximately 40 percent but they say the case fatality may decrease with “increased awareness of the adverse event and appropriate early treatment.”

“From what is known at this time, there is substantial uncertainty about the benefit of providing AstraZeneca COVID-19 vaccine to adults under 55 years of age given that the potential risks associated with VIPIT, particularly at the lower estimated rates,” the NACI continued in its release.

They said that adults 55 years of age and older may still be offered the AstraZeneca vaccine with informed consent, given the increased risk of hospitalization and death due to COVID-19 disease in this population.

“We have no concerns with those who have received it so far,” said Dr. David Williams, Ontario’s chief medical officer.

Canadian health officials first recommended the AstraZeneca vaccine for those under 65, but on March 16 it adjusted its advice to say that it could also be given to seniors.

“There is substantial uncertainty about the benefit of providing AstraZeneca Covid-19 vaccines to adults under 55 given the potential risks,” Dr. Shelley Deeks, Vice-Chair of the NACI.

Canada’s Chief Medical Advisor Dr. Supriya Sharma says there have yet to be any reports of these aforementioned side effects in the country.

“Health Canada has previously communicated on an ongoing assessment of very rare adverse events reported in Europe of blood clots with low platelets occurring after immunization with the AstraZeneca vaccine,” said Sharma.

“… To date no cases of these events have been reported in Canada. However, through our ongoing international collaboration, Health Canada has become aware that additional cases of these events have been reported in Europe. In light of this developing information, Health Canada will be issuing additional terms and conditions on the authorizations of the AstraZeneca and Verity pharmaceuticals serum institute of India vaccine.”

It is a recommendation and it is up to each of Canada’s provinces to decide to follow it or not.

Related article: COVID-19 vaccinations in B.C.: What you need to know

Canada is expected to receive 1.5 million doses of AstraZeneca from the U.S. this week.

“The messaging has been brutal overall. I am fearful it is toast. It shouldn’t be,” said Dr. Andrew Morris, a professor of infectious diseases at the University of Toronto and the medical director of the Antimicrobial Stewardship Program at Sinai-University Health Network.

Morris thinks those who are at high risk for COVID-19 outcomes and over the age of 55 should get AstraZeneca if the other vaccines are not available to them, especially during the third wave of COVID-19 infections in Ontario.

Several European countries suspended using the vaccine over concerns it could cause blood clots but have resumed administering it.

Canada Health Minister Patty Hajdu refused to directly comment Health Canada monitors real-world data on the use of vaccines.

“As you know, AstraZeneca has been under examination by a number of jurisdictions for its connection to potentially adverse effects,” said Hajdu on Monday.