Amid discussions about the priority of vaccination in Brazil, experts explain the possible contraindications to immunizers
About to complete the first 30 days of operation of the National Immunization Plan (PNI) against a Covid-19, more than 4.5 million Brazilians have already received at least the first dose of vaccines against the disease, which represents, in total, just over 2% of the Brazilian population. Therefore, considering the persistent increase in cases, hospitalizations and deaths due to coronavirus, states like São Paulo anticipate vaccination of priority groups and seek to boost mass immunization. However, in this context, a question still remains: who cannot be vaccinated against Covid-19? Health, pharmaceutical authorities and herself National Health Surveillance Agency (Anvisa) have already signaled that children under 18 and pregnant women should not receive immunizers, since clinical studies, which based the approval of the emergency use of the compounds, did not include representatives of these populations. Parallel to this, patients with autoimmune diseases or undergoing cancer treatment are also indicated to seek medical advice before vaccination, which reinforces the doubt. Are there, for example, restrictions for allergic or lactating people? Thinking about it, the Young pan talked to specialists in infectious diseases and immunization to understand possible contraindications to immunizers. Check out the recommendations below.
The main doubts related to immunization address possible allergic reactions caused by vaccines, as well as restrictions for people who have a history of allergies to drugs or foods that may be part of the composition of the immunizers. Although the fear is valid, so far there is no record of serious adverse reactions to current drugs against Covid-19 available in the country, explains the director of the Brazilian Association of Allergy and Immunology, Dr. Ekaterini Simões Goudouris. “None of these vaccines are reported to have any food, so people with food allergies, such as eggs, will in principle have no problems. When you get vaccinated, you may have an allergic reaction, but there was no warning about CoronaVac or Oxford vaccine, only about the Pfizer vaccine [não disponível no Brasil]”, Explain.
The recommendation of the Butantan Institute it’s at Oswaldo Cruz Foundation (Fiocruz), responsible for the vaccines currently distributed in Brazilian municipalities, is that only people with a history of allergy to the products that make up the vaccine do not take the immunizers. According to the CoronaVac package insert, the following are indicated as items of composition of the immunizing agent: aluminum hydroxide, disodium hydrogen phosphate, sodium dihydrogen phosphate, sodium chloride and sodium hydroxide. From the Oxford vaccine, produced in conjunction with the pharmaceutical company AstraZeneca, the components are: L-histidine hydrochloride monohydrate, magnesium chloride hexahydrate, polysorbate 80, ethanol, sucrose, sodium chloride and disodium edetate dihydrate (EDTA). However, Ekaterini Simões Goudouris indicates that, even in these cases, people should seek medical advice.
“The recommendation is for people who have a more significant allergy to talk to a doctor before getting the vaccine. Some patients may be instructed to apply in a more controlled environment, so to wait half an hour, which is a little complicated now in this scenario. But it may be that it reaches that point of indicating vaccination for some people in a controlled environment and not completely contraindicating the vaccine, ”he said. The recommendation is also valid for a future vaccination with the Pfizer immunizer in Brazil, which had serious adverse reactions on record in the first days of application in the UK. The infectologist indicates that the decision not to apply the immunizer should be based on specific professional guidance for each individual.
Autoimmune diseases and cancer patients
In addition to discussions about possible allergic reactions, another point of debate is the vaccination of people with autoimmune diseases or who are undergoing cancer treatment. The reason for the fear is the ineffectiveness of immunization, since the patient has a health condition or undergoes treatment that makes the immune system’s response difficult. “If the patient is in the middle of chemotherapy, which lowers resistance, he will probably lower the response to vaccination. So we can, eventually, decide to vaccinate at the best moment someone who has autoimmune disease, who has cancer or is being treated with drugs that lower immunity, so that the vaccine has its best effect. It is not a vaccination contraindication, it is a decision to find the best moment ”, explains Renato Kfouri, director of the Brazilian Society of Immunizations.
Likewise, Ekaterini also defends the possibility of vaccinating these patients and recalls that the recommendation is always to discuss the situation with the doctor in charge. According to her, there is no possibility that vaccines made with attenuated coronavirus, such as CoronaVac, for example, transmit the disease. Therefore, there is no contraindication. “The major concern is with vaccines produced with attenuated viruses or bacteria, because they can become infectious agents, which is not the case with these vaccines [contra a Covid-19]. But people who are undergoing cancer treatment, taking heavy medications or patients with defects in immunity may not respond well to immunization. So, for these patients, it is essential to maintain isolation measures and that the people around them are vaccinated to, precisely, protect those who may not respond well to the vaccine ”, he recommends.
Pregnant and lactating
There is also a discussion on the vaccination of pregnant women who are part of the priority groups in the immunization plan, which may include pregnant women who are health professionals or who are part of indigenous, quilombola and riverside communities. Although the Ministry of Health has contraindicated the application of the compounds to these women, the director of the Brazilian Society of Immunizations, Renato Kfouri, signals that it is up to an individual discussion about the advantages and disadvantages of immunization. According to him, the position of the federal government is due to a lack of studies involving pregnant, not necessarily being a contraindication. “We know that pregnancy increases the risk of severe Covid and, if she belongs to the risk group, this decision must be shared with your doctor and the family. They are probably vaccines that will not bring any risk, they are inactivated vaccines like the ones we are used to using in pregnant women, but there is no study. The ministry ended up leaving it as a contraindication, it stayed on the fence in order not to position itself. But it is a unanimous position. It is not contraindicated, but vaccinating routinely without telling the pregnant woman that she has not been studied is also not appropriate ”, said the professional, who defends the immunization of pregnant women who are working to combat Covid-19. “A pregnant woman who is involved in the front line, who has an increased risk, you have to consider vaccination much more than a pregnant woman who is at home, without any risk. The risk is different from those who are health professionals and are bathing patients with Covid-19. ”
Renato Kfouri also reinforces that there is no restriction for the immunization of lactating women. According to him, the position of health entities is to encourage the vaccination of these women, warning that there is no need to interrupt breastfeeding or that there is any risk of inactivated vaccines “passing through breast milk” and causing some harm to the baby. “We are more emphatic in saying that we should be vaccinated, in the sense of recommending, as long as it belongs to the risk group. If she is at risk and is being called on to vaccinate, she should be immunized and not interrupt breastfeeding, ”he said. Thus, the recommendation is that pregnant women seek medical advice to decide whether or not to vaccinate and breastfeeding women receive protection against the coronavirus.
Children under 18
In the same way that pregnant women were not included in clinical studies for the development of vaccines, children and adolescents were also not part of the groups tested. Therefore, the current position is that minors under 18 years of age will not be vaccinated in Brazil until new stages of research prove the safety and efficacy of the compounds for this population. “There are some groups in which the vaccine has not yet been studied, in the case of children, adolescents 18 years and pregnant women, but it is not a contraindication. Contraindication we say more that it is prohibited, this is a precaution. In fact, we are not managing for lack of data ”, says Renato Kfouri. According to him, some laboratories have already started the new stages of clinical tests, which should include even babies under two years old.
So far, there is no provision for children under 18 to be included in the immunization line in Brazil, which should happen only when the rest of the population is vaccinated. However, other countries already adopt the immunization of adolescents, as is the case of Israel, which initiated the voluntary application of the Covid-19 immunizer in young people aged 16 to 18. However, in order to receive the two doses of the Pfizer-BioNTech compound, authorization from those responsible is required. The goal of early vaccination for this age group is to ensure the safe resumption of face-to-face classes in the country.
Who can’t get vaccinated?
As we have seen so far, following medical guidelines, only those under 18 years of age have no indication, at the moment, to receive immunizations against Covid-19. On the other hand, people with a history of allergy, pregnant and lactating women, as well as patients with autoimmune diseases or undergoing cancer treatment, can be vaccinated. So, in fact, who can’t get the vaccine? The experts’ recommendation is clear: the only prohibition existing is by applying immunizers to people who have already had a serious adverse effect, such as anaphylaxis, after receiving the first dose of the vaccine. “Those who cannot take it are only those who took the first dose, felt very ill and had some serious allergic reaction to some component of the vaccine”, reinforces Renato Kfouri. According to him, people who had an allergic reaction may even receive another immunizer from a different laboratory. “It will depend on the type of allergy and the recognition of which substance in that vaccine the patient is allergic to. And with that you can use manufacturers that do not have allergic items in their composition. ”
Like the infectious pediatrician, Ekaterini Simões Goudouris points out that cases of severe reaction are uncommon. The recommendation is that all Brazilians be vaccinated, respecting the priority stages. According to the expert, if in doubt, citizens should seek medical advice before deciding not to vaccinate. “Of these vaccines, there is no contraindication to the point that the person does not go to the clinic or does not ask for professional help. The person may even be suspicious, but there is no contraindication that justifies deciding on my own ‘I cannot get a vaccine’. People who have a very severe allergy, immune problems or are on treatment have to ask their doctors. ”In addition to people who had an anaphylactic reaction, the Butantan Institute also recommends that citizens with a suspected Covid-19 or who have a fever at the time of application should not be vaccinated. For these cases, the recommendation is to seek medical advice. The institution indicates that patients who tested positive for the coronavirus wait seven days after the end of the acute symptoms to receive the immunization.