Northern Ireland news

Covid-19: Under-40s to be offered alternative to AstraZeneca vaccine

The Department of Health has said from Monday people aged under 40 will be offered the Pfizer vaccine against Covid-19
Jane Kirby and Aine Fox, PA

People under the age of 40 are to be offered and alternative to the AstraZeneca Covid-19 vaccine after the UK Joint Committee on Vaccination and Immunisation (JCVI) warned of an "extremely small risk" of people suffering blood clots.

The JCVI advised that another vaccine should be offered to under-40s without underlying health conditions where an alternative is available, and as long as it does not cause any substantial delays to the vaccination programme.

Following today's announcement, the Department of Health said a number of changes to the vaccine programme in the north will come into effect from Monday May 10:

  • People aged 40-plus can book AstraZeneca first-dose appointments at the SSE Arena vaccination centre and community pharmacies.
  • People aged 30-39 can book their Pfizer first-dose appointments at the other regional health trust vaccination centres in Northern Ireland.
  • People aged 30-39 can choose to make an informed decision to receive the AstraZeneca vaccine from participating community pharmacies if they prefer, or if they decide they would rather not wait to receive an alternative jab.
  • Anyone aged under 40 already booked for their first vaccine at one of the trust centres, including the SSE Arena in Belfast, will have this appointment honoured - with the Pfizer vaccine.
  • Anyone of any age who has received an AstraZeneca first dose should proceed with their second dose of AstraZeneca - unless they had an extreme adverse reaction to their first dose.

According to statistics released earlier this week, 41.1 per cent of 30-39-year-olds in the north have received their first dose of a Covid vaccination.

Chief Medical Officer Dr Michael McBride said: "It is important to reiterate that the potential risk associated with the AZ (AstraZeneca) first dose is extremely rare and that the threat from Covid-19 is much higher for the majority of adults.

"Getting vaccinated against this virus gives us hope - it protects us and helps us to start reclaim normality.

"I am looking forward to getting my second dose of AstraZeneca in the near future and I would again encourage everyone to come forward without delay for their first and second jabs when it's their turn."

While the balance of benefit and risk for the AstraZeneca vaccine is very favourable for older people, it is more finely balanced for younger groups, who do not tend to suffer serious coronavirus illness.

Experts have also assessed the risks from any third wave of Covid in the UK and concluded that that wave is likely to be smaller than previously anticipated.

It came as an expert source said they anticipate approval of the Johnson & Johnson vaccine in the UK shortly.

The Medicines and Healthcare products Regulatory Agency (MHRA) is currently appraising the jab and the review is said to be at an advanced stage.

Professor Wei Shen Lim, Covid-19 chairman for JCVI, said: "Safety remains our number one priority.

"We have continued to assess the benefit/risk balance of Covid-19 vaccines in light of UK infection rates and the latest information from the MHRA on the extremely rare event of blood clots and low platelet counts following vaccination.

"As Covid-19 rates continue to come under control, we are advising that adults aged 18 to 39 years with no underlying health conditions are offered an alternative to the Oxford/AstraZeneca vaccine, if available and if it does not cause delays in having the vaccine.

"The advice is specific to circumstances in the UK at this time and maximises use of the wide portfolio of vaccines available.

"The Covid-19 vaccines have already saved thousands of lives and the benefit for the majority of the population is clear - if you are offered the vaccine, you should take it."

Up to April 28, the MHRA had received 242 reports of blood clots accompanied by low blood platelet count in the UK, all in people who had the AstraZeneca vaccine, out of around 28.5 million doses given.

These clots occurred in 141 women and 100 men aged from 18 to 93 (one further case was in a person whose gender was not known), with 49 deaths. Six cases have been reported after a second dose.

A particular type of brain blood clot - cerebral venous sinus thrombosis (CVST) - was reported in 93 cases (with an average age of 47), and 149 had other major thromboembolic events (average age 55) accompanied by low blood platelet count.

The overall incidence of blood clots with low platelets after a first dose is put at 10.5 per million doses, and about one in a million for a second dose.

For those aged 40 to 49 the incidence is 10.1 per million doses, and 17.4 per million for those aged 30 to 39.

Overall, the death rate per million doses is 2.1, but is 4.5 for those aged 30 to 39.

MHRA chief executive Dr June Raine said: "Public safety is always at the forefront of our minds and we take every report seriously.

"Our position remains that the benefits of the Covid-19 vaccine AstraZeneca against Covid-19, with its associated risk of hospitalisation and death, continues to outweigh the risks for the vast majority of people.

"The balance of benefits and risks is very favourable for older people but is more finely balanced for younger people and we advise that this evolving evidence should be taken into account when considering the use of the vaccine, as JVCI has done."

In a press briefing, England's deputy chief medical officer Professor Jonathan Van-Tam was asked about the risk of vaccine hesitancy in light of the new AstraZeneca guidance.

He said: "All of the opinion polls I read very clearly show that the British public has very, very high confidence in the vaccine programme in the UK, can already see what it is doing in terms of changing our future, and the data get better and stronger in terms of the layers of protection, not just the aversion of deaths, serious infections, but now the prevention of transmission on top for young adults."

Prof Van-Tam said younger people were "young and sociable" and "therefore they have a higher propensity for transmission", adding that continuing the vaccine programme and maintaining confidence was "critically important", not only in terms of a third wave, "but basically, because although we're in a very good epidemiological situation now compared with a couple of months ago even, we don't retain control of this disease unless we continue the rollout of the vaccination programme".

On the Johnson & Johnson vaccine, also known as the Janssen vaccine, which has also been linked to a small risk of blood clots, he said it was not thought it would be rolled out in time to complete the UK's adult vaccine population.

But Prof Van-Tam said because it was a one-shot vaccine "it could potentially be very important, rather than no vaccine, in populations that are hard to reach, basically where you have one chance of vaccinating them and little chance of calling them back for a second vaccine".

Health experts are urging everyone who has had a first dose of AstraZeneca and not suffered a clot to have a second dose of the same jab, irrespective of their age.

The MHRA said that, as a precautionary measure, anyone who has a severe headache which is not relieved with painkillers or is getting worse, should seek prompt medical attention at any point from around four days to four weeks after vaccination.

The same goes for a headache that feels worse when a person lies down or bends over, a headache that is unusual and occurs with blurred vision, feeling or being sick, problems speaking, weakness, drowsiness or seizures, a rash that looks like small bruises or bleeding under the skin, and shortness of breath, chest pain, leg swelling or persistent abdominal pain.

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