06 April 2021

Dear colleagues,

Over the Easter long weekend, the Australian Technical Advisory Group on Immunisation (ATAGI) issued a statement noting that one case of an unusual thrombosis following the AstraZeneca vaccine has been reported to the Therapeutic Goods Association (TGA) and is currently under review. This is one case in over 400, 000 doses given.  

This is being taken seriously, including careful consideration of other reports of rare cases of thrombosis associated with thrombocytopenia occurring following administration of the AstraZeneca vaccine overseas. The onset of these reported cases was between 4 to 20 days after vaccination.  The incidence appears to be very rare.

ATAGI advice

Clinicians should be on alert for warning signs of this rare condition associated with thrombosis and thrombocytopenia in the period following vaccination (4 to 20 days). This has presented as either central venous sinus thrombosis (CVST) or thrombosis in other sites, such as intra-abdominal venous systems.

CVST may present as:

• a new onset, persistent headache not settling with analgesia
• features of raised intracranial pressure, including acute severe headache, vomiting, confusion
• focal neurological deficits
• seizures.

Patients require an urgent detailed assessment if CVST or another severe thrombotic complication with thrombocytopenia is suspected and the patient has received the AstraZeneca vaccine in the previous 4 to 20 days.

Clinical investigations should include a full blood count (to look for thrombocytopenia), a D-dimer, fibrinogen and relevant radiological imaging (e.g. brain CT or MRI). Patients suspected to have this condition should NOT receive any heparin or platelet transfusions.

For more information you can read the AstraZeneca vaccine and a specific clotting condition factsheet or visit the ATAGI website.   

Phase 1b vaccinations

We are now moving into vaccinating the phase 1b cohort. This means the following groups will start presenting at our vaccination clinics:

• healthcare workers and Queensland Government employees working in the community
• Emergency Services workers and volunteers
• Corrective Services personnel
• workers at licensed meat processing businesses
• workers at international airports
• maritime industry workers.

The Chief Health Officer has also included people living with health workers dealing directly with COVID-19 (I.e. working on our COVID-19 wards).

It is an exciting time for people to be able to receive their vaccination, and it is important that we all work together to ensure that people who want to access the vaccination can do so efficiently and as soon as practicable.

Receiving vaccination at our hospitals is a healthcare event, and so it is important that these people are welcomed into the vaccination clinic in an orderly fashion.

Please remember to be kind to one another as we work together to ensure everyone receives their vaccine.

Worked at the Princess Alexandra Hospital between 9 March and 23 March?

As you may be aware, there is a historical positive COVID staff member who worked in ward 5D. Contact tracing is being undertaken.

If you entered ward 5D or visited 5D Outpatients department between 9 March (20:00 hours) and 23 March (23:59 hours) and you have symptoms of COVID-19 you should get tested, and self-isolate until you have a negative COVID test result. Your household contacts should also get tested, and self-isolate until they have a negative COVID test result.

If you entered ward 5D or visited 5D Outpatients Department between 09 March (20:00 hours) and 23 march (23:59 hours) and you do not have COVID-19 symptoms, you should visit a GP this week to arrange a blood test for COVID-19 serology. There is no need to self-isolate whilst you are waiting for this blood test or the results.

More information is available on the contact tracing website.

Regards,

Dr Liz Rushbrook
Metro North Incident Controller

Metro North HHS – overview of cases*

HHS	Patients being managed by HHS						FEVER Clinics
	Total In-patients			Virtual Ward / HITH / or similar	Deaths **	Total cases managed by HHS (including recovered) ***	# of clinics	Presentations
		ICU Pts
		ICU-NOT Ventilated	ICU-Ventilated					Last 24 hrs	TOTAL^
MN TOTAL	30	0	0	0	3	527	3	395	164,778

*With effect 06 April 2021, 1000
**Metro North has three recorded deaths (one person a return traveller into NSW, who passed away in NSW)
*** These numbers reflect the cases being managed by Metro North.