09 April 2021

Dear colleagues, 

Last night the Prime Minister, Health Minister and Australian Chief Medical Officer announced changes to the rollout of the COVID-19 vaccination program. This was based on advice from the Australian Technical Advisory Group on Immunisation (ATAGI) following a small number of unusual thrombosis cases following the AstraZeneca vaccine.   

Our Metro North vaccination services remain open as planned for adults aged 50 or more who wish to receive the AstraZeneca vaccine.  

I acknowledge that there are many staff aged 50 and under across Metro North Health who have already received their first dose of the AstraZeneca vaccine and may be anxious about its effects.  

The AstraZeneca vaccine  

If you have safely had your first dose of the AstraZeneca vaccination, it is very safe for you to receive your second dose of the vaccine, including adults under 50. This should be delivered approximately 12 weeks after your first dose. 

ATAGI still strongly recommends that people over 50 still receive their first dose AstraZeneca vaccine.   

The incidence of thrombosis (clotting) with thrombocytopenia (low blood platelet count) following the AstraZeneca vaccine is around one in 500,000. This number may sound scary, but the chance of this occurring is very rare. In the United Kingdom, 79 people out of 20.1 million people who have been vaccinated have experienced thrombosis following the AstraZeneca vaccine. To compare this to something that could affect any of us, your chance of being bitten by a snake is approximately 15 in 500,000 (Fast fact: I’m not really fond of snakes). 

The signs or symptoms to look out for 

Unlike common COVID-19 vaccine side effects which have an onset within the first 24 hours and last 1-2 days, the onset of the reported rare clotting disorder is between 4 to 20 days after vaccination.  

If you experience any new, severe, persistent headache or other significant symptoms such as severe abdominal pain, with onset 4-20 days post vaccination, you should seek immediate emergency treatment flagging you have received the AstraZeneca vaccine.  

Cerebral venous sinus thrombosis (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.  

New guidelines for vaccinations  

Understandably, a lot of people under 50 may now be wondering if and how they can receive the Pfizer vaccine as an option in lieu of the AstraZeneca vaccine.  

In line with new ATAGI advice, the following principles have been agreed on to support our vaccination programs: 

• People who have had the first dose of COVID-19 Vaccine AstraZeneca without any serious adverse effects or blood clots can be given the second dose, including adults under 50 years. 
• It is acceptable for people who are booked in to receive their first dose of AstraZeneca to cancel their booking and await further information before rebooking to receive vaccination.  
• It is acceptable for people who are booked in and wish to proceed with their first dose of AstraZeneca to be allowed to do so. This must be within the context of informed consent that clearly convey the benefits and risks of vaccination.  

Our Pfizer vaccination clinic will continue to provide vaccinations to people who have appointments, primarily from group 1a. Appointments for the first dose of Pfizer vaccinations will be honoured regardless of age, and second doses of Pfizer will continue to be honoured for those who have already received their first dose. However, people who present to our Pfizer vaccination clinic and do not have an appointment will not receive a vaccination. Priority workers who work on COVID wards or in hotel quarantine will continue to be eligible to receive the Pfizer vaccination regardless of age.  

I appreciate that whilst we wait for further information, this may be an anxious time for many people across the health service, so I thank you for your patience and kindness as we work through this together.  

As always, we will keep you updated as more information becomes available.  

Dr Liz Rushbrook
Metro North Incident Controller

Metro North HHS – overview of cases*

*With effect 09 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.