12 April 2021

Dear colleagues, 

Over the weekend a number of updates have been provided regarding the AstraZeneca COVID-19 vaccine. As you know by now, ATAGI has recommended that the Pfizer vaccine is preferred over the AstraZeneca vaccine for adults aged under 50 years. This recommendation is based on the increasing risk of severe outcomes from COVID-19 in older adults (and hence a higher benefit from vaccination) and the small risk of serious harm of thrombosis with thrombocytopenia following AstraZeneca vaccine in those under 50 years.

Vaccinations for adults under 50 years – AstraZeneca

People who have had their first dose of AstraZeneca without serious adverse effects can safely receive the second dose of the vaccine, including adults under 50 years.

The AstraZeneca vaccine can be used in adults aged under 50 years where the benefits outweigh the risk for that individual and the person has made an informed decision based on an understanding of the risks and benefits. To be clear, any person aged under 50 years wishing to receive the AstraZeneca vaccine, can choose to do so, however should be fully informed about thrombosis in combination with thrombocytopenia as a rare but serious side effect before vaccination.

To assist individuals in making an informed decision, Queensland Health has updated the COVID-19 vaccination information. The following information should be provided to individuals who present requesting vaccination:

• COVID-19 patient information factsheet
• Australian Technical Advisory Group on Immunization (ATAGI) statement of 08 April 21
• COVID-19 pre-vaccination additional and temporary screening questions 

Should a person aged under 50 years wish to proceed to vaccination with AstraZeneca, then a note should be made by the Health Worker on the COVID-19 Pre-Vaccination Additional and temporary Screening Questions form, with words to the effect “informed about the risk of thrombosis with thrombocyopenia. Aware of the recommendation by ATAGI for Pfizer over AstraZeneca. Choses to receive AstraZenica today.”

To assist clinicians in answering questions from individuals regarding vaccination, Queensland Health has updated the COVID-19 vaccination screening questions – decision support guide.

There continues to be work being done in relation to sub-prioritisation of vaccination priority group 1b to the available Pfizer supply. I will provide more information as soon as it becomes available.

Information for clinicians – identification and treatment of thrombosis in combination with thrombocytopenia

Patients presenting with symptoms of thrombosis (such as severe headaches unresponsive to simple analgesia, abdominal pain or respiratory symptoms) 4-20 days after vaccination should be reviewed carefully for signs of thrombosis or bleeding. Other neurological symptoms of cerebral vein thrombosis can include those of raised intracranial pressure such as visual changes, severe headache, seizures, focal neurological deficits, and general symptoms of encephalopathy including confusion.

New clinician resources have been developed to assist clinicians in managing patients who present with symptoms suggestive of clotting following vaccination. For more information please see the information for clinicians factsheet.

Key initial investigations include:

• A full blood count and blood film
• Coag screen (including fribrinogen and D-dimer); and
• Targeted imagine (e.g. CT or MRI brain)

Early consultation with your local haematologist is advised.

The COVID-19 Adverse Event Following Immunisation (AEFI) Reporting Form has also been updated to capture any AEFI relating to thrombosis. It is important this information is captured so that rapid review and referral to the Public Health Unit and TGA can occur.

COVID-19 restrictions

As a reminder, Metro North remains on a Tier 1 response. As per the Chief Health Officer’s directive, visitor restrictions at our hospitals and mask wearing requirements also remain until 12 pm Thursday 15 April.

Regards,

Dr Liz Rushbrook
Metro North Incident Controller

Metro North HHS – overview of cases*

* As at 12 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.