COVID-19 Information

What’s new in vaccines?

Since our webinar on COVID-19 vaccines, there have been significant developments on COVID-19 vaccines in Canada. On February 26th, Health Canada approved the ChAdOx1-S vaccine (also known as the AstraZeneca Vaccine). This vaccine was developed by AstraZeneca and Oxford University and has two approved manufacturers as follows:

1. AstraZeneca
2. Serum Institute of India (COVISHEILD)

Unlike the single-stranded RNA (mRNA) technology used by Moderna and PfizerBiontech, AstraZeneca uses a vaccine that uses a double-stranded DNA. This genetic material carries the same instruction for the Coronavirus spike protein as the mRNA vaccines. The DNA is inserted into a harmless virus well known to scientists (adenovirus). The adenovirus acts as a “vector,” or vehicle to deliver the DNA. This technology is commonly referred to as a Viral Vector Vaccine. There is no risk of the DNA integrating into our own DNA.

For more information on the use of this vaccine, refer to https://covid-vaccine.canada.ca/info/astrazeneca-covid-19-vaccine-en.html

Another Viral Vector Vaccine using a similar approach, Janssen COVID-19 Vaccine, was approved in Canada on March 5, 2021. For more information on this vaccine, refer to https://covid-vaccine.canada.ca/info/janssen-covid-19-vaccine-en.html

Reports of clotting following the AstraZeneca Vaccine?

The World Health Organization and Canada do not believe that the recent news of clotting is related to the use of this vaccine. Over the last couple of days, several European countries are resuming vaccination with this vaccine.

You may follow Canada’s monitoring efforts by visiting this website: https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/drugs-vaccines-treatments/vaccines/astrazeneca/monitoring.html

Other important resources from trusted websites:

1. How Viral Vector Vaccines work (source: Centers for Disease Control)
2. Vaccine Safety: reports in Canada

Canada pauses the use of the AstraZeneca vaccine
Update – March 29 2021

New research has emerged from the Paul-Ehrlich-Institut in Germany reporting adverse events following the AstraZeneca vaccine. As a result, the National Advisory Committee on Immunization (NACI) has issued a statement on March 29th stating that:
“…AstraZeneca COVID-19 vaccine should not be used in adults under 55 years of age at this time while the safety signal of Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) following vaccination with AstraZeneca COVID-19 vaccine is investigated further.”

You may view the full statement by clicking here.

Already vaccinated with the AstraZeneca COVID-19 vaccine?

Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) following vaccination remains extremely rare but it is a good idea remain vigilant. VIPIT has two main features:

1. Occurs between 4 and 20 days following vaccination
2. Low platelets

Signs of VIPIT may include

• breathlessness,
• pain in the chest or stomach,
•  swelling or coldness in a leg,
•  severe or worsening headache or blurred vision after vaccination,
• persistent bleeding,
• multiple small bruises, reddish or purplish spots, or blood blisters under the skin.

Please remember to always consult your healthcare professional for questions or concerns.

Canadian PNH Network Position Statement on COVID-19 Vaccination

Disclaimer: The recommendations expressed herein are general guidelines based on the available data at the time of writing. Application of these statements must be adapted to individual patients. The Canadian PNH Network assumes no responsibility or liability arising from error or omission, nor from the use of any information contained herein. This document should not serve as an alternative to specific medical advice from a physician or other treating healthcare practitioner.

As COVID-19 vaccinations become available across Canada, patients with PNH and/or aplastic anemia (AA) will become eligible to receive them. Though the clinical trials performed did not include patients with PNH or AA, it is the position of the Canadian PNH Network that our patients receive the vaccination when invited unless there are specific reasons they are unable to do so. This is our position both for patients on specific treatments for PNH (e.g. eculizumab) and for those who are not.

After each vaccination, there is a small risk that symptoms of PNH may temporarily worsen (e.g. dark urine, abdominal pain, fatigue). If this happens, it would be important for patients to notify their hematologists.

There is a rare, severe adverse event associated with the adenoviral COVID-19 vaccines (AstraZeneca/COVISHIELD and Janssen/Johnson & Johnson) called vaccine-induced thrombotic thrombocytopenia (VITT). Though there is no clear increased risk in PNH patients, Health Canada has recommended that those with a history of cerebral sinus thrombosis with thrombocytopenia or previous heparin-induced thrombocytopenia (HIT) should receive alternate vaccines if available. Those patients who have already had their first dose of adenoviral vaccine without complications may receive the second dose, or whichever other vaccine is offered them in their jurisdiction.

The vaccines currently available are given as an intramuscular needle. Injections into the muscle can be associated with bleeding, so patients who have low platelet counts (<30 x 109/L) should consult with their doctors before being vaccinated.

Patients who are taking blood thinners are encouraged to get vaccinated. There may be a small risk of bruising or bleeding at the injection site; however, putting pressure on the area for 3-5 minutes after the injection should help to minimize that risk.

If patients with AA who have received ATG within the last 6 months, vaccine response may be reduced, and patients should discuss this with their hematologist in advance of vaccination.

Regardless of vaccination status, it is important that everyone continue to follow the general practices of masking, hand hygiene, and physical distancing.

If patients are diagnosed with COVID-19, it is important that they notify their treating hematologist to discuss their condition and continuation of treatment for their PNH/AA.

As provincial and national guidance on COVID-19 vaccination changes, our guidance may also change as we learn more about the reactions experienced in the general population. Updated information, should it be required, will be posted here. For specific questions, PNH patients should discuss vaccination with their treating hematologist. General information about the vaccination program in Canada can be found at the following link:
https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19/vaccines.html