Any scientists around who could help with this vaccine-related question?

[BeforetheFlood]

Hoping for any expert opinions or insight into this situation. My 23 yr old asthmatic daughter has been desperate to get her invitation for vaccination – she’s been working from home, massively missing her bf who lives at the other end of the country etc – and was over the moon to get an appointment through for today (Friday.)

This week’s news obviously put a big question mark over everything. In addition to being under 30, she also had an episode of ITP when she was 3, requiring regular hospital visits and blood tests over a period of a few months until her platelet count rose again. No further problems since.

She rang the GP’s surgery and was told that she should still have the AZ vaccine, as risk of covid is greater than risk of clotting. She’s been so keen to get it she was pleased that it still seemed possible and went along today. However, she checked with the doctor at the vaccination clinic and his advice was categorically not to have it. He strongly advised that she should go on a waiting list for a Pfizer or Moderna clinic, though couldn’t say when she would actually get called.

The question I have, and which I would really appreciate some expert advice on, is that the information I can find online seems actually to point to a greater risk of ITP with both Pfizer and Moderna as they are ‘genetic vaccines’? This is where my very non-scientific brain is struggling, as the articles I can find are just too far beyond my layperson’s understanding. Obviously, I would usually just go with the GP’s advice, but the doctor – though lovely and very willing to listen – didn’t seem to have any specialist knowledge of this, was reacting off the cuff and was basing his advice on the current official line of avoiding AZ for under 30s. My fear is that it might be, at best, a frying pan to fire situation, in waiting for the other vaccines, and at worst, actually opting for something that is more harmful to people who have had ITP previously.

I found a link to a letter in the BMJ about it, but am really struggling to understand it. If any scientists who can shed some light it would be so much appreciated. (Crazy times that we have to ask this on the internet, but here we are!)

www.bmj.com/content/372/bmj.n699/rr-20 (The final paragraph in particular makes me think that Pfizer and Moderna are even less suitable for her than AZ?? - Nevertheless, genetic vaccines are new, and their long-term safety evaluation is a key to identify potentially contraindicated group of subjects, for instance patients with history of blood disorders, past or current thrombocytopenia or pre-existing immunological conditions

Sorry for very long post, but if you’ve read this far – thank you!

You read the article correctly, but you have to bear in mind this is a single person (or group)'s hypothesis - it's not established science.

Basically the BIG concern atm is focussed on the AZ vaccine, where it is believed that in some cases, the spike protein itself is being attached to blood platelets which as far as the immune system goes, become the enemy, are attacked which causes clotting.

In the letter you cite, the authors suggest that the mRNA vaccines may also cause this mechanism and further study is warranted. What they AREN'T saying is that the mRNA jabs carry a greater risk.

In short you have multiple reinforcing and opposing risks to consider.

1. Your daughter's asthma putting her at risk of more severe covid and/or her mental health at staying confined and virus-risk-free for longer.
2. The very slight risk of the AZ vaccine
3. The potentially similar but also very slight risk from any other vaccine.

You also need to bear in mind that the clotting condition is mostly treatable if caught early enough - some of those who died waited weeks before reporting their issues.

Thank you so much for taking the time to respond bookworm - that is exactly the kind of clarity I was hoping for. She is bitterly disappointed not to have had the vaccination and you've hit the nail on the head about the mental health aspect - she really thought that today would be a turning point. It's a blow to find she's back to (what feels like) square one on the snakes and ladders board that has been this pandemic.

I didn't even pick up that the letter in the link was one person's theory, so I'm grateful to you for pointing that out. I guess it comes down to a whole host of medical unknowns, and the more definite psychological factor of her wanting it done.

Thank you again for your time and wisdom.

@BeforetheFlood

Thank you so much for taking the time to respond bookworm - that is exactly the kind of clarity I was hoping for. She is bitterly disappointed not to have had the vaccination and you've hit the nail on the head about the mental health aspect - she really thought that today would be a turning point. It's a blow to find she's back to (what feels like) square one on the snakes and ladders board that has been this pandemic.

I didn't even pick up that the letter in the link was one person's theory, so I'm grateful to you for pointing that out. I guess it comes down to a whole host of medical unknowns, and the more definite psychological factor of her wanting it done.

Thank you again for your time and wisdom.

I should add, that imo the risks from an individual perspective are quite difficult to understand. The reaction of regulators is because they're mindful of the overall impact.

But for comparison, the risk of a healthy person dying from a general anaesthetic is approx 1 in 100,000. The risk of these clotting events seems to be similar, but of these only about 1/4 die according to data so far.

Most people wouldn't think twice of going into hospital for a minor operation to make their lives better......

It's all about perception and what the newspapers are highlighting.

That's exactly it - we're looking for answers that just don't exist. There is no crystal ball style guarantee.

If I was a scientist I would spend the next week reading every piece of literature and research I could find and trying to put jigsaw pieces of information together. I might end up with a better insight into the balance of risk and probability, but I still wouldn't know for certain what was best for my daughter.

I don't want to put you on the spot bookworm - and obvs no pressure to reply, but would you suggest that the pros of going ahead with AZ now balance fairly equally with the cons of waiting (indefinitely) for Pfizer/Moderna?

Episode of ITP when she was 3yo, to now 20yrs later, is as near as 100% certain to be completely irrelevant to her risk profile. ITP comes in (very) temporary & chronic forms; OP hasn't describe chronic.

The real enough possibility that the mRNA vaccines may be more likely to cause clots is just one of the weird twists and turns in all of the pandemic saga.

The letter in BMJ is highly speculative; it's a discussion document. It is NOT evidence. It's the green row in this Hierarchy of Evidence pyramid (not something anyone should use to make actual decisions).

If your DD hasn't had jab yet then she's not Group 6; by the time she's offered the vacc then hopefully there will be more information to make a decision she's confident with. One thing to help decide is knowing the AZ vacc has consistently had more reported side effects than Moderna or Pfizer and that trait is likely to persist.

There is a table at the bottom of this article that shows the risks of covid versus vaccine for each age group

www.telegraph.co.uk/news/2021/04/08/vaccines-advice-could-still-change-30s-jcvi-suggests/

In summary the risk from the vaccine is greater than covid for 20-29 year olds if they have a low exposure risk to covid.

Thank you for your input MedSchoolRat and WaltzforDebbie

I think she's decided to go for the AZ and get it done sooner rather than having to wait indefinitely again (she is in Group 6 and has been called.) She sees it as being the ticket out of a really difficult year and just wants her life back, so she's prepared to take the small risk. I think she just wishes her appointment had been for a couple of days earlier and she wouldn't have been in the position of having to make the call for herself! She's got several friends her age who have had AZ already, without problems, which has also informed her choice.

Thank you again everyone for your insight.

Please check she knows to take into account the 22 days average to build up immunity after the first dose of AZ. The highest probability is that she'll be fine as the risk is only slightly elevated for younger people, but also good for her to know all the signs and go to get checked if she gets any.

I have itp and connective tissue disease and recently spoke to my haemotologist who has recommended itp patients to get the vaccine. He said there is a greater risk if a itp patient gets covid however my rheumatologist had advised getting the vaccine as there isnt enough evidence or data for people with that condition. As your daughter had itp at a young age it is unlikely that the vaccines will have a major effect and everyone has to be mindful that any vaccine can cause clotting issues.

Yes, I think that's one of the factors that's influenced her decision MRex Her commute to work involves 2 crowded trains each way, so she's been wary of going back to the office before being vaccinated, but really wants to get back there as her job isn't really suited to WFH. The thought of joining a growing waiting list for an alternative vaccine, and then having the additional wait for immunity means she could be looking at another 6 -8 weeks of WFH and not seeing her boyfriend instead of 3-4 if she gets the AZ.

Thank you for sharing your experience and the advice of your consultants independent98 That's reassuring for us, but difficult for you! Have you decided what to do?

I have decided not to take the vaccine as my platelets is generally low (last count 20) for now which I manage without immunosuppressants. I WFH which will change in the summer but I don't expect to be full time back in the office. I am mindful with that the current vaccines is causing a increase in clotting disorders so apprehensive ATM.