clot – UPDATE

UPDATE

Pfizer vaccine exceptions

On 8 April 2021 the Australian Technical Advisory Group on Immunisation (ATAGI) recommended that Pfizer vaccine is preferred over the AstraZeneca vaccine for people aged under 50 years.

In line with this, state vaccination clinics will prioritise: 

·        The Pfizer vaccine for people under 50 years of age, with consideration of priority groups eligible during each phase (see below).  

  • The AstraZeneca vaccine for people aged 50 years and over.

People eligible for COVID-19 vaccination under the South Australian rollout can now make an appointment via the online booking system.

Some people with specific health and vaccination requirements require a GP referral and must use a different vaccination pathway to make their appointment.

People aged 50 years and over

People aged 50 years and over with a history of cerebral venous thrombosis, heparin-induced thrombocytopenia and thrombosis with thrombocytopaenia syndrome should be referred to the RAH Specialist Vaccine Clinic as per the below process.

In line with the Australian Government COVID-19 vaccine rollout, at this time there are no other criteria for a person aged 50 years or over to receive the Pfizer vaccine.

Referrals to the RAH Specialist Vaccine Clinic

People who have the below contraindications should be referred to receive their COVID-19 vaccine at a Specialist Vaccine Clinic. This applies to people both under and over the age of 50. A template referral is attached to this email.

·        Have a history of cerebral venous sinus thrombosis (CVST), heparin-induced thrombocytopenia (HIT), thrombosis with thrombocytopaenia syndrome (TTS) and other situations where it is medically indicated.

·        Have had an immediate severe hypersensitivity reaction (occurring within 1 hour) after first dose of COVID vaccine.

·        Have a past history of anaphylaxis to polyethylene glycol (PEG, Macrogol) (all weights).

·        Have a past history of anaphylaxis to any component of the COVID-19 vaccine or other vaccine.

·        Have a history of severe immediate type 1 allergic reaction (anaphylaxis) to multiple drugs, or multiple unexplained episodes of anaphylaxis.

  • Have a history severe unexplained illness after receiving COVID vaccination requiring hospitalisation for greater than 24 hours.

People with these indications should be referred to:

Specialist COVID Vaccination Clinic Level 3C

Royal Adelaide Hospital, Central Adelaide Local Health Service

Direct line : 08 7074 0787
Direct fax : 08 7074 6135

Email : Health.RAHCOVIDVaccineAdverseEffects@sa.gov.au

Interchangeability of vaccine

As per clinical guidance from the Australian Technical Advisory Group on Immunisation (ATAGI), the Pfizer and AstraZeneca COVID-19 vaccines are not considered interchangeable.

The two-dose course should be completed with the same vaccine. There is no data yet on the efficacy of mixed schedules.

If a person had an anaphylaxis or severe allergic reaction after their first dose of vaccine, they should be referred to the RAH Specialist Vaccine Clinic as per the above process.

For further information, see page 15 of the Australian Technical Advisory Group on Immunisation (ATAGI) Clinical guidance on use of COVID-19 vaccine in Australia in 2021 (v2.0).

AstraZeneca Vaccine Expression of Interest update

Recently an Expression of Interest (EOI) was sought from the GP network, for SA Health’s additional supply of AstraZeneca to support the vaccination of individuals 50 years and older.

We received a large number of responses and we will now work directly with the selected GPs to arrange delivery of up to 1000 extra doses of AstraZeneca.

The selection process was based on the analysis of average AstraZeneca vaccination rates by postcode across the State with those areas which were below the average being prioritised for allocation.

SA Health remains open to ongoing transfer of excess AstraZeneca to the GP network if the opportunity presents and we will refer back to the original EOI’s to support this.

ATAGI update on AstraZeneca

The Australian Technical Advisory Group on Immunisation met this week to review the latest developments relating to the AstraZeneca COVID-19 vaccine and thrombosis with thrombocytopenia syndrome (TTS). You can read the latest statement on the website.

 

 

 

 

 

 

It seems like 2021 is going to be another year that just keeps giving: this months issue, sadly not an April Fools, is the apparent small increase in rare blood clotting problems with one of the COVID vaccine formulations. The problems appear to be low platelets and/or cerebral venous sinus thrombosis.

Experts (if Norman Swan can be called an expert in anything other than denigrating GPs, rabble rousing, and accepting fat paycheques) are divided on the issue:

Norman Swan of the ABC: stop current phase 1a vaccinations in nursing homes, stop phase 1b vaccinations with current vaccine, redirect phase 1a vaccine to those at risk.

Professor Tim Kleinig: We have been fooled by randomness and this is likely unconnected.

Professor Michael Kidd: 425000 doses given so far; too soon to tell.

Breaking news

Melbourne man in hospital with rare blood clots post vaccine, read on…

Authorities say they’re monitoring the situation closely after the rare condition was reported.

Do as I say not as I do.

Sometimes medical advice from your GP can come across this way. Sometimes we get the opportunity to walk the walk as well as talk the talk. It’s been a super challenging week for our front desk team at PartridgeGP as they have had to field a huge number of calls from people about the vaccine and phase 1b rollout. The government has hugely mismanaged this, mainly through micromanagement and a lack of appreciation for the fact that GPs have been doing the majority of vaccinations in this country for the last 20+ years. We are efficient and excellent.

government – big spend writ small

Still, I don’t dwell on the failings of control freakery from public servants. We could be here all day. Instead I spent 20 minutes having my first dose of COVID-19 vaccine under phase 1b of Australia’s vaccination program!

Many of you may have some concerns about rare blood clotting issues and pauses in vaccination programs elsewhere. The RACGP addresses these concerns here and below (spoiler: not very much to worry about in almost all cases):

The Australian Technical Advisory Group on Immunisation (ATAGI) on safety of the Oxford University/AstraZeneca COVID-19 vaccine, ATAGI has issued further advice related to the suitability of the Oxford University/AstraZeneca vaccine for people with a history of clotting conditions.
 
The updated advice stems from reviews conducted by the Therapeutic Goods Administration (TGA), European Medicines Agency (EMA) and World Health Organization, which pored over data from millions of recipients following reports of blood clots in some European countries.
 
As of 16 March, the EMA had reported 18 cases of cerebral venous sinus thrombosis (CVST) from millions of vaccine recipients, leading several European countries to pause their rollout of Oxford University/AstraZeneca vaccines.
 
However, the subsequent reviews have concluded that the benefits of the vaccine continue to outweigh the potential risks.
 
‘There is no increase in the rates of general thromboembolic disorders after vaccination over expected rates, noting these conditions occur commonly in the absence of vaccination,’ ATAGI states.

So, if you want to discuss further and you’re one of our regular PartridgeGP patients, book a normal appointment here (usual appointment, remember we are a private billing practice).

If you’ve heard enough and just want to get in the line for phase 1b vaccination, go through the process here!

REMEMBER, WE ONLY HAVE 80-100 VACCINES A WEEK AND BEING RUDE TO OUR AWESOME FRONT DESK STAFF WON’T CHANGE THIS.

PartridgeGP works with you to help you make your best health decisions, and we won’t back away from being your companion, guide, advisor, and sounding board through your health journey. We pride ourselves on great communication and we’re ready to share our professional skills and knowledge with you. This is only MORE important now with new vaccines here to END the pandemic. The way forward is clear: make your appointment with us conveniently online right here – or call our friendly reception team on 82953200.

Better, for you.

Want more?

Photo by Miguel u00c1. Padriu00f1u00e1n on Pexels.com

For everyone, we believe that having a usual GP or General Practice is central to each person’s care and recommend that people with any health issues that come to the attention of other health professionals should be advised to attend their usual GP or General Practice rather than a specialised service (ie a place not providing the holistic care a specialist GP would).   If  they say that they don’t have a usual GP or general practice, they should be helped to find one and to actually attend it. Call PartridgeGP on 82953200 or make an appointment online here.

(Hat tip: Dr Oliver Frank)

Photo by Miguel u00c1. Padriu00f1u00e1n on Pexels.com

If you’re employed, get a side hustle and get into business. If you’ve already got a business, get a network. Want to get started? Find your tribe here!

Photo by Miguel u00c1. Padriu00f1u00e1n on Pexels.com

If you are a great GP or a great Allied Health Professional, and you want to serve your clients or patients to the best of your ability, without worrying about all the non clinical things that get in your way, lets talk. Call Mrs Hayley Roberts on 8295 3200 and have a coffee and chat with us as to how PartridgeGP can help you to help others.

Photo by Linda Eller-Shein on Pexels.com

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