Who should not receive Astra Zeneca COVID-19 vaccine (Vaxzevria):

The Chief Epidemiologist has received the expert opinion of haematologists (in Icelandic here) at Landspitali University Hospital regarding the following groups who should be targeted for vaccination with mRNA vaccines (such as Moderna vaccine) rather than Vaxzevria. Please note that these conditions are not contraindications for Vaxzevria according to the European Medicines Agency. The vaccine has not been found to prompt thromboses in individuals at increased risk for spontaneous thromboses, the thromboses linked to Vaxzevria are likely to be related to idiosyncratic immune responses. Individuals with these conditions who request Vaxzevria may receive it despite these conditions and doctors are not required to send a notification of such decisions to the Icelandic Medicines Agency or the Chief Epidemiologist.

Women under age 55

Individuals with a history of spontaneous blood clots in veins, whether they are using blood thinners or not at this time, ICD10 codes:

  • I26 with all sub-categories (pulmonary embolism)
  • I80 with all sub-categories (phlebitis and thrombophlebitis)
  • I81 with all sub-categories (portal vein thrombosis)
  • I82 with all sub-categories (other thrombosis and embolism)
  • I67.6 (non-pyogenic thrombosis of intracranial vessels, this includes cerebral venous sinus thrombosis)

Individuals with increased risk of blood clots such as patients with (with ICD10 codes)

1. Myeloproliferative syndromes

      • C92.1 chronic myeloid leukaemia; D47.1 chronic neutrophilic leukaemia and myeloproliferative disease, unspecified; D47.5 chronic eosinophilic leukaemia
      • D45 polycythaemia vera
      • D47.3 essential thrombocythaemia
      • D47.4 primary myelofibrosis, including individuals with JAK2 mutations

2. D59.5 primary nocturnal haemoglobinuria (PNH)

3. D68.6 lupus anticoagulant/antiphospholipid syndrome – that is, patients with autoantibodies that increase the risk of blood clots in veins

4. bone marrow disease treated with lenalidomid or similar medications (ATC L04AX04)

It is important to remain vigilant for signs of rare and serious side effects of all the COVID-19 vaccines and respond quickly if a patient has symptoms or signs of thrombocytopaenia (such as bleeding from mucosa or petechiae), thrombosis in arteries or veins, including intracranial veins/sinuses or veins from internal organs or embolism, for example pulmonary embolism.  

A preliminary definition of these events and recommendations for appropriate work-up and treatments are still pending. It is recommended to consult a haemotologist if such events occur with clear reference to the possible link to the vaccination.

If serious events occur within 2 weeks of vaccination against COVID-19 they should be reported promptly to the Icelandic Medicines Agency.

Fyrst birt 13.04.2021

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