Covid-19 Vaccine and PBC
A statement from the PBC Foundation Medical Advisory Committee
This advice is intended for those resident in the UK. Covid vaccines are being rolled out in many countries and different countries have adopted different practices. While the principles underlying our advice applies to all, we recommend that those outside the UK familiarise themselves with the recommendations in their country.
At present, the UK has licenced three vaccines to protect people against Covid-19 infection and a vaccination programme is being rolled out across the four nations of the UK. The governments of the UK have identified a list of priorities. Those with advanced liver disease, those on immunosuppressive therapy (including those on corticosteroids) and those who have had a transplant are at greater risk of the effects of Covid and therefore have been given priority.
Vaccination has attracted controversy, much of it ill-informed and inaccurate.
The PBC Foundation Medical Advisory Board wishes to stress their advice to all those offered vaccination:
· Vaccination offers a huge opportunity to help bring the pandemic under control and allow everyone to return to a normal way of life
· We very strongly recommend all those who are offered vaccination to take full advantage of the opportunity
· Vaccination is associated with a low risk of minor complications (such as transient pain, fever and tiredness); we are aware of ongoing concerns about the possibility of the Astra Zeneca vaccine being associated with a risk of thrombosis
· The benefits of the vaccine far outweigh any risk or complication
· Those on immunosuppressive therapy may safely receive the vaccine
The BioNTech/Pfizer and the Moderna vaccines use mRNA technology; this technology is based on a large amount of scientific data and animal work but is new when applied to vaccines for human use. Thus, there is a great deal of background knowledge on this technology, and experience from animal vaccines has shown that this allows for faster development and production of vaccines than classical vaccines. The Oxford/AstraZeneca vaccine uses a modified non-replicating weakened version of the common cold virus.
Evidence to-date shows the side effects of these vaccines are very similar to the transient side-effects we see with most other vaccines, such as local reactions such as pain in the upper arm for a couple of days and in some cases, fatigue, headache and fever lasting up to three days. As with other vaccines, a few cases of allergic reactions have been reported, but they have been confined to patients with a strong allergic predisposition.
These are not live vaccines, so they are safe for immunosuppressed patients. Experience in those with liver disease and on immunosuppression is less than in the general population but there is no evidence that the side-effects are any greater in those with liver disease or on immunosuppression. We are aware of ongoing studies looking at the efficacy of Covid vaccines in preventing disease in transplant recipients but strongly recommend that transplant recipients accept the offer of vaccination.
As with any medical interventions, people need to be aware of potential harm and balance risk and benefit. There has also been a great deal of comment about a possible link between the Astra-Zeneca vaccine and clotting, affecting especially younger people. The possible association between the Astra Zeneca vaccine and clotting events is being closely monitored by the regulatory authorities around the world as well as by the media. The former have access to the actual data and have the expertise to assess causality (that is whether the vaccine does increase the risk of thrombotic episodes or whether this is coincidental). In general, younger people are less at risk of the consequences of Covid and may have a greater risk of thrombosis, so the balance of risks and benefit is different to that in older people or those with liver disease or taking immunosuppressive therapy.
Advice varies between different jurisdictions and will change over time, so we advise readers to familiarise themselves with the guidance in their own country. Even if a direct link between the Astra Zeneca vaccine and clots is shown, the risk from the vaccine is still very small. It has been estimated it is about the same risk as dying in a car accident when driving 250 miles. In the UK, the current advice is to use vaccines other than the Astra Zeneca one for those under 30 years and this is a precautionary measure. As more information becomes available, this advice may change. Overall, considering the huge benefits from the vaccines in saving lives and the number of people dying from Covid or the survivors with long-Covid, the risk-benefit balance seems obvious.
The view of the PBC Medical Advisory Board, in line with other professional and patient-based organisations, remains that the benefits of the vaccine far outweigh the risks and the Board strongly advises all those offered the vaccine to take the opportunity, so protecting their own health and indirectly the health of others and allowing a return to normal life.
As the roll out continues around the world, more vaccines will become available and there will be more information about the benefits and risks. The Medical Advisory Board will endeavour to keep members updated as robust information becomes available.
Finally, people should be aware that some unscrupulous people have lost no time in developing new ways of using the pandemic and roll out of the vaccination programme to scam people. So please be careful: the NHS will not ask you for money or for any financial details. Be vigilant and report any scams.
12th April 2021