COVID Vaccination

Aida Wen, MD5/20/21

How your body fights diseases

• “Foreign” proteins from invaders are recognized by your body’s cells= Antigens

• Your white blood cells gang up to fight off the antigen “enemies”.

• Some white cells produce antibodies (B cells) that fight specific targets.

• Antibodies only attack the antigens that “matches” perfectly with their target. It may take days or weeks for the body to “learn” who the specific enemy is to attack.

• Some people can fight infections better than others. If your immune system is weak, the virus may multiply faster than the body can kill the virus.

• Example: your care home clients may get very sick and may even die.

How Vaccines work

• Giving a vaccine introduces the antigen so that your body will learn to recognize the enemy- like a “WANTED” sign! Then when it actually encounters the enemy, it can respond faster and stronger to get rid of it before it can make you super sick.

• A vaccine introduces your body to the “enemy” in a “safe” way– it is NOT the entire virus, but only the code for a tiny part of it (ex: the spike).

• When your body sees the “enemy particle”, your body ramps up its immune system to fight this. That is why you may feel sick after you get a vaccine. It is just your body doing its “learning”. Symptoms= the Immune Response.

• We don’t yet know how long the “memory” lasts.

How Vaccines work

mRNA vaccines: https://www.youtube.com/watch?v=WOvvyq

J-vwo (4:10)

• mRNA vaccines teach our cells how to make a piece of a protein (spike protein) that triggers an immune response in our bodies.

• mRNA vaccines cannot give someone COVID-19. There is no live virus.

• mRNA does not interact with your DNA• Once the protein piece is made, the body gets rid

of the mRNA (destroys the instructions)

• Viral vector vaccines use a harmless virus to carry the piece of spike protein into the cell to teach our cells to begin producing antibodies and cell to fight the infection.

Different Vaccines• 3 Main types of COVID vaccines in the United States

• mRNA vaccine• 2 doses, 3 weeks apart• 94% effective for prevention

of disease• EUA for 12+ years• Requires Ultra Cold

refrigeration• 5-dose vial

Pfizer-BioNTech

• mRNA vaccine• 2 doses, 4 weeks apart• 95% prevention of disease• EUA for 18+ years• Regular refrigeration• 10-dose vial

Moderna

• Viral vector vaccine• 1 dose• 70% prevention of disease• 85% effective against severe

disease• EUA • Regular refrigeration• (Tested in Brazil and South

Africa)• *Now has a WARNING Label

J&Jpaused 6/13- 4/23 for CDC to review data

DO NOT MIX AND MATCH VACCINES!

• 2 other COVID vaccines in the United States are in the pipeline (phase 3):• AstraZeneca• Novavax

Vaccine Side Effects

• Side Effects are a sign that your body is building protection.

• These side effects should go away in a few days.

• Some people have no side effects.

• Some have “other” side effects if concerned, speak to MD to investigate.

• Side Effects from the 2nd shot may be more intense than after the 1st shot.

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/expect/after.html

Treatment of Side Effects

• Do not take Tylenol, Ibuprofen, Aspirin, or antihistamines before your COVID vaccine.

• You can take these AFTER the vaccine if you develop post-vaccination side effects (wait 4 hours)

• “COVID arm” = itchy, red , swollen, painful rash, which may last a few days to a week after 1st shot.

• If you get “COVID arm”- you can take antihistamine and pain medicine. It is also ok to take the 2nd

shot in the other arm.

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/expect/after.html

Side effects usually last up to 3 days

Report Side Effects

• Download the CDC V-safe app to your smartphone to do health check-ins, or

• Report to the VACCINE ADVERSE EVENT REPORTING SYSTEM

• ONLINE or CALL 1-800-822-7967• Healthcare Providers are required to report by law

• Patients, caregivers, or anyone can report on-line as well (optional)

https://vaers.hhs.gov/reportevent.htmlhttps://www.cdc.gov/vaccines/covid-19/toolkits/long-term-care/faqs.html

Allergic Reactions

• Continuous shortness of breath or wheezing

• Swelling of lips, eyes or tongue

• Redness, swelling or itchy on part of body that did not get the injection

Within 4 hours

Other Reactions (J&J)

Rare, severe, blood clot problem (6 cases/7.5 million doses)

• Shortness of Breath• Leg pain or swelling• New Neurological symptoms• Severe headache, backpain,

stomach pain• Unexpected bruising• Tiny red spots on the skin Within 3 weeks

What about Allergies?

If anyone has allergies that cause itchy eyes, runny nose, they can still receive the vaccine, and will be observed for 15 minutes.

• Severe life-threatening reactions (anaphylaxis) are extremely RARE. • Pfizer: 11 cases per million doses (.001%) • Moderna: 2.5 cases per million doses (.0003%)

• All vaccination sites will monitor everyone for 15-30 min after the shot.• All vaccination sites are able to handle allergic emergencies.

If anyone has a HISTORY of anaphylaxis to Food or insect stings, oral medications, or other vaccines/injectable medications, they can still receive the vaccine, but will be observed for 30 min (instead of 15 min)

Vaccine should NOT be given if: Allergy specifically to Polyethylene glycol or polysorbate or if they had anaphylaxis to the first vaccine.

Pre-Vaccination Checklist

• https://www.cdc.gov/vaccines/covid-19/downloads/pre-vaccination-screening-form.pdf

COVID VARIANTS

• Viruses constantly change by mutation

• There are many new variants in the world now.

• They seem to spread more easily and quickly

• Many are now being seen in the United States (see parenthesis)

India

UK(Dec 2020)

South Africa(Jan 2021)

Brazil(Jan 2021)

California x2(Feb 2021)

Original

COVID VARIANTS So far, current vaccines CAN

recognize these variants and can prevent you from getting severe illness.

The more these variants enter the community, the higher likelihood that even more mutations will develop.

CDC is studying these carefully.

May need shots every year, and to different variants. Similar to the flu vaccine.

Original UK(Dec 2020)

South Africa(Jan 2021)

Brazil(Jan 2021)

California x2(Feb 2021)

India

Special Populations

• Immune Compromised patients• Vaccinate- but they are likely to have a lower response

• Autoimmune Disease• Vaccinate- but they are likely to have a lower response

• Diabetes, Cancer, Lung disease- at higher risk for severe cases

• Pregnant women• Pregnant women at higher risk for severe case if they get

infected.• Appears safe• Beware of high fevers

There are People at High Risk for Severe COVID if not Vaccinated

How to get vaccinated/where

• Vaccines.gov or call 1-800-232-0233

• Hawaiicovid19.com/vaccination-registration/ • Appointments or walk-ins

• Kupuna Call Center:

• Those 65 and older can call 211 to speak with a trained specialist who can assist him/her/them with accessing COVID-19 vaccine appointments. You can also visit auw211.org for resources and information or email specific requests to info211@auw.org.or call 211

• Vaccination does NOT guarantee that you won’t get COVID (especially the new variants).

• It PROTECTS you from getting severely sick.

• A vaccinated person can STILL get the virus

• May have FEWER/ NO symptoms

• May be LESS LIKELY TO SPREAD it.

• Therefore, we must STILL TAKE PRECAUTIONS: Mask, Distance, Handwashing

Does NOT apply to healthcare settings.

Does NOT apply for vulnerable elders or those living in congregate settings like Nursing homes, Assisted Living, or Foster or Care Homes

Especially NOT for persons with immunocompromising conditions (cancer, transplant, RA).

https://www.cdc.gov/coronavirus/2019-ncov/images/vaccines/323698_A_COVID-19_AfterVaccine.jpg

The new relaxing visit rules for vaccinated people only apply to healthy people in the community

Visitation Recommendations

While we may be out of “lockdown” , we cannot go back to “Normal” as it was before. We have a “NEW NORMAL”

Healthcare Personnel in your Facility

• In general, fully vaccinated HCP should continue to wear source control while at work. However, fully vaccinated HCP could dine and socialize together in break rooms and conduct in- person meetings without source control or physical distancing.

• If you are fully vaccinated, and other unvaccinated/unknown status HCP are present, everyone should wear source control and unvaccinated HCP should physically distance from others.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-after-vaccination.html#anchor_1619116573222Activiti

Residents in your Facility• Group activities:

• If ALL patients/residents participating in the activity are fully vaccinated, then they may choose to have close contact and to not wear source control during the activity.

• If any unvaccinated patients/residents are present, then all participants in the group activity should wear source control and unvaccinated patients/residents should physically distance from others.

• Communal dining:

• Fully vaccinated patients/residents can participate in communal dining without use of source control or physical distancing.

• If unvaccinated patients/residents are dining in a communal area (e.g., dining room) all patients/residents should use source control when not eating and unvaccinated patients/residents should continue to remain at least 6 feet from others.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-after-vaccination.html#anchor_1619116573222Activiti

Residents going out?

• There are potential risks for going into public settings

• Avoid crowds and poorly ventilated spaces

• Adhere to wearing mask, physical distancing, and hand washing

• EVEN when visiting friends or families in private settings.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-after-vaccination.html#anchor_1619116573222Activiti

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Taking Admissions

We strongly recommend that care home operators follow what NH are doing:

• If new residents are not vaccinated, you should put them in quarantine/observation x 14 days before they can mingle with the other residents.

• If there is no space for quarantine/observation, then, full vaccination prior to admission is the safest way to go.

• The safest scenario is to do both. That is accept fully vaccinated residents and place them under quarantine/observation x 14 days before allowing them to mingle with the other residents.

Visiting Recommendations…even after vaccination

For Care Homes

• Schedule visits to limit the # of visitors to the home, and per individual, at any given time.

• Consider limiting length of visits

• On-site visits should be supervised (until families demonstrate consistent compliance).

• Outdoor visits preferable.

• Indoor visits should be in private resident room or designated visiting spaces with good airflow

• If BOTH visitor and resident vaccinated, they can choose to have close contact and not wear source control (CDC 4/27/21)

• No visits in shared rooms

• No indoor visits if # cases in the community is high

For Families and Visitors• Visitors must be screened for temperature and symptoms

• Visitor testing not required but recommended if community cases are high.

• Visitors must wear face masks, stay 6 feet apart, and do hand-washing.

• Limit visitor movement inside the home.

• Families may not take resident to “go out” for dinner, church or other family gatherings.

• *THIS STILL APPLIES to vaccinated family members who visit from local, neighbor island or travel from out of town!

Adapted from LeadingAge, based on CMS guidance on visitation in Nursing Homes, Sept 17, 2020

I am fully vaccinated. Can I gather with people who have been vaccinated? Can I gather with those who have NOT yet been vaccinated, even though I have been vaccinated?

• You may gather indoors without masks--with unvaccinated people from one other household (for example, visiting relatives who all live together) unless any of those people or anyone they live with has an increased risk for severe illness from COVID-19.

• If you have been around someone who has COVID-19, you do not need to stay away from others or get tested unless you have symptoms.

• However, if you live in a group setting (like a correctional or detention facility or group home) and are around someone who has COVID-19, you should still stay away from others for 14 days and get tested, even if you don’t have symptoms.

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html

Addressing Vaccine Concerns

https://health.hawaii.gov/coronavirusdisease2019/what-you-should-know/covid-19-

vaccine-frequently-asked-questions/

https://hawaiicovid19.com/vaccine-faqs/

What to do when it’s your turn to get the vaccine• While the entire process (including check-in and monitoring) is

estimated to take no more than 30 minutes, please allow for extra time to receive your vaccine.

• You will be asked to stay at the site where you receive the vaccine for 15 minutes after you have received the vaccine so you can be monitored for any side effects.

• If you have previously had any severe allergy or anaphylaxis, you will be monitored for 30 minutes.

What will happen after I get my vaccine?

• Do I need to wear a mask and avoid close contact with others if I am fully vaccinated?

• Being vaccinated does provide a little more leeway, in that you can take off your mask among “healthy” people who you know are also fully vaccinated.

• However, in nursing homes/care homes you should still wear a mask in common areas and when around people “outside your bubble”.

• In public, everyone should to continue using all the tools available to us to help stop this pandemic, like covering your mouth and nose with a mask, washing hands often, and staying at least 6 feet away from others.

• Where will my vaccine be documented?

• Once you get a COVID-19 vaccine, you will receive an immunization card. Keep this card safe. You may receive your second appointment in writing, and it will also be sent to you electronically. The back of the immunization card will have the date of your second appointment. The information will also be entered into a secure database that will help ensure you get the correct second dose at the right time.

• For safety monitoring, vaccine recipients are encouraged to enroll in v-safe, a smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins after you receive a COVID-19 vaccination.

I already had COVID-19. Should I still get the vaccine?

• Yes. While people who have been sick with COVID-19 and who have recovered are unlikely to be able to catch it again for 90 days, they can get still get sick with some of the variants. So far, vaccines have been shown to be effective against all the variant strains identified so far.

• Furthermore, the vaccine may produce a stronger immune response than natural infection

• It is strongly recommended that you get vaccinated.IMAGE:

https://www.pinterest.com/pin/456904324669841545/

Can COVID-19 mRNA vaccines give me COVID-19?• No. The COVID-19 vaccine cannot give someone COVID-19.

• mRNA vaccines do not use the live virus that causes COVID-19.

• Vector vaccines also do not use the live virus that causes COVID-19

How do we know that these vaccines are safe when they are so new?• The science to develop mRNA vaccines has been studied for decades and explored for other types of

virus vaccines and also in cancer research. The vaccines were developed more quickly than ever before because the U.S. government accelerated the timing of meetings and because a lot of funding was made available to develop the most promising vaccines. No scientific shortcuts were taken. The safety and efficacy standards for vaccines seeking Emergency Use Authorization (EUA) are higher than for other vaccine candidates going through the vaccine testing and approval process. Multiple agencies and groups in the United States are working together to make sure that a safe and effective COVID-19 vaccine is available as quickly as possible.

• The COVID-19 vaccines being offered to the public meet the US Food & Drug Administration’s (FDA) standards for Emergency Use Authorization (EUA). All COVID-19 vaccines were rigorously tested in thousands of people to make sure that they are safe and that they work.

• When a vaccine is granted EUA by the FDA, it means the benefits of this vaccine outweigh the harms of becoming infected with COVID-19.It also means that even after the initial studies, safety is continuously checked. There are many safety monitoring systems that watch for adverse effects and possible side effects that were not seen in clinical trials. If an unexpected adverse event is seen, experts quickly study it further to assess whether it is a true safety concern. Experts then decide whether changes are needed in the vaccine recommendations.

Should I receive the vaccine if I have other medical conditions?• Should I receive the vaccine if I have other medical conditions?

• Consult with your personal physician in order to decide whether to receive the vaccine. The vaccine trials did include people with medical conditions that place them at higher risk for developing severe COVID-19 disease.

• Should pregnant and breastfeeding women receive the vaccine?

• The vaccine has not been robustly studied in pregnant or breastfeeding/lactating women but the available data does not show that the vaccine is unsafe. The American College of Obstetrics and Gynecology recommends that the COVID-19 vaccines should not be withheld from pregnant or breastfeeding women who meet criteria for vaccination based on the CDC-recommended priority groups. Women should discuss with their personal physicians in order to decide whether to receive the vaccine.

• Should children get the vaccine?

• The initial vaccine studies did not include enough numbers of young children to make a recommendation at this time.

What is Herd immunity, and why do we want as many people in the community vaccinated as possible?

• Herd immunity refers to a situation where most of the population is immune to an infectious disease, either from previous infection or vaccination. This provides indirect protection (i.e., “herd immunity” or “herd protection”) to people who are not immune to the disease because it makes it harder for the disease to spread.…and harder for the disease to mutate!

• Experts do not know what percentage of people would need to get vaccinated to achieve herd immunity for COVID-19, maybe around >70%

Why Should I vaccinate?

Because this shows that you

care about others.

YOU may not get die or even get sick at all, but you can still spread it to people who can get sick.

IMAGE: https://www.google.com/search?q=heart&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjR1sXoitTwAhVWuZ4KHa94DOoQ_AUoAXoECAEQAw&biw=1349&bih=772&dpr=1.75#imgrc=I3Cr_0ZyhBlL5M

YOUR

What are

Hawaii DOH Immunization Branch Vaccination Call Center at (808) 586-8332 or 1-833-711-0645