NACI recommends Canada pause AstraZeneca vaccine for people under 55

Canada’s National Advisory Committee on Immunization (NACI) is recommending a pause on AstraZeneca COVID-19 vaccinations for people under 55 due to safety reasons.

The NACI will advise provinces to stop giving the vaccine to anyone under that age group, following Prince Edward Island’s lead after they halted the shot for those aged 18 to 29 early on Monday.

Quebec is also suspending the use of the AstraZeneca COVID-19 vaccine for people under the age of 55 following concerns it may be linked to rare blood clots.

The province says in a news release that the decision was taken in conjunction with the Public Health Agency of Canada as well as provincial and federal vaccine advisory committees.

“NACI recommends that AstraZeneca COVID-19 vaccine should not be used in adults under 55 years of age at this time while the safety signal of Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) following vaccination with AstraZeneca COVID-19 vaccine is investigated further,” said the NACI in a release.

The NACI says cases identified have been primarily in women under the age of 55 years but note that cases in men have also been reported and have mostly occurred between 4 and 16 days after administration.

“This adverse event is being referred to as Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT).”

Based on the NACIs latest round of information, the case fatality of VIPIT is approximately 40 percent but they say the case fatality may decrease with “increased awareness of the adverse event and appropriate early treatment.”

“From what is known at this time, there is substantial uncertainty about the benefit of providing AstraZeneca COVID-19 vaccine to adults under 55 years of age given that the potential risks associated with VIPIT, particularly at the lower estimated rates,” the NACI continued in its release.

They said that adults 55 years of age and older may still be offered the AstraZeneca vaccine with informed consent, given the increased risk of hospitalization and death due to COVID-19 disease in this population.

“We have no concerns with those who have received it so far,” said Dr. David Williams, Ontario’s chief medical officer.

Canadian health officials first recommended the AstraZeneca vaccine for those under 65, but on March 16 it adjusted its advice to say that it could also be given to seniors.

“There is substantial uncertainty about the benefit of providing AstraZeneca Covid-19 vaccines to adults under 55 given the potential risks,” Dr. Shelley Deeks, Vice-Chair of the NACI.

Just hours after his Health Minister got her first dose of the AstraZeneca vaccine, the Premier was asked if Ontario will limit the use of the vaccine.

Doug Ford says his government is following the lead of the feds.

“The feds are saying it’s still safe for 55-plus,” said Ford. “I understand there have been blood cots in patients in the UK. Female around 30 to 35 years old. But I won’t hesitate to cancel that [AstraZeneca vaccine] in half a heartbeat if it’s going to put anyone at harm, we just won’t use it.”

Ford adds that he “would rather wait” if it means a few months for Pfizer, Moderna, and Johnson & Johnson than “roll the dice” with AstraZeneca.

No one below 60 years old has received the AstraZeneca shot in Ontario.

Dr. Joss Reimer of Manitoba’s Vaccine Implementation Task Force says this all due to the possibility that those getting the shot may get a rare but serious blood clot.

“The increase in this rare type of serious blood clot affects somewhere around one in 100,000 to one in 1-million people who receive this vaccine,” said Reimer on Monday.

“Typically, the symptoms happen 4 to 20 days after immunization and the symptoms can mirror the symptoms of a stroke or heart attack.”

Canada’s Chief Medica Advisor Dr. Supriya Sharma says there have yet to be any reports of these aforementioned side effects in the country.

“Health Canada has previously communicated on an ongoing assessment of very rare adverse events reported in Europe of blood clots with low platelets occurring after immunization with the AstraZeneca vaccine,” said Sharma.

“… To date no cases of these events have been reported in Canada. However, through our ongoing international collaboration, Health Canada has become aware that additional cases of these events have been reported in Europe. In light of this developing information, Health Canada will be issuing additional terms and conditions on the authorizations of the AstraZeneca and Verity pharmaceuticals serum institute of India vaccine.”

Canada is expected to receive 1.5 million doses of AstraZeneca from the U.S. this week.

“The messaging has been brutal overall. I am fearful it is toast. It shouldn’t be,” said Dr. Andrew Morris, a professor of infectious diseases at the University of Toronto and the medical director of the Antimicrobial Stewardship Program at Sinai-University Health Network.

Morris thinks those who are at high risk for COVID-19 outcomes and over the age of 55 should get AstraZeneca if the other vaccines are not available to them, especially during the third wave of COVID-19 infections in Ontario.

Several European countries suspended using the vaccine over concerns it could cause blood clots but have resumed administering it.

Canada Health Minister Patty Hajdu refused to directly comment, only stating Health Canada monitors real-world data on the use of vaccines.

“As you know, AstraZeneca has been under examination by a number of jurisdictions for its connection to potentially adverse effects,” said Hajdu on Monday.

They have, however, updated warning labels to note the very rare occurrence of blood clots.

Christine Elliott got the AstraZeneca vaccine on camera at a Toronto pharmacy around 9:15 a.m. Monday.

“It’s important for everyone when it’s their turn to get a vaccine,” said Elliott. “The more people that get the vaccine the sooner we can go back to normal life.”

Ontario’s health minister says the province is studying COVID-19 vaccine hesitancy levels as it continues to urge people to get inoculated.

With files from The Associated Press

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