Spain, Belgium and Italy restrict AstraZeneca Covid vaccine to older people

Italy, Spain and Belgium have joined other European countries in restricting or recommending the use of the Oxford/AstraZeneca vaccine in older age groups as the EU struggles to agree common guidelines to counter expected public hesitancy.

The European Medicines Agency (EMA) on Wednesday found a possible link between the vaccine and very rare cases of blood clots, although it said its benefits far outweighed the risks and did not announce any restrictions.

In Britain, the government’s joint committee on vaccines and immunisation said healthy people aged 18 to 24 who were not at high risk of Covid should have the option of a different jab if one was available in their area.

Belgium’s national and regional health ministers subsequently agreed to restrict the vaccine to the over-55s for a month, while Italy’s health minister, Roberto Speranza, said late on Wednesday the shot should be offered only to those aged 60 and over.

Franco Locatelli, the head of the country’s health council, said people who had already had the first dose of the AstraZeneca jab could proceed with the second, and officials stressed that while the shot was not recommended for under-60s, it was not prohibited.

After meeting regional health chiefs, Spain’s health minister, Carolina Darias, also announced late on Wednesday that administration of the AstraZeneca vaccine would be temporarily suspended nationwide to people under the age of 60.

Spain’s autonomous regions have given more than 2.1m first shots of the Anglo-Swedish shot under a patchwork of rules and at various paces. Authorities now have to decide whether to use a different vaccine for the second dose.

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Quick Guide

Covid vaccine side-effects: what are they, who gets them and why?


What are the most common side-effects from the Covid vaccines?

According to Public Health England, most side-effects from the Covid vaccines – Pfizer/BioNTech and Oxford/AstraZeneca – are mild and short-lived. These include soreness where the jab was given, feeling tired or achy and headaches. Uncommon side-effects include having swollen lymph nodes.

Why do the common side-effects occur?

“The sore arm can be either due to the trauma of the needle in the muscle, or local inflammation in the muscle probably because of the chemicals in the injection,” said Prof Robert Read, head of clinical and experimental sciences within medicine at the University of Southampton and director of the NIHR Southampton Biomedical Research Centre.

“The other common side-effects – the muscle aches, flu-like illness and fatigue – are probably due to generalised activation of the immune system caused by the vaccine. What this means is that the white blood cells that are stimulated by the vaccine to make antibodies themselves have to secrete chemicals called cytokines, interferons and chemokines, which function to send messages from cell to cell to become activated.”

Are blood clots a side-effect of the vaccines?

The Oxford/AstraZeneca jab has been linked to a small but concerning number of reports of blood clots combined with low platelet counts (platelets are cell fragments in our blood that help it to clot).

These include a rare clot in the brain called cerebral venous sinus thrombosis (CVST). In an unvaccinated population, upper estimates suggest there may be 15 to 16 cases per million people per year.

The Medicines and Healthcare products Regulatory Agency (MHRA) said recipients of the Oxford/AstraZeneca jab should look out for new headaches, blurred vision, confusion or seizures that occur four days or more after vaccination. The MHRA also flagged shortness of breath, chest pain, abdominal pain, leg swelling and unusual skin bruising as reasons to seek medical advice.

Up to and including 31 March, the MHRA said it received 79 reports of cases of blood clots combined with low platelets, including 19 deaths, following more than 20m doses of the Oxford/AstraZeneca jab. That equates to about four cases for every million vaccinated individuals.

Two cases of blood clots with a low platelet count have also been reported among recipients of the Pfizer/BioNTech jab. The European Medicines Agency is also examining three cases of venous thromboembolism blood clots involving the Johnson & Johnson jab.

The MHRA says blood clots combined with low platelets can occur naturally in unvaccinated people as well as in those who have caught Covid, and that while evidence of a link with the Oxford/AstraZeneca vaccine has become stronger, more research is needed.

Nicola Davis Science correspondent

EU countries that have already imposed restrictions include Germany, which is limiting its use to under-60s and priority groups and has recommended that people under 60 who have had a first shot should receive a different second dose.

But countries are setting a range of age limits for the shot, with France restricting its use to people aged 55 and over, the Netherlands to those aged 60 and over, and Finland and Sweden to people aged 65 and over.

EU health ministers failed at an extraordinary meeting on Wednesday night to agree a coordinated approach despite a plea by Portugal, which holds the bloc’s rotating presidency, to urgently seek common ground on the use of the vaccine.

“It is essential that we follow a coordinated European approach – an approach which does not confuse citizens, and that does not fuel vaccine hesitancy,” the EU health commissioner, Stella Kyriakides, reportedly told ministers at the meeting.

The EMA said it received reports of 169 cases of the rare brain blood clot by early April, after 34m doses had been administered in the European Economic Area (EEA), adding that most occurred in women under 60 withintwo weeks of vaccination.

In Germany, Christian Bogdan, a member of the country’s vaccine committee, said instances of the condition in women under 60 who had been given the AstraZeneca shot were 20 times higher than would normally be expected, representing what he called a “very clear risk signal”.

Countries that have imposed age restrictions on the AstraZeneca vaccine now face the conundrum of what to do about younger people who have had a first dose. Some experts say different vaccines could work together to fight the virus because all target the same outer “spike” protein of the virus.

Germany has recommended that people under 60 who have had a first AstraZeneca shot should receive a different product for their second dose. Other countries are waiting for the results of a British trial launched in February to explore mixing doses of Pfizer and AstraZeneca vaccines.

France’s top health advisory council is reportedly considering using mRNA vaccines such as those produced by Pfizer/BioNTech and Moderna as a second dose, but no formal decision has not been yet taken.



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