Under-30s to be offered alternative to AstraZeneca COVID-19 vaccine after reports of rare blood clots

People under 30 are to be offered alternatives to the Oxford/AstraZeneca COVID-19 vaccine after the MHRA said evidence was 'firming up' of a link between the vaccine and extremely rare blood clots.

No causal connection has yet been established between the AstraZeneca COVID-19 vaccine and blood clots. | GETTY IMAGES
No causal connection has yet been established between the AstraZeneca COVID-19 vaccine and blood clots. | GETTY IMAGES

Both UK and EU regulators reiterated on 7 April that the benefits of vaccination with the AstraZeneca COVID-19 vaccine continue to outweigh the risks for the vast majority of people.

At a Downing Street press briefing on 7 April, MHRA chief executive Professor June Raine said 79 cases of clots and 19 deaths have been reported in the UK after more than 20m doses of the AstraZeneca vaccine.

Of the 79 cases, 51 occurred in women and 28 in men - aged from 18 to 79 years of age. Of the 19 deaths, three were in people aged under 30, with 14 of these cases involving cerebral venous sinus thrombosis (CVST), and five 'other types of thrombosis' in major veins.

Based on the different risk-benefit balance for people in different age groups, the Joint Committee on Vaccination and Immunisation (JCVI) is now recommending that people aged under 30 with no other health conditions that put them at increased risk from COVID-19 are offered alternatives to the AstraZeneca vaccine.

Currently there are two other vacccines being used in the UK programme - the Pfizer/BioNTech vaccine, which was the first to be introduced, in December; and the Moderna vaccine, which began its UK rollout today in Wales.

Alternative vaccine

JCVI COVID-19 immunisation chair Professor Wei Shen Lim said that following a review of available evidence, the committee was advising that adults aged 18-29 'who do not have an underlying condition that puts them at higher risk from serious COVID-19 disease should be offered an alternative COVID-19 vaccine in preference to the AstraZeneca vaccine where such an alternative is available'.

'We are not advising a stop to any vaccination for any individual in any age group,' he told the briefing. 'We are advising a preference for one vaccine over another for a particular age group really out of the utmost caution rather than because we have any serious safety concerns.'

The JCVI has also recommended an update to advice for patients to reflect the latest information and has said that people who have received a first dose of AstraZeneca vaccine should continue to receive a second dose in line with the 11- to 12-week schedule.

Commission on Human Medicines chair Professor Sir Munir Pirmohamed told the briefing that anyone who had experienced a cerebral or other major blood clot alongside a low platelet count after a first dose of the AstraZeneca vaccine should not be offered the second dose.

He highlighted that COVID-19 itself was associated with a significant risk of clots and lowered platelets - and said pregnant women should continue to be advised to discuss with healthcare professionals whether the benefits of vaccination outweighed risk.

Course correction

Professor Raine said the UK vaccination programme had already saved thousands of lives. She said very rare effects were only detected when vaccines were used at scale - and that UK monitoring systems were now detecting a 'potential side effect of the COVID-19 vaccine Astra Zeneca in an extremely small number of people'.

She said: 'The evidence is firming up and our review has concluded that while it is a strong possibility more work is needed to establish beyond all doubt that the vaccine has caused these side effects.'

Deputy chief medical officer Professor Jonathan Van Tam said the update to advice on use of the AstraZeneca vaccine was a 'course correction' for the vaccination programme but that expected supply of Pfizer and Moderna vaccine over the coming weeks would likely mean the impact on rollout of vaccination to UK adults would be 'zero or negligible'.

Professor Lim added that there was a 'slight gradation in the risk of this serious adverse event occurring in younger people compared with older people' - but made clear that the key factor behind the advice on preference for other vaccines in younger people was 'the benefit-risk balance'.

Meanwhile a review by the European Medicines Agency did not conclude based on available evidence that age and gender were risk factors for blood clots in patients receiving the AstraZeneca vaccine.

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