Frequently asked questions for vaccinating people in special groups or with other special circumstances.

FAQ

COVID-19 vaccines in pregnancy and breastfeeding

Pregnant people are encouraged to be vaccinated against COVID-19 at any stage of pregnancy.

 

Vaccination against COVID-19 is recommended for pregnant people at any stage of pregnancy.

Vaccination is highly recommended during pregnancy, especially for those with underlying health conditions or high-risk pregnancies. The mRNA COVID-19 vaccine, Comirnaty™ (Pfizer/BioNTech, 30μg with purple cap) is available to anyone from 12 years of age. Two primary doses are given, ideally at least six weeks apart (minimum 21 days apart).

Booster doses

For those aged 18 years or over, a booster dose can be given from three months after the primary course, and if aged 16 to 17 years from six months after the primary course. Further doses (ie, second boosters) are not required at this stage for healthy people, including in pregnancy.

Safety

Millions of people have been given this vaccine while pregnant, and large-scale, international surveillance data (see below) indicate that there are no safety concerns with administering this COVID-19 vaccine in any stage of pregnancy. Vaccinating during pregnancy also offers temporary protection for newborns via passive transfer of antibody across the placenta and in breastmilk.

Discuss with health professional

Anyone with questions or concerns about receiving this vaccine in pregnancy is advised to discuss these with their health professional. Everyone has a right to make an informed decision about receiving the vaccine. The attached factsheet is designed to help support health professionals with these discussions.

More information:

References: see fact sheet for full references.
 

Can COVID-19 vaccines be safely given to frail and elderly people?

There are no safety concerns around giving COVID-19 vaccine to older and frail adults. Multiple COVID-19 vaccine candidates have shown to protect against severe disease in older age groups. A guidance statement has been produced.

Guidance statement for COVID-19 vaccination of frail elderly 
Guidance has been prepared to clarify the use of the COVID-19 vaccination for the frail elderly.
In general, it is recommended that all eligible adults, including the frail and elderly with comorbidities are offered vaccination against COVID-19, if there are no contraindications to its administration, to provide protection for the individual as well as their community.
As with all clinical interventions, there needs to be an individual risk/benefit appraisal and shared decision making between clients, whanau, surrogate decision makers, and clinicians on the individual and collective benefits and risk of COVID-19 vaccination. For frail elderly people with a prognosis of a short number of weeks (including those in terminal decline or on an end of life care pathway) the individual risk/benefit appraisal will be particularly important.
 

A single dose of COVID-19 vaccine substantially reduced (over 70%) the risk of COVID-19-related hospitalisation in elderly, frail patients with extensive co-existing conditions in the UK. By 2 weeks after the second dose effectiveness against symptomatic COVID-19 in adults aged over 70 years was 85-93%. This is important, as increasing age is a risk factor for severe COVID-19.

Following reports of deaths of frail, elderly adults in residential care facilities after COVID-19 vaccination, independent reviews by both the CDC and the WHO concluded that the mortality rate in this population is typically high and a substantial number of deaths will occur coincidentally following vaccination. For further information, click here.

When vaccinating an elderly person who has an intercurrent or comorbid condition, it is wise to ensure they are stabilised or as well as possible before they have the vaccine. Following vaccination ensure good hydration and careful management of potential systemic adverse events, such as fever. It is advisable for them to be with someone else for 24 hours after receipt of the vaccine to help manage such adverse events.


Reference

  • Shrotri M, Krutikov M, Palmer T, et al. Vaccine effectiveness of the first dose of ChAdOx1 nCoV-19 and BNT162b2 against SARS-CoV-2 infection in residents of long-term care facilities in England (VIVALDI): a prospective cohort study. The Lancet Infectious Diseases. 2021 Jun 23.

Can mRNA COVID-19 vaccine affect fertility or affect future babies?

There is no biologically plausible reason why this vaccine could have any effect on our genes or fertility and there is strong evidence it does not.

Vaccination is recommended before and during pregnancy

Women who are trying to become pregnant need not to delay the vaccination nor avoid becoming pregnant. COVID-19 is a potentially very serious disease. Pregnant women and their unborn babies are greater risk of needing hospital care than women who are not pregnant

For more information: see here for advice from the Ministry of Health and here for the advice of the Royal Australian and New Zealand College of Obstetricians and Gynecologists.

Comirnaty and fertility

Shortly after the Pfizer mRNA vaccine, Comirnaty, became available overseas misinformation circulated on social media about negative effects on fertility of vaccinated women. Such statements are misleading and calculated to cause unnecessary fear. There is no plausible reason why this vaccine (or any previously) could have such effects and there is strong evidence that is does not.

Preclinical studies

Every new vaccine or new medicine is tested thoroughly before it can be given to humans, to check for any potential harms prior to conception, during pregnancy or to the baby. If a vaccine candidate fails this stage of testing, further research will be stopped. 

Animal studies have shown no effects on fertility – for this vaccine or other the COVID-19 vaccines approved in New Zealand. For example, when female rats were given very large doses of the Pfizer COVID-19 vaccine (300 times the human dose) before mating and during pregnancy, no changes were seen in mating performance, fertility or any ovarian or uterine measurement. In addition, no effects were seen before or after birth on the survival, growth, physical development or neurofunctional development of the babies.

The vaccine is short-lived

Comirnaty vaccine contains messenger ribonucleic acid (mRNA) inside a fatty bubble which is delivered to muscle cells in the arm when you are vaccinated. The mRNA and its protective bubble are very fragile, so that it needs to be stored at very cold temperatures to stop it from degrading.

Once outside of its lipid bubble, mRNA is quickly destroyed by enzymes (ribonucleases) found everywhere, including inside and outside of our cells. It only has a day or two to do its work. The components of the lipid bubble are also cleared from our body as a waste product. The vaccine gives the body the recipe to make replicas of the COVID-19 virus spike protein and is completely gone within a couple of days.

The quantity of this protein produced after vaccination is much lower than the amount seen in people with COVID-19 infection with the virus spreading throughout their body. Furthermore, as soon as it is produced, this protein is dismantled inside specialist cells and the pieces are shown to the immune system in the lymph nodes nearest to the arm muscle.

The ovaries and testes are protected.

The ovaries or testicles are protected, from infection and damage, by special cells (such as Sertoli cells in males and columnar epithelial cells in females) which prevent cells of the immune system or antigens (such as parts of any vaccine) from entering.

Evidence from fertility clinics

In Israel, patients attending fertility clinics have been carefully studied after having the Comirnaty vaccine. No difference in the in vitro fertilisation (IVF) cycle outcomes, including the number of eggs collected; the number of matured eggs; the fertilisation rate; and the number and quality of embryos at day 3, were seen in women who had intracytoplasmic sperm injections (ICSI) before and after two doses of Comirnaty (time from first dose 57± 24 days). Additionally, the number and percentage of clinical pregnancies did not differ significantly between the pre and post vaccination groups. Another study, which looked at women having eggs collected shortly after vaccination (mean 12 days among those having had one dose and 49 days after first dose among those having had two doses), found no differences in follicular function, including hormone production, and oocyte (egg) quality biomarkers. In addition, sperm parameters including semen volume, sperm concentration, sperm motility, and total motile sperm count have been the same in men following vaccination (33 days after first dose). Studies in America have also found no differences in embryo implantation or early pregnancy development nor sperm parameters.

Vaccinated women can fall pregnant

As well as this detailed information about the lack of impact on factors related to fertility, the real-world experience with the vaccine is also reassuring. Numerous women have conceived following Comirnaty vaccination. Looking at participants in the v-safe pregnancy registry in the US, found no difference from the expected spontaneous abortion rate in women who received an mRNA vaccine from 30 days before the first day of their last menstrual period through to 14 days after (NIH preprint).

False alarms

Any alleged similarity between the SARS-CoV-2 spike protein and the human protein, syncytin-1, has been completely disproven. Any amino acid sequences in common are much too short to activate an immune response. Furthermore, antibodies in the serum of women previously infected with COVID-19 cannot recognise or bind to syncytin-1.

Some women have reported their menstrual periods may be early or heavy following the vaccination. This is possible since there is a connection between the immune system and the bleeding of menstrual cycles, but such changes can also occur coincidentally or due to anxiety that some people experience when being vaccinated. Any potential effect is brief and will not affect long term fertility. There is no effect on the placenta during pregnancy because different biological processes maintain the uterus lining.


References

Published articles

  • Bentov Y, Beharier O, Moav-Zafrir A, et al. Ovarian follicular function is not altered by SARS-CoV-2 infection or BNT162b2 mRNA COVID-19 vaccination. Hum Reprod. 2021;36(9):2506-13. doi: 10.1093/humrep/deab182
  • Bowman CJ, Bouressam M, Campion SN, et al. Lack of effects on female fertility and prenatal and postnatal offspring development in rats with BNT162b2, a mRNA-based COVID-19 vaccine. Reproductive Toxicology. 2021;103:28-35. doi: https://doi.org/10.1016/j.reprotox.2021.05.007
  • Gonzalez DC, Nassau DE, Khodamoradi K, et al. Sperm parameters before and after COVID-19 mRNA vaccination. JAMA. 2021;326(3):273-4. doi: 10.1001/jama.2021.9976
  • Zauche LH, Wallace B, Smoots AN, Olson CK, Oduyebo T, Kim SY, et al.. Receipt of mRNA COVID-19 vaccines preconception and during pregnancy and risk of self-reported spontaneous abortions, CDC v-safe COVID-19 Vaccine Pregnancy Registry 2020-21. 2021;
  • Morris RS. SARS-CoV-2 spike protein seropositivity from vaccination or infection does not cause sterility. F&S Reports. doi: 10.1016/j.xfre.2021.05.010
  • Safrai M, Herzberg S, Imbar T, Reubinoff B, Dior U, Ben-Meir A. The BNT162b2 mRNA Covid-19 vaccine does not impair sperm parameters. Reproductive BioMedicine Online 2022;44(4):685–8.

Preprint papers, not peer-reviewed

  • Safrai M, Rottenstreich A, Herzberg S et al.  Stopping the misinformation: BNT162b2 COVID-19 vaccine has no negative effect on women’s fertility medRxiv preprint  [accessed 13 Sep 2021; posted 01 June 2021] doi: 10.1101/2021.05.30.21258079

Medical appointments and treatment planning with vaccination

Some people experience swollen lymph nodes in their armpit and neck after vaccination. This is where the immune response is taking place and is expected. Swollen lymph nodes are also detected by screening tests for cancers, so it is important to inform your radiographers or oncologist if you have been vaccinated recently.

Some treatments can reduce your immune response to the vaccine. If you are severely immunosuppressed, you may like to discuss the timing of your COVID-19 vaccination with your specialist to try to time it between treatments to provide the best possible protection. It is important not to delay treatments or avoid vaccinations.

It is also important for the people around you, in your household, to have the vaccine when it is offered to them to widen your protection.

  • For information about Cancer care and COVID-19 vaccine see Te Aho o Te Kahu (Cancer Control Agency) information here.
  • For information about COVID-19 vaccination and treatments for autoimmune disease from Arthritis New Zealand, see video here.

Who can't have the Pfizer/BioNTech COVID-19 vaccine?

The Pfizer/BioNTech COVID-19 vaccine has an excellent safety profile and there are only a handful of people (fewer than 100) in Aotearoa who cannot receive it at all. Almost everyone can have at least one dose. The list of reasons why the Pfizer/BioNTech COVID-19 vaccine may not be suitable is short:

Before the first dose: 

  • History of severe allergic reaction (anaphylaxis) to an ingredient of the vaccine. This is very rare, and only applies to previous anaphylaxis to a stabiliser in the vaccine called polyethylene glycol (PEG). However, this is often unclear as problems with PEG most commonly occur after having it by mouth and there may not be any problem with having it in a vaccine. Cases like this require expert assessment by an immunology specialist. 

After problems with the first dose: 

  • People who had a severe allergic reaction (anaphylaxis) after the first dose – this typically occurs within 15 minutes of receiving it and is the main reason for waiting after vaccination. Even when suspected anaphylaxis has occurred after the first dose, increasing experience now shows that many people can be revaccinated safely in a specialist immunology clinic setting.
  • Those who had myocarditis (inflammation of the heart muscle) or pericarditis (inflammation of the lining around the heart) after their first dose of this vaccine. Myocarditis or pericarditis after the vaccine is rare. Diagnosis requires special tests and often assessment by a heart specialist. 

Find more information about who can't have the Pfizer/BioNTech COVID-19 vaccine here.

Can people who have had rheumatic fever and rheumatic heart disease have the COVID-19 vaccine?

It is important for people age 12 years and older with underlying health conditions, including rheumatic heart disease, to be vaccinated against COVID-19. Although most healthy children and young people have mild COVID-19, those with certain medical conditions are at increased risk from severe COVID-19. These include heart conditions, like (non-acute) rheumatic heart disease.

People with other pre-existing heart conditions, including congenital heart disease and a history of Kawasaki disease, are also highly recommended to have the COVID-19 vaccine. Other groups highly recommended COVID-19 vaccine from aged 12 years include those with respiratory conditions (eg, asthma and cystic fibrosis), nervous system disabilities (like cerebral palsy) and diabetes (type 1 or type 2).

To find out more about COVID-19 immunisation for children aged 12 and over, see the Kids Health page here

The video below features Blues rugby player Matt Johnson sharing his story about rheumatic fever and his choice to be vaccinated against COVID-19.

 

 

What is the guidance around receiving a COVID-19 vaccine and having a general anaesthetic?

Based on first principles and our experience with other vaccines, there is no expectation that an anaesthetic would affect the safety or immune response to the mRNA COVID-19 vaccine.

After surgery, you can have any vaccination as soon as you are recovered and well. It is preferable to avoid booking a vaccination within 48 hours of any major elective surgery in case responses to the vaccine, such as fever, cause delay in surgery or anaesthesia. Do not delay any urgent surgery after vaccination.

The general recommendation when planning vaccination with any vaccine is explained in Section 3.1.3 in the Immunisation Handbook 2020.

In certain circumstances, in situations where it is the pragmatic best option for an individual, it is safe to vaccinate in surgery while under anaesthetic.

People with compromised immune systems or receiving treatment for cancer

Many people take medication that suppresses their immune system, especially for the treatment of cancer, severe asthma, autoimmune diseases, or following organ transplantation. Others have medical conditions that can affect the immune system, such as HIV infection or kidney failure.

These conditions put you at increased risk from COVID-19, and although you may not respond as strongly to the vaccine as someone with a fully functioning immune system, it is safe for you to receive the COVID-19 vaccine and it will provide some protection against COVID-19, particularly against severe, life-threatening disease.

It is important and safe for those receiving active treatment with immunosuppressive medications to have the COVID-19 vaccine. If you are severely immunocompromised, it is recommended to talk to your GP or specialist to discuss the optimal timing for vaccination before the vaccine appointment. Ideally, vaccination should be conducted prior to any planned immunosuppression.

It is also important for the people around you, in your household, to have the vaccine when it is offered to them to widen your protection.

For information about Cancer care and COVID-19 vaccine see Te Aho o Te Kahu (Cancer Control Agency) information here.

For information about COVID-19 vaccination and treatments for autoimmune disease from Arthritis New Zealand, see video here.

What if the person has an allergy or is allergic to latex?

Comirnaty™ is latex-free. The vial stopper is made with synthetic rubber (bromobutyl), not natural rubber latex.

The only contraindication for Comirnaty is a history of anaphylaxis to a previous dose of this vaccine or its contents. Find more information on severe allergic reactions after immunisation here, and the contents of Comirnaty here.

Those with a history of immediate allergic response to another product or vaccine can receive this vaccine but are asked to wait to be observed for a little longer after vaccination. 

Individuals who have anaphylaxis following a previous dose of Comirnaty can be offered an other COVID-19 vaccine (currently, Nuvaxovid COVID-19 vaccine) if not contraindicated.
 

Can a person who is currently sick with COVID-19 receive a vaccine?

Internationally, guidance states that people who are currently isolating or experiencing symptoms of COVID-19 should not be vaccinated until they have recovered and met the criteria to stop isolating.

Vaccination after COVID-19 infection

Vaccination is being offered to people who have had SARS-CoV-2 infection.

Data from clinical trials and from countries with a lot of COVID-19 cases have shown the vaccines to be safe and effective for those who have had COVID-19 ie SARS-CoV-2 infection. This includes those who were asymptomatic.

IMAC recommends that if someone has had COVID-19 infection, then they should start or continue their vaccination from 3 months after recovery; if they have had a positive test but were asymptomatic, then vaccination can start 3 months after the first positive test. 

NOTE: In all instances, if there are clinical reasons for vaccinating earlier, they can be vaccinated from 4 weeks post-infection.

For all other vaccinations, including flu, vaccination can commence from when the person is no longer acutely unwell.

Is the Comirnaty vaccine safe and effective for people living with HIV?

The vaccine has been through rigorous testing to ensure safety and efficacy and is now being used widely overseas without any serious concerns appearing. People with HIV were included in clinical trials though efficacy and safety data specific to this group are not yet available.

With some vaccines people living with HIV can produce a weaker immune response. People living with HIV are encouraged to be vaccinated. People with HIV were included in clinical trials for the Pfizer vaccine, although the data specific to this group is not yet available there are no safety concerns.

Based on what we know about people living with HIV and their response to other vaccines:

  • those with a suppressed viral load are likely to have some protection from the COVID-19 vaccine
  • they may have a weaker response to some vaccines, including the COVID-19 vaccine

For people who are newly diagnosed and starting HIV treatment are advised to take advice from their specialist about the timing of their vaccination. Any medication being taken for HIV is not expected to change how effectiveness of the COVID-19 vaccine. The vaccine will not affect HIV medications.​

Can I have a COVID-19 vaccination before a CT scan?

It is important to advise your oncologist or radiographer if you have received the COVID-19 vaccine recently. This is because the vaccine can cause the lymph nodes in your armpit and neck to swell which can be detected by CT scans used to diagnose and monitor cancers.

This is particularly detected by FDG PET/CT scans, in which you are given a contrast medium containing a type of radioactive sugar that is taken up by active cells. When an immune response to a vaccine takes place, the cells in the lymph nodes near the injection site become very active and take up a lot of this sugar. Depending on the type of cancer, you may be able to request the injection on the opposite side to your tumour. If possible, have the vaccination at least 2 weeks before a scheduled scan or as soon as you can afterwards. Do not delay any treatment.

See also https://covid.immune.org.nz/faq/covid-19-vaccine-may-cause-swelling-local-lymph-nodes-does-affect-mammogram-results


Reference

McIntosh LJ, Bankier AA, Vijayaraghavan GR, et al. COVID-19 Vaccination-Related Uptake on FDG PET/CT: An Emerging Dilemma and Suggestions for Management. American Journal of Roentgenology. 2021. doi: 10.2214/AJR.21.25728
 

COVID-19 vaccine may cause swelling of local lymph nodes. Does this affect mammogram results?

When you attend breast screening appointments, mammogram, breast ultrasound or other types of cancer screening, it is recommended to mention to your doctor or radiographer that you have had a COVID-19 vaccination recently.

This is because it is quite common for the vaccine to cause swelling of the lymph nodes nearest to the injection-site, such as armpit and neck. This occurs most commonly after the second or booster dose. Swollen lymph nodes (medically called lymphadenopathy) is one of the top ten events reported to Medsafe through the CARM reporting system. 

Swelling of lymph nodes near to the site of injection, in the case of vaccines, or closest to an infection is a normal response when the immune system is stimulated. It usually occurs within one or two days and settles after a few days but can persist for a few weeks and may be detectable on a mammogram or scan for a month or two. In this case, it is advised to monitor such lymph node changes for at least 6 weeks after vaccination. You do not need to delay your vaccination, your mammogram or treatment. 

Click this link for further information from BreastScreen Aotearoa.

See also information about PET CT scans. https://covid.immune.org.nz/faq/can-i-have-covid-19-vaccination-ct-scan


Reference

Edmonds CE, Zuckerman SP ,Conant EF. Management of unilateral axillary lymphadenopathy detected on breast MRI in the era of coronavirus disease (COVID-19) vaccination. AJR: American Journal of Roentgenology, 2021.

Garreffa E, Hamad A, O'Sullivan CC, et al. Regional lymphadenopathy following COVID-19 vaccination: Literature review and considerations for patient management in breast cancer care. European Journal of Cancer, 2021. 159: p. 38-51.

Medsafe. 2022 Adverse events following immunisation with COVID-19 vaccines: Safety Report #40 – 31 January 2022. online. URL: https://www.medsafe.govt.nz/COVID-19/safety-report-40.asp. (accessed 25 February 2022)

If the person has had a dose of COVID-19 vaccine overseas

If you were partially vaccinated overseas with one dose of Comirnaty (Pfizer/BioNTech) vaccine, you will need to have another dose 6 weeks after your previous dose (or at least 3 weeks if you are at high risk of exposure to individuals with COVID-19). There is no maximum time limit between doses, so you do not need to repeat the first dose or receive a third dose.

Although, different COVID-19 vaccines are not interchangeable, it is recommended that if you have received one dose of any two-dose COVID-19 vaccine (including Vaxzevria/Covishield/AstraZeneca, or Spikevax/Moderna) outside of New Zealand that you have one dose of Comirnaty (Pfizer/BioNTech) at least 4 weeks after the first vaccine dose.

If you received one dose of COVID-19 Vaccine Janssen, you are considered fully immunised. However, in certain groups (such as border workers) at high risk of exposure to people infected with COVID-19 virus, may be advised to have a further dose of the Pfizer vaccine at least 4 weeks later.

Vaccination after COVID-19 infection

Vaccination is being offered to people who have had SARS-CoV-2 infection.

Data from clinical trials and from countries with a lot of COVID-19 cases have shown the vaccines to be safe and effective for those who have had COVID-19 ie SARS-CoV-2 infection. This includes those who were asymptomatic.

IMAC recommends that if someone has had COVID-19 infection, then they should start or continue their vaccination from 3 months after recovery; if they have had a positive test but were asymptomatic, then vaccination can start 3 months after the first positive test. 

NOTE: In all instances, if there are clinical reasons for vaccinating earlier, they can be vaccinated from 4 weeks post-infection.

For all other vaccinations, including flu, vaccination can commence from when the person is no longer acutely unwell.

Can a person be vaccinated early if they want to travel overseas?

Vaccination is now widely available to everyone aged from 12 years - there is no need to apply for early vaccination. Two doses are required to be fully immunised.

It is important that anyone travelling overseas is fully vaccinated against COVID-19. This is primarily to protect them in countries with widespread infection from serious illness, but also to reduce the risk of returning to New Zealand with infection. To be fully immunised, two doses of Comirnaty are required given preferably at least 6 weeks apart (and no less than 21 days apart). You are considered fully immunised from 7 days after your second dose.

If you are required to travel urgently:

  • ensure you have at least one dose before departing to give you some protection
  • preferably, if you have time before departure, get your second dose at least 21 days later.
  • make sure you get a second dose on return (there is no maximum time limit to have your second dose, if you are away longer than 6 weeks).

Be aware that some countries have border restrictions and entry requirements for COVID-19 vaccination. Check these before you leave.

Also check with your health provider if there are any other vaccines you need, such as MMR, influenza, meningococcal vaccines, or country-specific travel vaccines.

Last updated: 26 January 2022