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.
COVID-19 vaccine may cause swelling of local lymph nodes. Does this affect mammogram results?
When you attend a mammogram, it is recommended that you mention to your doctor or radiographer that you have had a COVID-19 vaccination recently.
This is because occasionally the vaccine can cause swelling of the lymph nodes in the armpit near to the injection-site. This usually settles after a few days after vaccination but may be detectable on a mammogram for up to a few weeks. 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 or your mammogram.
Will ACC provide cover for COVID-19 vaccination injuries?
ACC can provide treatment and support for injuries caused by COVID-19 vaccination if the criteria for treatment injury are met. This means there’s a physical injury caused by the vaccination, that’s not a necessary part or ordinary consequence of the treatment.
For example, inflammation around the site of the injection is common with COVID-19 vaccination (an ordinary consequence) and is unlikely to be covered. Infections (such as cellulitis or septic arthritis) due to the vaccination, and anaphylaxis resulting in injury, are not ordinary consequences and are likely to be covered.
To help with reporting, ACC needs to know the COVID-19 vaccine brand name and vaccination dose number (i.e. dose one or two). This can be noted:
on the ACC45: please tick the treatment injury box, identify this as an adverse event in the drop-down menu and then enter the COVID-19 vaccine brand name and vaccination dose number in the open comments section
on the ACC2152: in Section 3 - Treatment claimed to have caused the injury.
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.
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 fertilization 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).
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.
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
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
Preprint papers, not peer-reviewed
Head Zauche, Bailey W, Smoots AN, 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. Research Square. 2021 (preprint).[accessed 13 Sep 2021; posted 9 Aug 2021] doi: 10.21203/rs.3.rs-798175/v1
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
Safrai M, Reubinoff B and Ben-Meir A. BNT162b2 mRNA Covid-19 vaccine does not impair sperm parameters medRxiv preprint [accessed 13 Sep 2021; posted 03 May 2021] doi: 10.1101/2021.04.30.21255690
How long will COVID-19 vaccine immunity (i.e. protection from the COVID-19 disease) last?
We would expect COVID-19 vaccines to provide protection for longer than 2 months, although exactly how long for, remains unknown at this stage. This is because not enough time has passed since the clinical trials started to be able to accurately answer this.
We know that the Pfizer/BioNTech COVID-19 vaccine lasts for AT LEAST two months, because data supporting this has been reviewed by Medsafe. As part of the conditional approval of the Pfizer/BioNTech COVID-19 vaccine, more data is to be provided as it becomes available. It is anticipated that further data will be provided on durability of the immune response post vaccination in coming months.
If a person is vaccinated against COVID-19, will they still be able to spread the virus to susceptible people?
An ideal vaccine stops everyone from carrying and passing on the infection as well as protecting them from becoming seriously ill. It is currently unclear whether COVID-19 vaccines only protect against symptomatic and severe disease, or if they can also stop all infection, including asymptomatic infection (i.e. showing no symptoms).
If the vaccine is only able to stop the symptoms of the disease, but unable to stop the virus from infecting us and reproducing, then the virus may still be able to be spread. Even in this case, by reducing the number of people with symptoms will help to reduce spread of the virus because fewer people will be coughing large quantities of virus on others. However, this possible limitation of the vaccine highlights the importance of continuing to follow public health advice such as hand washing and isolating if unwell, even post vaccination. For more information, please click here.
Recently published data from Israel showed that its mass COVID-19 vaccination campaign (using the Pfizer vaccine) was working well with two doses cutting symptomatic cases by 94% across all age groups. Data reported by the CDC in the US has also shown that mRNA COVID-19 vaccines were 90% effective in health care workers against SARS-CoV-2 infection (with and without symptoms).
Will other COVID-19 prevention measures such as social distancing be needed if a COVID-19 vaccine is available?
As not all New Zealanders are be able to be vaccinated at once, the current public health measures, including social distancing, mask usage, rapid contact tracing and managing cluster outbreaks, will continue for some time.
With an effective vaccine programme, it is anticipated these control measures can be reduced. This will require a high proportion of the population to be immunised.
Even when we have a high proportion of the population vaccinated, we will still need to maintain a level of public health measures particularly when we can travel more freely. See this infographic to explain why.
What side effects may be expected after vaccination?
The most common responses to the COVID-19 vaccine are injection-site reactions (sore arm for example) and general symptoms such as ‘flu-like’ illness, headache, chills, tiredness, nausea, fever, dizziness, weakness or aching muscles.
Generally, these potential responses happen within a day or two after the vaccination and are not associated with more serious or lasting illness. These types of reactions reflect the normal immune response to this vaccine. Not everyone experiences this type of response. They are more likely after the second dose and tend to resolve within a day or two. Pain relief, such as paracetamol or ibuprofen, is not recommended to be taken before having the vaccine but can be used after it if required.
In addition, as with any vaccine or medicine, there is a risk of allergic reactions shortly after the vaccinations. Because of this people should wait at a vaccination centre as instructed after having their vaccine. Those with previous allergic reactions or anaphylaxis should tell their vaccinator before going ahead.
Do we need a gap between MMR, influenza or other vaccines and COVID-19 vaccination?
Since we are now much more familiar with the side effects of the COVID-19 vaccine, other vaccines can be given at the same time or immediately before or after COVID-19 vaccination.
COVID-19 vaccine can been given at the same time or close to other vaccinations on the National Immunisation Schedule, including MMR (measles, mumps, rubella vaccine), influenza (flu), human papillomavirus vaccine (HPV, Gardasil 9), whooping cough and tetanus (Tdap, Boostrix) and meningococcal vaccines. If given at the same time, the vaccines at separate places on your arms and with different syringes.
When visiting your GP or pharmacist, ask if there are any other vaccines you can have - you may have missed them in the past. Pregnant women are also recommended to have influenza and whooping cough vaccines. Young adults may have missed MMR and HPV.
The only exception to this is the shingles vaccines, Zostavax, for which a seven day gap is recommended. This is to ensure the immune response to both vaccines is good. Zostavax can still be given at the same time as the influenza vaccine.
Not that the mass COVID-19 vaccination clinics, including drive-through sites, are not likely to have other vaccines, so ask your usual health provider for advice.
Will booster doses of a COVID-19 vaccine be needed?
Not enough time has passed since first vaccinations were given to be able to answer this question.
People enrolled in clinical trials are being followed up closely, which will allow this question to be answered in due course. For more information, please click here.
It is expected that small adjustments may be made to the vaccine if the COVID-19 virus changes so much that vaccine loses effectiveness. In this case booster doses will be required to better match the virus variants in circulation, like for the influenza vaccine. How frequently these changes will need to be made is unknown. A major advantage of mRNA vaccine technology is that these changes can be made very quickly (new batches available within a few months compared with more than 6 months for seasonal flu vaccines).