Immunocompromised: extra doses and booster doses

Please go to our page on immunocompromise.

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.

 

 

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.

Myocarditis, pericarditis and the COVID-19 vaccine in New Zealand

An increased risk of heart inflammation (myocarditis, pericarditis, or both) has been observed in people who have received mRNA COVID-19 vaccines in New Zealand and overseas, particularly in males under 30 years of age after the second vaccine dose.

IMAC emphasises that the overwhelming benefits of vaccination in protecting against COVID-19 greatly outweigh the rare risk of these conditions, and Comirnaty (Pfizer mRNA vaccine) continues to be recommended for all people ≥ 5 years of age who do not have any contraindications to the vaccine.

For 1-3 days after vaccination, some people can feel unwell with headaches, tiredness, muscles aches, chills or a mild fever, this a normal response, and is more common after the second dose and in younger people. If unwell, you are advised to rest, drink plenty of fluids and to avoid vigorous exercise, until you are feeling better. If symptoms persist after a few days or worsen, to seek medical advice.

For further in-depth information for health practitioners, see our factsheet here.

Please also find "Guidelines for COVID-19 vaccination post proven or probable myocarditis or pericarditis after mRNA COVID-19 vaccine" here

Key points 

  • What are myocarditis and pericarditis? Can it occur after Pfizer (Comirnaty) vaccination? An increased risk of heart inflammation (myocarditis, pericarditis, or both) has been observed in people who have received mRNA COVID-19 vaccines. Myocarditis occurs particularly in males under 30 years of age after the second vaccine dose. Pericarditis is observed in a range of age groups.
  • Can myocarditis or pericarditis occur after Nuvaxovid? Cases of myocarditis and pericarditis were identified in clinical trials of Nuvaxovid and have also been reported during post-authorisation use particularly in Australia. These findings suggest that an increased risk for these conditions may be present after receiving Nuvaxovid.
  • Myocarditis and pericarditis symptoms. A key symptom of myocarditis is chest pain. Other symptoms may include chest heaviness, discomfort or tightness, shortness breath or breathing difficulty, feeling lightheaded, faint or dizzy, heart palpitations, racing or fluttering heart, or a feeling of skipped beats. Fever has also been reported. One or more of these symptoms can occur shortly after vaccination due to stress or anxiety. However, if anyone experiences these symptoms after receiving Comirnaty (Pfizer mRNA vaccine) from more than 6 hours to 7 days (typically around 1 to 5 days), they should seek immediate medical attention.
  • The benefits of vaccination in protecting against COVID-19 greatly outweigh the risks of adverse events including myocarditis. Confirmed cases are rare.
  • Cases after vaccination are more frequently reported following the second dose and in males 12 to 29 years. Even in this group, risk has been reported internationally to be from 1 to 10 per 100,000 vaccine doses. There is increasing evidence that the rate declines as the interval between doses increases up to 8 weeks and the risk following booster doses is lower than after dose two.
  • How severe is myocarditis? Most reported cases of myocarditis and pericarditis, linked to mRNA vaccination, have required hospital care for assessment and monitoring, because sudden death is a rare complication of myocarditis (read more: what happens if a death occurs following immunisation). More than 80% of reported cases have recovered quickly with rest and commonly used oral medications. Longer-term follow-up of these cases is ongoing.

Advice about being vaccinated

Comirnaty (Pfizer mRNA vaccine) continues to be recommended for all people from 5 years of age. The only contraindication to the vaccine is anaphylaxis to a vaccine component which is very rare and requires specialist review.

If feeling unwell after vaccination, it is advised to rest, drink plenty of fluids and avoid vigorous activities, such as going to the gym. Seek medical advice if symptoms worsen, or persist for longer than 3 days.

All episodes of myocarditis and pericarditis following COVID vaccines should be reported to CARM.

For further advice and for plans for the patient’s next vaccination, please call 0800 IMMUNE (0800 466 863) or email [email protected]

Note: Adverse reactions to vaccines, including the COVID-19 vaccine may be covered by ACC as a treatment injury. Treatment injury does not cover ordinary consequences of vaccination. More information here: https://www.acc.co.nz/for-providers/treatment-safety/#lodging-treatment…


References

  • Gargano JW, Wallace M, Hadler SC, et al. Use of mRNA COVID-19 Vaccine After Reports of Myocarditis Among Vaccine Recipients: Update from the Advisory Committee on Immunization Practices - United States, June 2021. MMWR Morb Mortal Wkly Rep. 2021;70(27):977-82. doi: 10.15585/mmwr.mm7027e2
  • COVID-19 subcommittee of the WHO Global Advisory Committee on Vaccine Safety (GACVS): updated guidance regarding myocarditis and pericarditis reported with COVID-19 mRNA vaccines.   Retrieved 12 July 2021, from https://www.who.int/news/item/09-07-2021-gacvs-guidance-myocarditis-per…
  • Barda N, Dagan N, Ben‑Shlomo Y et al (2021) Safety of the BNT162b2 mRNA Covid-19     Vaccine in a Nationwide Setting DOI: 10.1056/NEJMoa2110475
  • Medsafe. Myocarditis and pericarditis – rare adverse reactions to Comirnaty (Pfizer COVID-19 vaccine). Alert Communication 21 July 2021. Retrieved 15 September 2021 from https://www.medsafe.govt.nz/safety/Alerts/comirnaty-myocarditis-alert.h…
  • Mevorach D, Anis E, Cedar N, et al. Myocarditis after BNT162b2 mRNA vaccine against COVID-19 in Israel. N Engl J Med. 2021;385(23):2140-9. doi: 10.1056/NEJMoa2109730
  • Buchan SA, Seo CY, Johnson C, et al. Epidemiology of myocarditis and pericarditis following mRNA vaccines in Ontario, Canada: by vaccine product, schedule and interval. medRxiv. 2021 (preprint):2021 doi: 10.1101/2021.12.02.21267156
  • Hause A, Baggs J, Marquez P, et al. Safety Monitoring of COVID-19 Vaccine Booster Doses Among Adults — United States, September 22, 2021–February 6, 2022. MMWR Morb Mortal Wkly Rep, 2022;71:249–254.

 

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)

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.

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.

Can I delay receiving my second dose of Comirnaty?

To be fully immunised with Comirnaty requires two doses given at least 21 days apart. The current recommendation is for the two doses to be given six weeks apart. A delay for longer than six weeks is not considered harmful, however it is important to remember that two vaccine doses are needed for full protection, particularly against the Delta variant.

It is not yet known, for how long the first dose provides protection. If you are at risk of exposure to SARS-CoV-2, it is advisable to have the second dose when recommended. During clinical trials, the vaccine efficacy against symptomatic COVID-19 between the first and second doses was around 50% compared with 90% within 2 days of the second dose increasing to 95% after a week. Recent real-world data has shown that protected against SARS-CoV-2 infection was around 62 to 91% from 14 days after dose one and 68 to 97 % from 14 days after dose two in frontline workers.

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, Astrazeneca COVID-19 vaccine) if not contraindicated.
 

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

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).

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. 

The Varicella vaccine, which is a lower concentration and used mainly with children so their immune systems are much better than those over 50, can also be given at the same time as the COVID-19 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.

What is the acceptable timeframe between the first and second doses of the Comirnaty vaccine?

To be fully immunised with Comirnaty requires two doses given at least 21 days apart and preferably 6 weeks apart.

Vaccinators are advised not to give the second dose earlier than this, and while longer spacing is acceptable, the recommended spacing is for the second dose to be given at 6 weeks after the first dose.

People at highest risk of exposure to others with COVID-19 are advised to have their second dose at least 21 days after the first to provide more immediate protection. Everyone else can allow 6 weeks between doses to provide a strong immune response and good protection after the second dose. See here for more information.

A closer spacing (at least 21 days) may also be advised for people who are due to commence planned immunosuppressive treatments for longer than 28 days, to provide a good immune response before treatment starts. Do not delay treatment or vaccination. Those who are already receiving such treatments are advised to allow 6 weeks between doses to give the best immune response.

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.

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.​

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.