Australia Can you mix coronavirus AstraZeneca and Pfizer vaccines? Should I get a second dose?

23:40  18 june  2021
23:40  18 june  2021 Source:   abc.net.au

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Should I get a second dose ? By the Specialist Reporting Team's Leonie Thorne, national medical reporter Sophie Scott, and Widia Jalal. Posted Fri 18 Jun 2021 at 10:35pmFriday 18 Jun 2021 at 10:35pmFri 18 Jun 2021 at 10:35pm Can I mix vaccines , and get Pfizer for my second dose ? This isn't the official advice in Australia yet, but research into mixing vaccines is taking place overseas. Giving Pfizer as a second dose after one shot of AstraZeneca produced a "robust immune response" to COVID-19, according to preliminary results from a Spanish trial with more than 600 people.

One dose of Pfizer or Moderna vaccines appears at least 80% effective against symptomatic COVID-19. For AstraZeneca , one-shot efficacy is 70%. More than 183 million Americans and more than 45 million Britons have received their first dose of a two -shot COVID-19 vaccine . The US has authorized vaccines from Moderna and Pfizer -BioNTech, while the UK has authorized Pfizer 's shot as well as one made by AstraZeneca and Oxford University.

Lynne, 56, was hesitant about getting the AstraZeneca vaccine for a long time.

But after weighing up the risks of COVID with her GP, she booked in to get the shot this week, only to have her appointment cancelled yesterday.

"They [Victoria's coronavirus hotline] don't know when we can be vaccinated [with Pfizer]," Lynne, from Melbourne suburb Croydon Hill, told the ABC.

"We're stuck — we're in a catch 22 situation."

Thousands of people are in the same boat, after Australian health officials recommended that Pfizer become the preferred vaccine for under 60s.

The change in advice came after the 50-59 age group recorded an increased rate of developing a rare blood clotting condition called thrombosis with thrombocytopenia syndrome (TTS) after getting the vaccine.

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Germany's vaccine committee recommends anyone who received an AstraZeneca first dose have Pfizer or Moderna shots as the second for better protection against the coronavirus , including the Delta variant. Viral vector vaccines like AstraZeneca and Johnson & Johnson use genetically-engineered version of a common-cold causing adenovirus as a "vector" to shuttle genetic instructions into human cells. German Chancellor Angela Merkel had received a Moderna second jab after getting an AstraZeneca injection for her first.

The study found that with the two mixed schedules— Pfizer followed by AstraZeneca , and AstraZeneca followed by Pfizer — both were safe, but resulted in more frequent side-effects after the second dose . Data on efficacy of these mixing schedules is expected to arrive this month. So while there were more side-effects when you mixed a mRNA vaccine with the AstraZeneca vaccine , I don't think that that should prevent anybody," Kalina said. The Spanish study suggests that taking two different COVID-19 vaccine doses may actually produce more antibodies.

Lynne is keen to get her first dose of either vaccine, but doctors have told the ABC they've seen patients who have had their first AstraZeneca dose and are scared of getting their second.

So if you've had a first dose of AstraZeneca, what are your options for a second?

Can I mix vaccines, and get Pfizer for my second dose?

This isn't an option in Australia yet, but research into mixing vaccines is taking place overseas.

Giving Pfizer as a second dose after one shot of AstraZeneca produced a "robust immune response" to COVID-19, according to preliminary results from a Spanish trial with more than 600 people.

Early results from a German study also showed having Pfizer after AstraZeneca gave some parts of the immune system that fight COVID-19 a bigger boost than having AstraZeneca twice.

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Adults are more likely to report mild and moderate side-effects after mixing doses of the AstraZeneca and Pfizer Covid vaccines , a study indicates. Chills, headaches and muscle pain were reported more frequently when different vaccine doses were combined. Any adverse reactions were short lived, with no other safety concerns. "It's a really intriguing finding and not something we were necessarily expecting," Prof Matthew Snape, from the Oxford Vaccine Group said. The Com-Cov study launched in February to see whether a different jab for the second dose might give longer-lasting immunity, better

Getting a second dose earlier offers less protection, but could be a way to get more people vaccinated sooner. The federal government's expert vaccine advisory panel currently recommends that the Pfizer vaccine is given three weeks apart "[It] produces a very, very good immune response, at least as good or possibly better than if you had the first and second doses of Pfizer , and much better than if you had the first and second AstraZeneca doses ," Professor Nolan said. In addition to producing a better immune response, mixing vaccines could lead to other benefits, Dr Quinn said.

Research into mixing COVID-19 vaccines is still in its infancy though — the studies mentioned above have not yet been peer reviewed.

But Cassandra Berry, a professor in immunology at Murdoch University, said the results so far were promising.

"Vaccines are like a personal trainer for our immune system, and instead of just making us train for a sprint race, we really want to train to endure an ultramarathon," she told the ABC.

"We really want that memory and that long-lasting immunity to protect us for years and decades ahead, because we are going to live with COVID in our future, unfortunately."

Canada and some European countries allow vaccine mix-and-matching, but Australian officials have said there aren't plans to do the same here yet.

"The evidence is very low at this point in time on the efficacy of [mixing vaccines]," Chief Nursing and Midwifery Officer Alison McMillan said on Friday.

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The most widely used coronavirus vaccines are designed as two-shot inoculations, and nearly everyone worldwide who has had both doses has received the same vaccine both times. But that is changing, as more countries are allowing — and even, in some cases, encouraging — mix -and-match inoculation In response to delayed deliveries of the AstraZeneca shot, South Korea announced last week that health care workers who had received a first dose of that vaccine could receive the Pfizer shot as a second dose . Canada’s vaccine advisory panel has also said that the Pfizer and Moderna

The Moderna vaccine requires two shots spaced 28 days apart. You must receive the same manufacturer’s vaccine (either Pfizer or Moderna) for your first and second shot and follow the recommended schedule for the second dose . Should I get an antibody test after the vaccine to make sure it’s working? Antibody testing is not currently recommended check someone’s immunity to COVID-19 following either the Pfizer -BioNTech or Moderna vaccines . The COVID-19 antibody test used at MSK detects the immune response after being infected by COVID-19.

Should I get a second dose of AstraZeneca? Is it safe?

Australia's official advice is if you've already had one dose of AstraZeneca without issues, you should also get AstraZeneca for your second dose.

And that's because data from the United Kingdom indicates the risk is very low.

More than 17 million people in the UK have had their second dose of AstraZeneca, and of those, 27 developed cases of TTS afterwards.

That's a rate of about 1.5 per 1 million.

So from a safety or effectiveness point of view, there is no reason to start mixing vaccines just yet, says professor Fiona Russell, a senior principal research fellow at the Centre for International Child Health at The University of Melbourne.

"We know that if TTS were to occur, it occurs mostly after the first dose," she said.

"So for those people over 50 years who have had a first dose of AstraZeneca and [are] now wondering what to do, it is even more unlikely for TTS to occur after a second dose of AstraZeneca.

"In fact, no TTS cases have occurred after the second dose of AstraZeneca in Australia.

"So, at this stage, there is no need for mix and match schedules for this reason in Australia."

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Can I just leave it at one dose?

Whether you're getting Pfizer or AstraZeneca, the advice is that you need two doses for the best protection.

And there is good news — recent data from the UK suggests both vaccines will help protect against the newer Delta variant.

Two doses of the AstraZeneca vaccine is 92 per cent effective against being hospitalised from the Delta variant, the UK analysis of 14,019 cases found.

The same data, which has not been peer reviewed, suggests two doses of Pfizer is 96 per cent effective against being hospitalised.

An earlier analysis of UK vaccine data also found there was a big difference between the protection offered by one or two doses.

Two doses of AstraZeneca was 60 per cent effective against having symptoms from the Delta variant, compared to just 33 per cent with one dose, that analysis of 1,054 cases indicated.

I'm going to get the second dose of AstraZeneca but I'm still worried…

The good news is that doctors are getting better and better at diagnosing TTS and treating it.

And the earlier it's caught, the better.

Some symptoms to watch out for four to 30 days after getting an AstraZeneca vaccine are unusual headaches, stomach pain, and blurred vision.

If TTS is suspected, doctors would investigate platelet counts, clotting factors and run special immune and antibody tests, as well as imaging studies to determine the site and size of any potential clots.

According to the Melbourne Vaccine Education Centre, patients would likely be treated by a specialist haematologist.

Meanwhile, some people just want to get vaccinated with anything

Lynne said she wished to get vaccinated with either AstraZeneca or Pfizer, due to the risks she could face from COVID if she wasn't vaccinated.

She's going to keep trying to get an appointment.

"Because we had the outbreak [in Victoria], a lot of people are very interested in getting vaccinated, which was shown by how many people turned up to the walk-in sites to get done and waited hours in line," she said.

"I have a lot of friends, all in the same boat, and we have been seeing mixed messages since yesterday.

"All of us are frustrated that we can't get vaccinated now — not with AstraZeneca, not with Pfizer."

[Zendesk COVID form embed]

Berejiklian warns NSW cannot deliver Pfizer without more GPs .
Only 140 GPs in NSW are signed up to administer Pfizer vaccines, as the state remains in the grip of a growing COVID-19 outbreak.

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