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Information for Health Professionals
Blood Clotting following COVID-19 Vaccination
For example, the risk of dying in an individual
aged 40-49 years is 3 times higher than someone
aged 30-39 years and 12 times higher than
someone aged 20-29 years.
JCVI have continued to review the available data
on the current epidemiology, benet-risk prole
by age, modelling predictions on future disease
trends and the current forecast on vaccine supply.
Given the risk (albeit extremely rare) of these
adverse events associated with the AZ vaccine,
the current control of COVID-19 in the UK, model
predictions of the potential scale and timing of
a future wave, and promising forecasts for the
availability of vaccines in the UK, JCVI has issued
updated advice on 7 May 2021.
• in addition to those aged under 30, unvaccinated
adults aged 30–39 years who are not in a clinical
priority group at higher risk of severe COVID-19
disease, should be preferentially offered an
alternative to the AZ vaccine, where possible
and only where no substantial delay or barrier in
access to vaccination would arise.
• for those within this age group who are of older
age, male, obese (BMI >30), from certain ethnic
minority backgrounds or experiencing socio-
economic deprivation, the risks of acquiring
and/ or suffering complications of COVID-19 are
higher. Every effort should be made to remove
barriers to accessing vaccination in those
individuals. These individuals can choose to
have the AZ vaccine if they have been provided
with information on the risks and benets of the
vaccine.
• for those aged 18-29 years the precautionary
advice for a vaccine preference is stronger,
reecting a gradient in the benet-risk balance
with age.
This new advice is specic to the current UK
context and is based on all of the following
remaining favourable: the current low incidence
of disease, the availability of alternatives to the AZ
vaccine, and the strength of the whole vaccine
programme in terms of maintaining speed and
uptake. Should there be a deterioration in any of
the above factors, JCVI advises that vaccination
of adults aged 30-39 years with any of the UK
authorised vaccines is always better than no
vaccination, except where there are specic
contraindications.
Healthy adults aged 40-50 years who are offered
vaccine are recommended to receive any of the
available COVID-19 vaccines. Those who have
received their rst dose of AZ vaccine without
suffering this rare side effect, should continue
to be offered the second dose to complete
the course (see the Green Book for further
information).
The AZ vaccine should also continue to be offered
to those in the priority groups (which includes
older adults, those with underlying conditions,
health and social care workers over 40 years
old) who have not yet been offered the vaccine.
Those who have received their rst dose of AZ
vaccine without suffering this rare side effect,
should continue to be offered the second dose
to complete the course. This includes individuals
aged 18 to 39 years who have received their rst
dose of AZ vaccine in the initial priority groups,
which includes those who are health and social
care workers, unpaid carers and family members
of those who are immunosuppressed.
Due to its storage and transport requirements,
the AZ vaccine is much more easily delivered
in some settings, and in these settings may be
the only vaccine it is practical to offer. In such
circumstances JCVI advises that the benets of
receiving the AZ vaccine outweigh the risks, and
individuals in this event should be offered the AZ
vaccine.
JCVI considers that there continues to be no
safety concerns for this extremely rare adverse
event following receipt of a second dose of AZ
vaccine. All those who have received a rst dose
of the AZ vaccine should continue to be offered a
second dose of AZ vaccine, irrespective of age.
The second dose will be important for longer
lasting protection against COVID-19.
7. Can COVID-19 infection cause the
same problem?
Thrombotic events are known to occur in
individuals with natural COVID-19 infection
and more than a fth of hospitalised patients
with COVID-19 have evidence of blood clots.
A preprint of a study based on analysis of US
data showed that CVST was a complication of
COVID-19 infection, with a higher incidence (42.8
per million) compared to a matched cohort of
patients with inuenza (RR=3.83, 95% CI 1.56–
9.41, P<0.001) and people who had received an
mRNA vaccine ((RR=6.67, 95% CI 1.98–22.43,
P<0.001). However, this particular combination
of thrombotic events and thrombocytopenia is
extremely rare and not known to be a common
feature of COVID-19 infection. Based on cases
reported to MHRA as of 28 April 2021, the overall
incidence following the AZ vaccine is estimated at