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2 April 2021

The newsletter on COVID-19-vaccination is an RIVMNational Institute for Public Health and the Environment  publication with up-to-date information for professionals involved in COVID-19 vaccination.

Progress report on the COVID-19 vaccination campaign

Starting next week, eligible people who are not mobile enough to come to a vaccination site will be vaccinated at home with the AstraZeneca vaccine. Home vaccination will be deployed for elderly people and for people in the medical high-risk group due to neurological disorders accompanied by respiratory compromise. The vaccines will be delivered in phases. GPs in the province of Drenthe will be first, followed by deliveries to GPs in North Holland, Overijssel, Groningen and Friesland.

Due to a large delivery from AstraZeneca, all GPs in North Holland, Overijssel, Groningen and Friesland will in principle be able to vaccinate not only people born in 1956 and 1957, people with a BMI over 40 and people with Down syndrome, but also people born in 1958, 1959 and 1960.

Previously unvaccinated employees involved in direct COVID care in hospitals will also be vaccinated with the AstraZeneca vaccine.

How fast the vaccination roll-out is proceeding in the Netherlands has been the topic of much discussion lately. Would you like to know more? Then read this Parliamentary letter (in Dutch) which was released yesterday.

Single vaccination after COVID-19 infection within the past six months

Starting today, people who tested positive for COVID-19 in the past six months can indicate when scheduling a vaccination appointment that they only want one vaccine dose. If the coronavirus infection did not occur until after the first vaccination, then the appointment for the second vaccination will go ahead as planned. People who already have an appointment to get vaccinated, and tested positive in the past six months, are asked to cancel the appointment for the second vaccination as soon as possible. The advice applies to all three COVID-19 vaccines: AstraZeneca, Pfizer/BioNTech and Moderna. An exception has been made for four categories in the the medical high-risk groups. This applies to people whose immune system is very seriously compromised. In addition, patients with a severe neurological disorder who have difficulty breathing and can travel to the vaccination site will also receive two vaccinations. More information on a single vaccination after coronavirus infection is available in the RIVM news item and under frequently asked questions.

AstraZeneca vaccine

AstraZeneca’s COVID-19 vaccine has a new name: Vaxzevria®. It will take a few more months for this name to appear on the packaging.

 

Pending further investigation and assessment by the EMA’s Pharmacovigilance Risk Assessment Committee (PRAC) of the combined presentation of thrombosis and thrombocytopaenia picture and its possible relation to vaccination, as a precautionary measure, postponement of vaccination with the AstraZeneca vaccine is currently advised for people with a medical history of heparin-induced thrombocytopaenia (HIT). There is no recommendation to offer an alternative vaccine in such cases at this time. More on this topic is expected to be announced next week.

Vaccination starts for medical high risk groups

Vaccination started last week for five groups of patients who have a high risk of severe illness resulting from COVID-19. Patients have already received an invitation to be vaccinated with Moderna’s mRNA vaccine in hospitals. This applies to the following groups:

  • Patients with a haematological malignancy (certain types of blood cancer);
  • Patients with severe renal failure;
  • Patients who have received an organ, stem cell or bone marrow transplant (or are on the waiting list);
  • Patients with a severe congenital immune disorder;
  • Patients with a neurological disorder accompanied by respiratory compromise.

In addition to these five groups, there are two other groups of patients who have a higher risk of severe illness due to COVID-19. They will receive the AstraZeneca vaccine from their GP:

-        People ≥18 years old with Down’s syndrome who are living at home;

-        People ≥18 years old with morbid obesity (BMI >40 kg/m2).

More information on the medical high-risk groups and on the steps and schedule can be found here. An explanation of the selection process is also provided.

Advisory report of the Health Council of the Netherlands

The Health Council has recommended prioritising vaccination of people who are on the waiting list for an organ transplant, giving them an mRNA vaccine (Pfizer/BioNTech or Moderna). After a transplant, patients have a higher risk of severe illness resulting from COVID-19 because their immune system is compromised by the treatment. The impaired functioning of the immune system also reduces the effectiveness of the vaccination. Vaccination before receiving the transplant is therefore preferred. This group of patients had already been selected for vaccination with the high-risk groups.

Intradermal and intramucosal administration of COVID-19 vaccines could be a solution in the future if efficacy and safety are proven. Since COVID-19 vaccines are in short supply, a major advantage of these forms of vaccine administration is that a lower dose of vaccine could be sufficient to induce an immune response. Further research is needed on the duration of protection and on comparing the advantages and disadvantages of different forms of administration. The COVID-19 vaccines registered so far are exclusively for intramuscular administration.

Ministerial decree on vaccination strategy

In response to the Health Council’s advisory opinions regarding the Janssen vaccine, the timing of the second dose, and the deployment of AstraZeneca vaccine for people over 65, the Minister has decided to make additional improvements to the vaccination strategy:

  • The AstraZeneca vaccine will also be used for people over 65, which is mainly relevant to people aged 65 to 74 years old.
  • In addition, it will soon be possible when scheduling the appointment for people to state that they had COVID-19 (confirmed by a test) less than six months ago. For this group, one COVID-19 vaccination is sufficient, provided they are not severely immunocompromised. If a person thinks they had COVID-19 within the past six months, but has not been tested, the current recommendation is to get both vaccinations.
  • In the interest of ensuring continuity of acute care (including COVID care), an additional round of vaccination with the AstraZeneca vaccine will also take place soon via the Dutch Network for Emergency Care (LNAZ). This involves new employees (who have received extra training, are back from illness/leave, or on rotation) and additional employees who are deployed when COVID care has to be scaled up.
  • Finally, it has been decided to accelerate vaccination for patients on a waiting list for organ transplants. These patients had already been selected for vaccination with the high-risk groups that started receiving their vaccinations this week.

This flowchart reflects the implementation of the vaccination strategy as it is currently planned.

Updated implementation guidelines for COVID-19 vaccination

The implementation guidelines for COVID-19 vaccination 2021 have been updated. The latest version of the implementation guidelines is always available online (in Dutch). Section 1.3 outlines the main changes compared to the previous version; more minor interim changes are listed under Version Management (at the end of the document). An update of the e-learning module on COVID-19 vaccination is expected next week. Like the guideline, it will contain a chapter on the COVID-19 vaccine made by Janssen.

Compatibility of syringes and needles

RIVMNational Institute for Public Health and the Environment has ordered various types of syringes and needles for use in the COVID-19 vaccination programme. These types are matched to ensure compatibility, among other aspects.

The intention is to provide implementing parties with a combination of syringe and needle from the same supplier. However, this is not always possible due to shortages, varying deliveries and varying usage.

The products that are supplied do fit together properly (with the exception of the BD safety needle and the SOL-M syringe). For some combinations, it is necessary to press the needle firmly when attaching it to the syringe. In addition, it may be necessary to hold the needle connection when removing the protective cap.

Wanted: participants for a study on adverse reactions to COVID-19 vaccination

Pharmacovigilance Centre Lareb is researching health problems after COVID-19 vaccination. For this study, Lareb is looking for people under 80 who have been vaccinated with the Pfizer/BioNTech vaccine, men (all ages) and women (over 65) who have been vaccinated with the AstraZeneca vaccine, and people of all ages who have been vaccinated with the Moderna or Janssen vaccine. Please bring this study to the attention of the target group. GP practices, hospitals and other care institutions can request free leaflets and posters to promote this study via this registration form. For more information about the study (in Dutch), go to: www.mijncoronavaccin.nl.

Public communication

Coronavirus explained: scientific models and the virus

Did you miss the live session on ‘Coronavirus explained: scientific models and the virus’, or would you like to watch it again? Then click here.

Upcoming events

Extra attention will be focused on COVID-19 vaccination in various ways in the next few weeks. (Please note: all events are exclusively in Dutch.)

  • Friday 9 April 2021, 14:00-15:00 hrs: online explanation of 11th round of the COVID-19 behavioural survey combined with results of focus group discussions (RIVMNational Institute for Public Health and the Environment Corona Behavioural Unit, registration via coronagedragsunit@rivm.nl).

Editors

Editors: Vaccination implementation, National Coordination Centre for Communicable Diseases Control (LCI).

For questions and/or comments about this newsletter, healthcare professionals can send a message to vaccin-covid@rivm.nl.

Private citizens can call the public information number 0800 - 1351 with their questions.