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25 May 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

As of last week, people born in 1963, 1964, 1965 and 1966 are invited for COVID-19 vaccination. They will be vaccinated by the Municipal Public Health Service (GGD) with the Pfizer/BioNTech or Moderna vaccine. Young people aged 16-18 years living at home who are in medical high-risk groups are now also invited to get vaccinated, and will be vaccinated by the GGD with the Pfizer/BioNTech vaccine. This group and the young adults aged 16-18 years who are living in residential institutions are currently the only exception to the age limit for the vaccination programme, which is in principle being rolled out to people aged 18 and over.

The Ministry of Health, Welfare and Sport (VWS), general practitioners, hospitals, pharmacies, municipalities, Municipal Public Health Services (GGDs) and communities are making an extra effort to reach and provide information to people who are still unsure about getting vaccinated against COVID-19. The joint approach focuses on people who may be semi-illiterate or do not understand Dutch well, have a migrant background, or do not have a permanent address of record. There is a particular focus on migrant workers, homeless people and undocumented immigrants.

On 10 May, RIVMNational Institute for Public Health and the Environment launched an extensive study to research the long-term effectiveness of the various COVID-19 vaccines in the Netherlands: the Vaccination Study on the Coronavirus (VASCO). Anyone living in the Netherlands who is between 18 and 85 years old can take part in the study, signing up here.

Preparing for large-scale vaccination

The Municipal Public Health Services (GGDs) are preparing for vaccination on a large scale in the second quarter of 2021. The Minister of Health, Welfare and Sport (VWS) has asked GGDs to focus on continuing to ramp up maximum capacity, rising to about 2 million vaccinations a week from early June on. In doing so, they will take over the role of vaccinating people aged 18-60 years, which will be handled by GGDs rather than GP practices. The number of vaccination sites operated by the GGD is expected to be expanded from over 100 to over 140 sites in the next few weeks. In addition, the Minister has asked hospitals to prepare to provide additional capacity in the event that the GGD vaccination capacity is not sufficient to administer the vaccine doses available at a given time. Finally, GPs have been asked to be available for deployment at the GGD vaccination sites and to contribute to the various medical positions that need to be filled there.

Advisory reports of the Health Council

The Health Council of the Netherlands previously advised maintaining an interval of 12 weeks between the first and second dose of the AstraZeneca vaccine. More vaccines are now available. For that reason, the Health Council reassessed the optimal interval between the two doses. The Health Council has concluded that this is not possible to determine based on scientific data. It therefore advises following the interval recommended in the product information: between 4 and 12 weeks.

Based on this advisory report, the Ministry of Health, Welfare and Sport (VWS) has decided to shorten the interval between the first and second doses of the AstraZeneca vaccine wherever possible, within the framework offered by the product information leaflet (interval between 4 and 12 weeks). In actual practice, this means that an interval of 6 to 14 weeks can be scheduled.

The Health Council considers it likely that vaccination against COVID-19 contributes to some extent to preventing infections in others. However, based on the studies done so far, it is unclear to what extent vaccination can prevent transmission of the virus, under which conditions, and which factors play a role. Further investigation is needed, according to the Health Council.

7 vaccine doses drawn from Pfizer/BioNTech vial using Vernacare needle and SJJ needle-syringe combination

The Comirnaty® vaccin (Pfizer/BioNTech) is registered for 6 doses from a vaccine vial. By using low dead-space needles and/or syringes, it is possible to draw 7 doses of 0.3 ml from a vial. The reduction in dead space in the syringe or needle leads to less vaccine loss. 

It is possible to draw 7 doses from a vial by using the following items supplied by RIVMNational Institute for Public Health and the Environment :

1.       SJJ needle-syringe combination: using this combination, draw up to the line at 0.3 ml. The working instructions (only in Dutch) are available here.

or

2.       Vernacare needles in combination with the BD Plastipak or Sol-M syringes. Using these combinations, draw up to the line at 0.27 ml. The working instructions (only in Dutch) are available here.

Because the Vernacare needle fills the residual space between the syringe hub and the plunger, there is less dead space in the syringe, so you do not have to draw as much vaccine from the vial in order to inject 0.3 ml. Normally, 0.03-0.05 ml of fluid remains in that residual space and is then discarded.

Using the specified needles, it is therefore sufficient to draw vaccine into the syringe up to the line at 0.27 ml. Using this method, it is still possible to administer 0.3 ml of vaccine to the client, since almost nothing is left behind in the syringe-needle combination.

The method described above does not apply to people with more padding on their upper arm, requiring a longer needle that does not fill the residual space between the plunger and the syringe hub. Using these needles, it is important to ensure a dose of 0.3 ml by drawing vaccine into the syringe up to the line at 0.3 ml.

Frequently asked questions

Is low body weight a reason to adjust the vaccine dose?

No, the normal vaccination schedule should be followed. A vaccine needs to prompt an immune response. This response is determined by the maturity and functionality of the immune system, not the amount of active substance administered and its distribution throughout the body (as is the case for other medications).

Is it possible to be vaccinated with a COVID-19 vaccine and the maternal whooping cough vaccine at the same time during pregnancy?

No, a minimum interval of 7 days is advised between the two vaccines. This is primarily related to assessment of any adverse events or allergic reactions. See also: COVID-19 vaccination | LCI guidelines (rivm.nl) - in Dutch.

Is it possible to administer Anti-D and COVID-19 vaccination at the same time during pregnancy?

Yes, Anti-D (rhesus-D immunoglobulin) is not a vaccine, and the antibodies in rhesus-D immunoglobulin do not affect how the COVID-19 vaccine works (since COVID-19 is not a live vaccine). It is therefore possible to administer Anti-D and COVID-19 vaccine simultaneously. See also: Frequently asked questions about COVID-19 - for midwives (KNOV) - Dutch.

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).

Adverse reactions

Pharmacovigilance Centre Lareb has posted a new update about reports of possible adverse events following immunisation with COVID-19 vaccines which were reviewed by experts up to and including 9 May 2021.

Public communication

Brochure on disinformation and misinformation

The Ministry of Health, Welfare and Sport (VWS) has published a brochure on disinformation and misinformation that helps people differentiate between correct and incorrect information. This brochure can be printed and deployed in regions, municipalities or neighbourhoods where incorrect information about vaccination is being distributed door-to-door.  The print file for the brochure is available here.

Information cards

A simple answer to many frequently asked questions is now provided on information cards. Information cards are now available about side-effects, pregnancy and choosing to be vaccinated. The cards are also being translated into English, German, French, Polish, Turkish and Arabic. The cards are available in the communication toolkit for COVID-19 vaccination in a PDF format and as a print file, so you can deploy them yourself as well.

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.