Issue 33, 26 October 2021

The newsletter on COVID-19 vaccination is an RIVM publication with up-to-date information for professionals involved in COVID-19 vaccination.

Progress report on the COVID-19 vaccination campaign

Route for first or second injection in case of allergic reaction 

People who have an allergic reaction to the COVID-19 vaccine or a component of the vaccine have a provisional contraindication for a first or second vaccination. A pilot involving six hospitals showed that there are sufficient possibilities to vaccinate these patients safely despite the possible allergic reaction. A route has now been set up for these people. From 21 October on, they can receive a referral from their GP via Zorgdomein to see an allergist for vaccination. This option replaces the previous recommendation not to vaccinate in the event of an allergic reaction. More information and detailed instructions can be found in the Work instructions on COVID-19 vaccination for people with an allergic reaction (in Dutch).

Discontinuing use of Vaxzevria (AstraZeneca)

As of 1 November 2021, vaccination with Vaxzevria (the AstraZeneca vaccine) will be discontinued in the Netherlands. The available vaccine supplies until that date have an expiry date of 31 October 2021. From Thursday 21 October 2021 on, the invitation letters for AstraZeneca in the “missed second jab” route will be replaced by a Pfizer invitation letter. This update has been included in the implementation guidelines for COVID-19 vaccination.

European Medicines Agency (EMA)

Evaluation starts for use of COVID-19 vaccine Comirnaty (Pfizer) in children aged 5 to 11 years

The European Medicines Agency (EMA) has started evaluating the use of Comirnaty (the COVID-19 vaccine made by Pfizer/BioNTech) in children aged 5 to 11 years. Comirnaty is currently approved for use in people aged 12 years and older.

Risk of immune thrombocytopenia after vaccination with Vaxzevria (AstraZeneca)

Immune thrombocytopenia (ITP), a condition in which the immune system mistakenly targets platelets, has been confirmed as a rare risk following vaccination with COVID-19 vaccine Vaxzevria (AstraZeneca). [link:…] The Medicines Evaluation Board (CBG-MEB) recommends that care providers and people receiving a vaccination should be alert to symptoms of ITP after vaccination with Vaxzevria.

Risk of venous thromboembolism and immune thrombocytopenia after Janssen vaccination

There is a rare risk of venous thromboembolism or immune thrombocytopenia (ITP) following vaccination with COVID-19 vaccine Janssen.  The Medicines Evaluation Board (CBG-MEB) recommends that care providers and people receiving a vaccination should be alert to symptoms of venous thromboembolism and ITP after vaccination with COVID-19 vaccine Janssen.

Rolling review starts for Evusheld, a medicine to prevent COVID-19

The European Medicines Agency (EMA) has launched a rolling review of Evusheld in anticipation of an application for marketing authorisation. The medicine combines two monoclonal antibodies, tixagevimag and cilgavimab, and is intended for the prevention of COVID-19 in adults. EMA is currently evaluating data from laboratory and animal studies.

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 all major 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 10 October 2021.

Public communication

A Twitter update from the Ministry of Health, Welfare and Sport (VWS): Should you get vaccinated if you are pregnant?

The recommendation is to get vaccinated. Pregnant women have a higher risk of ending up in intensive care if they develop COVID-19 symptoms. Still trying to decide? Read more about pregnancy and the COVID-19 vaccine.

Report infection through CoronaMelder at

From 14 October on, everyone who can view their own positive test result on the website at can immediately notify others via the CoronaMelder app.

Three questions about a third jab

Based on a review of various national and international studies, a working group including researchers as well doctors representing professional associations has compiled a list of people who have not built up sufficient protection after two vaccinations. A third dose may enable these people to build up sufficient antibodies. This video explains in more detail.

Vaccination reduces transmission to unvaccinated household members by 63% for Delta variant

Vaccination protects against COVID-19, and also reduces the risk of transmitting the virus to others. RIVM research shows that vaccination also significantly reduces transmission of the Delta variant. This follow-up study in August and September 2021 used data from source and contact tracing by the Municipal Public Health Services (GGDs). A preprint of the research findings is available on MedRxiv.

4 in 5 COVID-19 patients in ICU are not vaccinated

4 in 5 COVID-19 patients in intensive care are not vaccinated against the coronavirus SARS-CoV-2. The chance that a fully vaccinated person will end up in ICU due to COVID-19 is 33 times lower than for a non-vaccinated person.


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

The newsletter is also available in Dutch.

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