2021 issue 4

29 January 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.

Expansion of COVID-19 vaccination

From this week on, the first people over 90 years old who are still living at home will be vaccinated. This will be followed shortly by the people aged 85-90 years who are living at home. 

In addition, this week GPs started vaccinating vulnerable elderly people and people with disabilities in small-scale residential facilities, working in mobile teams through the out-of-hours medical centres. Before administering the vaccines, these GPs are also vaccinated

Updated implementation guidelines on COVID-19 vaccination

The implementation guidelines for COVID-19 vaccination 2021 have been modified in a number of sections. A summary of the most important changes is provided below. (See also Section 1.3 of the guidelines.)

 

Points for attention in the context of obesity

In administering mRNA vaccines, intramuscular (i.m.) vaccination is important for the vaccine to be properly effective; subcutaneous injections should be avoided. When using the proper vaccination technique, i.m. vaccination is usually possible with a 25 mm needle, even in people who have more subcutaneous fat. In the event of severe obesity, it will be necessary to use a longer needle (38 mm) These needles are not included in the standard supplies, so they must be kept in stock at the location.
It is recommended to vaccinate with a longer needle (38 mm) if:
1. Weight: women >90 kg or men >118 kg
2. BMI >40

If in doubt about the correct needle length: take a fold of skin between thumb and forefinger and assess the thickness. If the needle is shorter than half the skin fold, a longer needle is needed.

Note: If someone comes in for the 2nd vaccination, and turns out to need a longer needle (but a longer needle was not used for the 1st vaccination), then a 3rd vaccination will be offered. The 3rd vaccination must be with the same vaccine (brand) and administered after the regular interval according to the guidelines.

 

Stricter anticoagulant policy

The treating medical specialist only needs to be consulted prior to the vaccination in cases of congenital coagulation disorder, thrombopathy or thrombocytopaenia.

Intramuscular (i.m.) vaccination is possible when using coumarin derivatives (also known as Vitamin K antagonists) and a stable INR. In the event of a variable INR that needs to be checked regularly by the anticoagulation clinic, i.m. vaccination is only permitted if the INR was <3.5 in the 7 days prior to vaccination.
I.m. vaccination is possible if other anticoagulant medication is used, as long as the timing between taking the medication and receiving the vaccination is followed as described in the guidelines. In addition, it may be necessary to put pressure on the injection site for at least 10 minutes after the vaccination.

 

COVID-19 after 1st vaccination

People who have already had the 1st COVID-19 vaccination, and then get COVID-19 or test positive for COVID-19, are subject to the same interval of at least 4 weeks after the onset of symptoms or the positive test result. This is not only to make it possible to differentiate between symptoms relevant to the course of the disease and symptoms that may be caused by the vaccination, but primarily also because receiving the 1st vaccination as well as having COVID-19 has already activated the immune response twice within a short time frame. For that reason, it is better to postpone the booster shot (2nd vaccination) until at least 4 weeks after the onset of symptoms. If this interval is longer than the currently recommended time, that is not a problem. The person is probably sufficiently protected, and can still get the 2nd vaccination later.

 

Number of doses per vaccine vial

It has been agreed with the Medicines Evaluation Board (CBG-MEB) that, if it can be managed, one dose more may be taken from a vaccine vial than is stated in the package leaflet, as long as it is a full dose. For Pfizer/BioNTech’s Comirnaty®, this means that a maximum of 6 to 7 full doses may be taken from a vaccine vial; for Moderna’s vaccine, this means a maximum of 11 full doses. 
Hospital pharmacists have a few more options for getting the maximum number of doses out of the vial. However, they are not allowed to prepare the vaccines in the injection syringes to then distribute outside their own organisation, because vaccine which is already in the syringe cannot be transported to another location. This is due to the significant fragility of the mRNA.

Figures on vaccination and side-effects

Since this week, the coronavirus dashboard provided by the Dutch Government has been expanded to include daily updates on vaccinations. The figures show how many vaccines have been administered and how many vaccines are becoming available. RIVMNational Institute for Public Health and the Environment publishes a weekly update about vaccination rates. Pharmacovigilance Centre Lareb publishes a weekly update about side-effects.

Public communication

Basic information about the vaccination is now available in the following languages: English, French, German, Spanish, Polish, Romanian, Bulgarian, Turkish and Arabic. The information in an easy-to-read version (Steffi module) will also soon be available in other languages.
In addition, a poster campaign was developed by the Ministry of Health, Welfare and Sport (VWS), entitled #ikstroopmijnmouwop (“I’m rolling up my sleeve”). The posters can be hung in care institutions, for example. Using the poster generator provided at www.stroopjemouwop.nl, everyone can produce their own personalised version of the poster, and share it on social media if they want.

Newsletter on COVID-19 and behaviour

Since spring 2020, the RIVMNational Institute for Public Health and the Environment Corona Behavioural Unit has been researching how people in the Netherlands are behaving in response to the coronavirus measures and associated factors. In recent months, many studies have already been published via rivm.nl, including the large-scale survey-based study in collaboration with the Municipal Public Health Services (GGDs). To keep interested parties informed, RIVM is now combining all the news items and activities of the Corona Behavioural Unit in the newsletter on ‘COVID-19 & Behaviour’ (in Dutch). Would you like to receive this newsletter? Subscribe here. We would appreciate it if you could also share the newsletter within your network. The newsletter will be published about 10 times a year.

Upcoming events

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

  • Friday 29 January 2021, 10:00-11:00: Cécile van Els, immunologist and professor of vaccinology, will be on BNR’s Big Five talk show in the context of the Vaccination Week on BNR news radio;
  • Friday, 29 January 2021, 12:00 to 13:00: online session explaining behavioural research, looking at doubts and uncertainties regarding participating in COVID-19 vaccination, based in part on in-depth interviews. Sign up via coronagedragsunit@rivm.nl;
  • Sunday 31 January 2021, 17:30-18:30: Merel Westrik presents Het Grootste Coronaspreekuur, answering questions about vaccines in a programme made with the Medicines Evaluation Board (CBG-MEB).