Who should or shouldn’t take the COVID-19 vaccine

More than 12.3 million people registered till the first week of May 2021 through the Co-Win and Arogya Setu platforms in response to the opening of online registrations for the novel coronavirus disease (COVID-19) vaccination for those above 18.

A total of about 150 million shots have been given till date. These cover only 11.5 per cent of India’s population. The first phase of vaccination in India covered frontline workers and citizens over 45 years of age. It has now been opened for all above 18 years in India from May 1.

The demand for vaccination has suddenly grown manifold after the devastating second wave of COVID-19. But there are many myths and misconceptions about who should or should not take the COVID-19 vaccine. This article describes precisely that.

Pregnant women  

Soumya Swaminathan, chief scientist at the World Health Organization (WHO) has stated:

Globally, it has been observed that pregnant women are at a higher risk of complications and that of premature birth because they already have a low respiratory reserve and therefore, vaccinating them is perhaps the best option available.  

A recent study published in the American Journal of Obstetrics and Gynaecology revealed that vaccine-induced immune responses were significantly greater than the response to natural infection and immune transfer to neonates occurred via placenta and breastmilk.

The American College of Obstetricians and Gynaecologists also recommends that the COVID-19 vaccine should not be withheld from pregnant or breastfeeding individuals. The COVID-19 vaccine is not a live virus vaccine. The mRNA present in the vaccine degrades quickly and cannot interfere with cell functions. 

Pregnant women may receive the vaccine if they are at high risk of exposure to the COVID-19 virus or very likely to be in contact with people with COVID-19. The COVID-19 vaccines currently being used in India are not recommended by Indian health authorities for pregnant women.

Lactating women

According to WHO recommendations, breastfeeding women can be vaccinated against COVID-19 and can continue breastfeeding after vaccination. Currently, there is no data on the safety of COVID-19 vaccines in breastfeeding women or on the effects of mRNA vaccines on the breastfed infant or milk production / excretion.

However, early studies have demonstrated that secretion of antibodies in breastmilk can protect the breast-fed infant. The Centers for Disease Control and Prevention (CDC), USA, stated that COVID-19 vaccines are non-replicating vaccines. They can produce immune responses but do not reproduce inside host cells.

People who would like to have a baby 

There is currently no evidence that any vaccines, including COVID-19 vaccines, cause fertility problems. There is no evidence showing a link between menstruation, fertility and vaccines.

A woman can take the vaccine during her period cycle also. Clinical studies are on to find out any possible side effects and the findings will be reported as they become available. At present, all future parents are encouraged to take the COVID-19 vaccine. 

People with allergies

Yes, people with severe allergic reactions to foods, oral medications, latex, pets, insects and environmental triggers can get vaccinated. But people with a severe allergic reaction (anaphylaxis) to any component of the COVID-19 vaccine or injectable (intramuscular or intravenous) medication should NOT receive the vaccine.

People with chronic disease or suppressed immune systems

The vaccine is safe and effective in people with chronic diseases including hypertension, diabetes, asthma, pulmonary, liver, or kidney disease, as well as chronic infections that are stable and controlled.

Specific efficacy and safety data are not yet available, however, for people with immunosuppression or autoimmune conditions. Only limited clinical data is available regarding HIV- infected persons. This group of people should be counselled by health professionals on the potential for reduced immune responses before vaccination. 

Frail and elderly people

The frail and elderly are at risk of becoming very sick from COVID-19 and can be severely affected by even mild illness. They should be carefully considered on a case-by-case basis for COVID-19 vaccines. 

Those who have had COVID and have recovered

The answer is yes as experts do not yet know for how long somebody like this is protected after recovering from COVID-19. However, people who were treated for COVID-19 with monoclonal antibodies or convalescent plasma should wait 90 days before getting a COVID-19 vaccine. 

People who were recently diagnosed with COVID-19

Yes, the person who was recently diagnosed with COVID-19 can get the first dose four weeks after onset of symptoms or a positive test (whichever is earlier). The second dose may be received after the completion of the isolation period. The isolation period may be counted for 10 days or 10 days plus 24 hours with no fever and an improvement in symptoms.

Children below 18 years

Recently, Pfizer's COVID-19 vaccine was authorised for use children aged 12-15 in Canada and the United States. Children may receive the two shots of the same dose as an adult. This authorisation comes at a time when people under the age of 18 account for 1 of every 5 newly reported coronavirus infections in the USA.

In the vaccine clinical trial, there were no cases of COVID-19 infection in the children who received the vaccine and had high levels of antibodies in their blood. 

Who should not take the vaccine

Anyone who has an allergy to any component of the vaccine, should not take it. Children in the US can take the vaccine currently. However, Indian health authorities do not recommend vaccination of children below 18 years of age, even if they belong to a high-risk group. People with thrombocytopenia (low blood platelet count) should also take extra caution while taking the vaccination.

Preventive measures to be taken after vaccination

It is essential that fully vaccinated people should continue to wear masks and stay six feet apart from other people in public or while visiting unvaccinated people from multiple households.

Many studies agree that fully vaccinated people are less likely to be infected without showing symptoms (called asymptomatic infection) and potentially less likely to spread the virus that causes COVID-19 to others. However, further investigation is ongoing. 

All adults should take the vaccine based on the individual’s conditions and risk of exposure. Others having any doubt should consult their health practitioner before taking the vaccine.

The head of the WHO has urged wealthier nations to postpone their plans to give the COVID-19 vaccines to children and teenagers. Priorities should be given to health workers, people at high risk, old people above 65 years of age and low-income countries.

Wearing masks and staying six feet apart from others would help to reduce the chance of being exposed to the virus or spreading it to others. (India Science Wire)

Jyoti Sharma is a Senior Scientist and Sanjeev Kumar Varshney is Head & Advisor, International Cooperation Division, Department of Science and Technology, Ministry of Science and Technology, Govt. of India. The views expressed in this article are those of the authors and do not necessarily reflect the views or policies of the India Science Wire

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