加拿大国家免疫咨询委员会建议:患有自身免疫系统疾病,免疫系统有缺陷的患者,孕妇和16岁以下的青年人暂缓注射辉瑞疫苗,因为疫苗的试验中为包含这类数据。
Immunocompromised may have to wait longer for COVID-19 vaccine
The reason behind the precautions regarding the immunosuppressed and other groups is that
they weren’t included in Pfizer’s vaccine trials, so there simply
isn’t any data to indicate whether the drug is safe for them.
Author of the article:
Bruce Deachman
Publishing date:
Dec 17, 2020 • Last Updated 14 hours ago • 4 minute read
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Tim Smith is a double-lung transplant recipient. He was somewhat disappointed to learn that immunocompromised people are not being recommended for the COVID vaccine, but he is willing to wait his turn. PHOTO BY JEAN LEVAC /Jean Levac
Tim Smith was a little surprised over the past few days to hear U.S. immunologist Dr. Anthony Fauci, B.C.’s provincial health officer Dr. Bonnie Henry, and his own thoracic surgeon say that the long-awaited COVID-19 vaccine was not being recommended for those who, like Smith, have compromised immune systems.
For the 60-year-old Alta Vista resident and double-lung transplant recipient, the news pushed the light he’d been eyeing at the end of a long tunnel a little further away.
“At first, I was thinking ‘I’m immunosuppressed, and they talked about people who are immunosuppressed, saying they might be at the front of the line,’” he says. “So that’s what I thought was going to happen.”
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Tim Smith is a double lung transplant recipient. He was somewhat disappointed to learn that immunocompromised people are not being recommended for the COVID vaccine, but he is willing to wait his turn. PHOTO BY JEAN LEVAC /Jean Levac
But when the rollout of the first vaccine, from Pfizer-BioNTech, began this week, Canada’s National Advisory Committee on Immunization recommended that it
not be given to those with
autoimmune disorders or those who are immunosuppressed, as well as
pregnant women or those under 16, advice that has been echoed by such organizations as Ottawa Public Health.
Smith has been at much greater risk of infection after undergoing his double-lung transplant in Toronto on Nov. 15, 2019. Since returning to Ottawa at the end of February, shortly before the world locked down, he says he’s pretty much stayed in his home, notwithstanding occasional medical tests and a few other outings. “I literally don’t go out,” he says. “There’s the odd time to get some sanity. But someone else’s cold is my pneumonia.”
Smith tempers his disappointment knowing that, as a retiree, he still can isolate at home, while those more likely to spread the virus — employees at long-term care homes, bus drivers and other essential workers — don’t have that luxury.
The reason behind the precautions regarding the immunosuppressed and other groups is that they weren’t included in Pfizer’s vaccine trials, so there simply isn’t any data to indicate whether the drug is safe for them.
According to epidemiologist and uOttawa health sciences associate professor Dr. Raywat Deonandan, this isn’t at all unusual. “The government has licensed this drug based on what is known in the clinical trial. So it would be considered a bit untoward to do anything that deviates from the testing procedure in the clinical trial. For example, it wasn’t tested on children, so it would be very odd to now go and give it to children. It probably does work on kids, to be honest, but we won’t do it because that’s not what we looked at.”
The good news, says Dr. Deonandan, is that the vaccine appears to work well on older people, who typically have less responsive immune systems. “So it probably will work on a very high percentage of people who have autoimmune disorders. But we don’t know. So it’s a precautionary principle at this point, saying that because there’s insufficient data, let’s hold off, for at least a few months, until we assess the true safety profile.”
Further trials, he says, as well as evaluations and post-market surveillance of ongoing vaccinations, including the occasional happenstance of those with compromised immune systems actually getting the vaccine, will provide more data. Meanwhile, people currently unable to be vaccinated, including the immunocompromised, will benefit by the vaccination of those around them.
“That’s where we need to focus,” says Dr. Kumanan Wilson, a physician/scientist at The Ottawa Hospital. “We call that shielding of the vulnerable, where we vaccinate those who might come in contact with the immunocompromised.”
Dr. Wilson points to the measles vaccine as an example, noting that because it’s a live vaccine, unlike the COVID one, it can’t be given to the immunocompromised. “That’s why everyone else gets vaccinated, to protect those who can’t get the vaccine.”
That’s largely how Danny Norris, another double-lung recipient who, like Smith, expected to be among those vaccinated early in the process, is looking at things.
“It’s definitely a disappointment,” says the 30-year-old Cumberland resident, whose wife is also a double-lung recipient. “But if everybody else is able to get vaccines, it will help control the spread, which means it will be safer for us in general.”
But Norris adds he won’t need any encouragement to get a vaccine as soon as he can. “Some health officials have said get it, because the vaccine is probably safer than actually catching COVID. No one really knows. But if we’re eligible, I’ll try to get it as soon as possible.”
Smith, meanwhile, says he’ll hold off until there’s solid evidence that he can be safely vaccinated before doing so. In the meantime, he’s not counting on others being vaccinated for his safety.
“I don’t think I’ll feel comfortable going out knowing that 60 or 70 percent of people are vaccinated. That leaves at least another 30 per cent out there, and I know that I’m at risk to get something.
“It would be nice to have more data,” he adds, “but I can wait my turn.”
For the immunosuppressed and other groups not part of Pfizer's vaccine trials, there is no data to show whether the drug is safe for them.
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