Immunisation weekly update – 11 August 2021

11 August 2021

Call-out for GPs, pharmacists, and nurses to assist in vaccination

 We are compiling a register of GPs and authorised pharmacist and nurse immunisers who are available to work shifts in COVID vaccination clinics. Please complete this form if you are interested.

Who is eligible for Pfizer?

The Department of Health has released a fact sheet which outlines who is currently eligible to receive the Pfizer COVID-19 vaccine. Access to the Pfizer vaccine is prioritised for those whom the Pfizer vaccine is the only COVID-19 vaccine currently recommended.

Access to Pfizer vaccine for eligible patients aged ≥ 60 years

NSW Health has updated the referral process and referral form for patients aged ≥ 60 years who meet ATAGI criteria for Pfizer vaccination. Patients can use the referral form to access Pfizer vaccination at a NSW Health vaccination clinic or Commonwealth vaccination clinic, if their regular GP does not have access to Pfizer vaccination.See local Health Pathways site for more information on how to make a referral:

• Sydney HealthPathways
• South Eastern Sydney HealthPathways

NSW Health walk-in vaccination clinics

NSW Health walk-in vaccination clinics in Greater Sydney are offering COVID-19 AstraZeneca vaccines to anyone aged 18 years and over.

The Local Health District Facebook pages are also updated regularly with details of new pop-up clinic locations:

• SLHD: facebook.com/SydneyLHD
• SESLHD: facebook.com/SESLHD

Aged care and disability vaccination clinics

There is a pop-up COVID-19 vaccination site in Ashfield open ONLY for workers of residential aged care facilities and disability group homes. This new vaccination hub for workers in residential aged care facilities and disability group homes is running between 9:00am and 4:00pm Monday to Friday.

There is a pop-up COVID-19 vaccination site in Burwood for use ONLY by NDIS participants and their support staff/carers.

Incentive payments for in-reach clinics 

Incentive payments are now available for administering in-reach COVID-19 vaccination clinics to residential aged care and disability support workers. Primary care vaccination providers can access additional payments of:

• a $1,000 payment once a minimum threshold of 50 unvaccinated residential aged care or disability support workers (cumulative) have been provided a COVID-19 vaccination (1 dose) at an in-reach clinic.
• $20 for every dose provided to an unvaccinated residential aged care or disability support worker thereafter (with a maximum payment of $40 per worker for two doses).

These payments are in addition to the per patient fees payable in line with existing funding arrangements (Medical Benefits Schedule (MBS) COVID-19 Vaccine Assessment items and practice incentive payments).

Only practices participating in the Practice Incentives Program (PIP) or which operate as a CVC are eligible to participate 

Missing COVID-19 vaccination records on AIR

Patients who are missing their vaccination record and received their vaccines at one of the below NSW Health vaccination hubs can complete a Vaccination record query form:

• NSW Health Vaccination Centre at Sydney Olympic Park,
• RPA COVID-19 Vaccination Centre,
• Sydney Airport COVID-19 Vaccination Centre, or
• Canterbury Hospital COVID-19 Vaccination Centre

Patients who were vaccinated at a different NSW Health vaccination hub can call the NSW Health Vaccination Support Line on 1800 57 11 55. 

Vaccination rates by geographic regions

The Department of Health have released a new vaccination rate report (9 August) listing the percentage of people aged 15 and over who have been vaccinated against COVID-19, by geographic regions and whether they’ve had one dose or are fully vaccinated.

Primary care approach to thrombosis with thrombocytopenia syndrome 

ATAGI updated their guidance for health professions outlines the primary care approach to identifying, diagnosing and treating thrombosis with thrombocytopenia syndrome after COVID-19 AstraZeneca vaccine.

NSW Health have also issued a clinical alert for TTS. Key points for COVID-19 immunisation providers:

1. All people offered the COVID-19 AstraZeneca vaccine should be advised of the risk of TTS, the symptoms to watch out for in the 4 to 42 days following vaccination, and when to seek medical advice.
2. Thrombosis with thrombocytopenia syndrome (TTS) is a rare, newly identified condition associated with the COVID-19 AstraZeneca and Janssen (Johnson & Johnson) vaccines.
3. TTS usually involves thrombosis, thrombocytopaenia (<150 × 109) and/or a high d-dimer (typically > 5 × upper limit of normal) with onset of symptoms 4 to 42 days after COVID-19 AstraZeneca vaccination.
4. TTS can be treated effectively. If TTS is suspected, investigate with appropriate blood tests and imaging, seek haematologist advice and notify your local public health unit. Do not give heparin-based anticoagulants or platelet transfusions. The latest guidance is available from the ACEM and THANZ.

It is incredibly important to ask patients if they have received the AstraZeneca vaccine if they are presenting with unusual or persistent symptoms of headache or abdominal pain, and to refer patients for further testing or treatment.

Contraindications and precautionary conditions for AstraZeneca 

Contraindications to COVID-19 Vaccine AstraZeneca are:

• anaphylaxis after a previous dose
• anaphylaxis to any component of the vaccine, including polysorbate 80
• history of capillary leak syndrome
• thrombosis with thrombocytopenia occurring after a previous dose
• any other serious adverse event attributed to a previous dose

Precautionary conditions for COVID-19 Vaccine AstraZeneca are:

• a history of cerebral venous sinus thrombosis (CVST)
• a history of heparin-induced thrombocytopenia (HIT)
• a history of idiopathic splanchnic (mesenteric, portal, splenic) thrombosis
• a history of antiphospholipid syndrome with thrombosis.

For people in the above groups who have received a first dose of COVID-19 Vaccine AstraZeneca, Comirnaty is recommended for the second dose.

People who develop immune thrombocytopenia (ITP) within 42 days after receiving COVID-19 Vaccine AstraZeneca should consult a haematologist regarding whether to proceed with the second dose using the same or an alternate vaccine, and the timing of the second dose.

See Clinical Guidance document.

Contraindications and precautionary conditions for Pfizer 

Contraindications to Comirnaty are:

• anaphylaxis after a previous dose
• anaphylaxis to any component of the vaccine, including polyethylene glycol (PEG)
• myocarditis and/or pericarditis attributed to a previous dose
• any other serious adverse event attributed to a previous dose

Precautionary conditions for Comirnaty:

People with a history of any of the following conditions can receive Comirnaty but advice should be sought from a cardiologist about the best timing of vaccination and whether any additional precautions are recommended:

• Inflammatory cardiac illness e.g., myocarditis, pericarditis, endocarditis
• Current acute rheumatic fever
• People aged 12-29 years with dilated cardiomyopathy
• Complex or severe congenital heart disease including single ventricle (Fontan) circulation
• Decompensated heart failure
• Cardiac transplant recipients.

Vaccination should be deferred in people with ongoing cardiac inflammation, or an alternative vaccine (e.g. COVID-19 Vaccine AstraZeneca) considered in people aged ≥ 60 years. People who develop myocarditis and/or pericarditis after receiving Comirnaty should defer further doses and discuss this with their treating doctor.

For further information, refer to guidance on Myocarditis and/or Pericarditis after mRNA COVID-19 Vaccines and Clinical Guidance document.

New Resources 

• COVID-19 vaccination – Practice incentive payment – in-reach residential aged care and disability support worker COVID-19 vaccination

Incentive payment guideline for GPs, ACCHS and CVCs administering in-reach COVID-19 vaccination clinics to residential aged care and disability support workers.

• ATAGI statement on considerations for establishing drive-through COVID-19 vaccination clinic sites

A statement from the Australian Technical Advisory Group on Immunisation (ATAGI) on considerations for establishing drive-through COVID-19 vaccination clinic sites