The doctor responded about the medical reasons for not getting vaccinated against the coronavirus

Professor Laura Malinauskienė, allergist and clinical immunologist at Clinicas Santara, explained the causes and how they are determined in the “Delfi rytas” program.

– In recent weeks, we have heard more and more about the term ‘not being able to vaccinate for medical reasons’. However, doctors recommend vaccination for those with chronic diseases or weaker immunity. So what reasons could prevent vaccination?

– Here we should point out two large groups of reasons.

One group of reasons is when the vaccine can actually cause very serious and unpleasant consequences: allergies or other immune diseases that develop as a result of the vaccine. This is described as, say, thrombotic syndrome, possibly some kind of autoimmune disease of the nervous system.

If such things have happened in the past after a vaccine or after the first dose of this vaccine, then we would really think that the person should not be vaccinated.

The second group of reasons would be temporary contraindications, as with all vaccines: if there is a fever, if the chronic disease is completely uncontrollable, uncontrollable, it gets worse, in which case the vaccine should also be postponed until the condition is controlled.

– So, people’s fears can sometimes be justified, especially when they are extremely allergic, have chronic diseases. It’s probably natural for them to wonder which is worse: getting vaccinated or getting sick. What advice would you give them?

– I think that at this moment we have a very high fear that this particular vaccine has been little investigated and that there may be something. We hear through the media and other networks all kinds of theories about what this could be. So naturally, that fear forms in humans.

It seems to me that I should try to rationalize that fear, that is, simply think about what specifically I am afraid of, what I could have from that vaccine.

I don’t think getting sick is better than getting vaccinated. Because when we get sick, there is always a lottery: you never know how your body will react. As this pandemic shows, people went to work today, and are already on intubated resuscitation tomorrow, which is completely unexpected. Our immune system does not fully recognize the virus and is fighting them.

As for the fact that the vaccine has not been studied, it is also necessary to look at it very philosophically here: after all, people take drugs for blood pressure, for other chronic diseases. Every year new and new drugs appear, but somehow people do not ask in that case, and how long this drug has been tried before it was used for the first time in humans.

Sometimes I wonder how people imagine how long a drug is specifically researched and how much time is wasted evaluating paperwork, documentation, dealing with reimbursement issues.

The rapid appearance of the vaccine in no way means that that time was too short for the vaccine to be of value for testing or not.

And if there is a chronic disease, of course, it is scary what it may be, but it is in people with chronic diseases that exposure to a coronavirus can end badly.

So considering that most reactions after a vaccine are like a fever, feeling worse for a while, it seems to me that that does not outweigh the benefits you will get in the future.

– Why do you have allergies to vaccines in general? What are your symptoms? When can a person be suspected of being allergic to the vaccine?

– Allergies to any vaccine are extremely rare. Regardless of how many millions of people are vaccinated, those cases of allergies that enter the medical literature, or at least have been described, are isolated.

The substances that are included in this type of vaccine are widely used: both polyethylene glycol 2000 and polysorbate 80. These substances are found in creams, foods and laxatives – if someone does colonoscopy, intestinal exams, they drink large amounts of this substance. and everything is fine.

There are no proteins or special chemicals that have the potential to cause allergies. But these are substances that affect the immune system, so for a very small percentage of people, it can cause not only allergic reactions, but also other too strong and turbulent reactions of the immune system. This is what we call hypersensitivity, when the immune system reacts too strongly. This is a very small percentage of people judging by how many people fear it may be because of them.

– Where should a patient with hypersensitivity to a substance or allergy to other vaccines go, possibly in childhood?

– Perhaps the word ‘allergy’ should not be emphasized. It wasn’t necessarily an allergy at all. There can be many different reactions.

If a person is concerned about this, of course, it is best to have a family doctor who has a complete history of the patient, because obviously, if there was any reaction in childhood or even earlier, if it was mild, the person is probably And it didn’t attract no matter how bad it felt. If they have died without specific treatment, they are not yet considered medically serious.

If they were more severe and this is recorded in the documentation, then it is really worth looking and thinking about what they could be, or if this could be a contraindication to this particular type of vaccine, as the active ingredient in each vaccine is different. If the reaction was once from a pertussis vaccine, it has absolutely nothing to do with vaccinating this virus.

In any case, advice should be given: if the family doctor cannot answer or the patient is still concerned, he can always consult a specialist in clinical immunologist-allergist.

– What tests are being carried out to determine the sensitivity of the components of the vaccine?

– Because, as I said, those additional ingredients are used a lot in life, the first and most important thing is the patient: if they have taken certain types of medications or if they have any reaction to certain foods, certain medications. That is, a history is collected.

Then we can do the test with the vaccine itself, in small amounts, and see if the patient develops a reaction or not. We can really “catch” and detect quick allergic reactions.

And even this is not a contraindication to vaccination. This only indicates that a person needs to be vaccinated in some special way and perhaps for a longer period of time to see if they will develop that quick allergic reaction or not.

– How much does a study of this type cost and is it carried out in public polyclinics?

– It is not performed in polyclinics since the patient needs a longer follow-up. This is done in a day hospital for allergic and immune diseases.

We provide this service at Santara clinics. It’s free.

– Is it true that in case of hypersensitivity to a component, vaccination is possible, but with the supervision of a doctor, perhaps even if the patient is hospitalized for some time?

– Yes, if we mean allergic sensitivity. Allergy develops when blood pressure drops, skin rashes, swelling of a person. That person does not need to be hospitalized because it is a quick reaction. Allergic reactions are those that develop quickly. There is a day hospital where we can observe the person from 13 to 15 to 17 hours. – whenever necessary, as we hope that some quick reaction can develop.

There are other reactions that we cannot know or protect ourselves from. This usually happens after the first dose if you are vaccinated in two doses.

There are reactions so slow that they develop the next day. These are more commonly associated with skin lesions, certain types of rashes or those subsequent reactions such as myocardial injury or neurological complications, Guillain-Barré neuropathy, which is also of immune origin but develops by slower mechanisms, is not so potentially fatal like allergies. , which can be developed in minutes.

– Have you received many of these inpatients at the Santara clinics this year?

– I can’t say much. But yes, we have those patients. There are people who have what is called mastocytosis when they have more than certain cells involved in allergic reactions. That’s why we even vaccinate them prophylactically in a day hospital, noticing for a couple of hours if any reactions are developing. Everything’s okay.

– What chain of treatment in a patient’s medical history should reflect the fact that he or she cannot be vaccinated for medical reasons.

– It could be done by a family doctor, and probably any specialist doctor to whom the patient has referred, and this is a problem that is linked in time or simply pathogenetically to this vaccine.

The specialist doctor records this in a register, and that information still has to be stored on the card of the family doctor and the patient himself.

For several years, the State Drug Control Agency has had a special form that a patient can fill out on their own if they think something has happened to them because of a vaccine. Other people say, “I will report, and the doctors say you are definitely not against vaccines.” Okay, so you can go to the institution yourself and fill out a form about what you think has happened to you since the vaccination. It also contributes to the accumulation of information.

– Who would you recommend seeing an allergist before getting vaccinated?

– First I would recommend talking to a trusted doctor. Sometimes I cannot name a single disease, but there is a very great fear and what will happen to me. We, as specialists, also talk to these patients. Those fears should be allayed.

I think anyone who cares is not sure who they might be and those who trust medicine can always turn up. Only a referral from a family doctor is required to see an allergist. This should first be discussed with your family doctor.