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This remarkable account of the successful treatment of two cases of Vaccine Induced Thrombosis with Thrombocytopenia(VITT) aged 86 and 38, respectively(1), is also remarkable for the fact that the second patient, aged 38, did not qualify for receipt of a vaccine other than the AstraZeneca vaccine. She failed to qualify because , either in April or in May 2021, Public Health England and Joint Committee on Vaccination and Immunisation(JCVI) issued a directive which stated "JCVI currently advises that it is preferable for adults aged < 30 years without underlying health conditions that put them at higher risk of severe COVID-19 disease, to be offered an alternative COVID vaccine, if available"(2)(3). However, this recommendation did not apply to people aged 30-40(the age group of patient )(1), notwithstanding the fact that, on the 6th May 2021, headlines in the Independent had declared "Under 40s to be offered alternative to AstraZeneca vaccine over increased clot risk"(4).
By the 30th July 2021, 411 cases of VITT had been documented, including 73 fatalities. In the age group 30-39 there were 51 cases of VITT, including 11 deaths(5). By the time this patient had been vaccinated, however, the BNT162b2(Pfizer) vaccine, and probably also the mRVA-1273(Moderna) vaccine must have been available as potential alternatives to the AstraZeneca vaccine. The Pfizer vaccine is 95% effective in preventing Covid-19(95% credible interval, 90.3 to 97.6).
The Moderna vaccine showed 94.1% efficacy at preventing Covid-19 illness, including severe disease. " Vaccine efficacy was 94.1%(95% CI, 893 to 96.8%; P < 0.001)".
Neither of the two vaccines have been associated with VITT(2)(5).
Accordingly, instead of having to choose between vaccination vs cancellation of vaccination, the patient should have been required to choose between the AstraZeneca vaccine and either the Pfizer or the Moderna vaccine.
(1)Yi Wong JS., Kang J H-E., Maw KZ
Acute immune thrombocytopenic purpura post first dose of COVID-19 vaccination
Postgraduate Medical journal 2021 doi:10.1136/postgradmedj-2021-140947
JCVI statement on use of the AstraZeneca COVID-19 vaccine: 7 April 2021
Covid-19 vaccination and blood clotting
Updated 4 May 2021
Under 40s to be offered alternative to AstraZeneca vaccine over increased blood clot risk
The Indpendent 6th may 2021
Coronavirus vaccine-weekly summary of Yellow card reporting
Updated 30 July 2021
(6)Polack FP., Thomas SJ., Kitchin N et al
Safety and efficacy of the BNT162b2 mRNA covid-19 vaccine
(7) Baden LR., El Sahly HM., Essink K et al
Efficacy and safety of the mRNA -1273 SARS-CoB-2 vaccine