There has been lots of news recently about the coronavirus vaccines, with the first being given to a patient this week. Here we provide a short update on what we know so far. We hope to provide further information on how this impacts those with liver conditions as we learn more and receive updates from professionals. The vaccine is very new and so we need to make sure we have the right facts before we share information. For this reason, we may take some time to publish and communicate what we know.
What is the new vaccine?
On 2nd December, the Pfizer BioNTech mRNA vaccine was approved by the body that regulates medicines called the Medicines and Healthcare products Regulatory Agency (MHRA). Read the announcement here.
What is the current priority list?
This priority list is as follows:
- residents in a care home for older adults and their carers
- all those 80 years of age and over and frontline health and social care workers
- all those 75 years of age and over
- all those 70 years of age and over and clinically extremely vulnerable individuals
- all those 65 years of age and over
- all individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality
- all those 60 years of age and over
- all those 55 years of age and over
- all those 50 years of age and over
Read more about the priority groups here.
If you are a young person aged 16 and over and have a chronic liver disease without transplant or immunosuppressant treatment you may come under category 6. If you are a young person aged 16 and over and deemed clinically extremely vulnerable (as per advice from doctors) you would come under category 4. Those eligible for the vaccination will be contacted by invitation when the time comes. It is advised that you talk to your specialist if you are invited to have the vaccination to ensure it is safe for you.
On 10th December, it was advised that those with a history of significant allergic reactions should not have the Pfizer vaccine. This should be discussed with your GP.
Why are children not included?
At this stage, it does not seem that children (under 16) will be vaccinated. Current evidence strongly indicates that the single greatest risk of mortality from COVID-19 is increasing age and that the risk increases with age. So far children have been seen to be less at risk of complications, even those with underlying health conditions. It appears trials have been started in children so this may change in the future. Below is an excerpt from JCVI:
“Following infection, almost all children will have asymptomatic infection or mild disease. There is very limited data on vaccination in adolescents, with no data on vaccination in younger children, at this time. The committee advises that only those children at very high risk of exposure and serious outcomes, such as older children with severe neuro-disabilities that require residential care, should be offered vaccination. Clinicians should discuss the risks and benefits of vaccination with a person with parental responsibility, who should be told about the paucity of safety data for the vaccine in children aged under 16 years.” Joint Committee on Vaccination and Immunisation: advice on priority groups for COVID-19 vaccination.
If this changes or we hear more, updates will be provided on our website and social media pages.
Is the vaccine live?
The Pfizer BioNTech vaccine is not a live vaccine. This vaccine relies on messenger RNA (mRNA) which is a type of genetic material that produces antigens which cells use as an instruction manual to start producing antibodies. Therefore, mRNA vaccines don’t actually use an inactivated or weakened virus but the genetic information from it (a synthetic version of the virus or imitation of it). The mRNA in the vaccine is normally degraded within a few days and cannot incorporate into the host genome. This is a new development in this field.
Is it safe for those immunosuppressed and on immunosuppressant treatment?
As this particular vaccine primes the immune system to make an immediate response, those who are immunosuppressed might not have as strong a reaction to the vaccine as others. While they may have a weaker response (although this is not yet completely clear), it may still be worth having.
“Many individuals who are clinically extremely vulnerable will have some degree of immunosuppression or be immunocompromised and may not respond as well to the vaccine. Therefore, those who are clinically extremely vulnerable should continue to follow government advice on reducing their risk of infection even if they do have the vaccination.”
There may be some people without a functioning immune system who cannot be given the vaccine. It is important that if offered the vaccine, you talk to your specialist before accepting.
Consideration has been given to vaccinate household contacts of immunosuppressed individuals. Evidence is expected to develop during the vaccine programme before advising vaccination solely based on indirect protection. Evidence will also be gathered about whether any specific vaccine is preferred in this population.
The UK is to begin clinical trials of a new coronavirus antibody treatment aimed at people with a weakened immune system who cannot be vaccinated. This drug is to be developed by AstraZeneca and is a combination of two long-acting monoclonal antibodies (man-made proteins that act like natural human antibodies in the immune system).
Update 07.01.2021: Dr Ansgar Lohse, ERN RARE-LIVER Coordinator and specialist in both hepatology and infectious diseases, provides a video message and written statement about the COVID-19 vaccines for patients with rare liver diseases. See more here.
Transmission
Whether any of the vaccines can stop transmission of the virus is not yet known. It may not be the case that it will stop people from getting the virus altogether but instead reduce the severity of it.
Other vaccines
With a number of other vaccines due to follow in the months, this is a fast-moving area. The two most common vaccines mentioned other than the Pfizer BioNTech are:
- Oxford/AstraZeneca – uses traditional inoculation method where a spike protein of the virus is injected which the immune system builds up a response to if the real virus enters the body. This is ‘live’ but not in the conventional sense (they don’t replicate).
- Moderna – like Pfizer this also uses mRNA technology.
Further vaccines in progress include Novavax, Valneva, GSK/Sanofi Pasteur, Janssen (some at very early stages). You can read more detailed scientific explanations about the different vaccines here.
Other than what is discussed in this article, there is no specific information to share at this time regarding specific implications for those with liver conditions. There is still a lot to learn and we hope to share more as time goes on.
Further Information
JCVI Priority Groups
NHS Coronavirus vaccine information page
UK authorises Pfizer/BioNTech COVID-19 vaccine statement
Pfizer BioNTech Information for UK recipients
