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Understanding the dynamics – breastfeeding, pregnancy and COVID vaccines

Understanding the dynamics - breastfeeding, pregnancy and COVID vaccines

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As Sri Lanka rolls out its vaccination program, the questions have shifted from “Which vaccine should I get?” to “Should pregnant and breastfeeding women get vaccinated?” 

The answer in short: Yes, everyone should get vaccinated when offered the chance.

For a more detailed answer on how the vaccine affects pregnant and lactating women, read more below.

Breastfeeding and vaccinations 🤱🏾

Women who have recently given birth or are still breastfeeding should get the vaccine. 

Initially, the clinical trials for the COVID-19 vaccines currently in use did not include women who were breastfeeding. So, there was no clinical data on the safety of vaccines in lactating women, effects of the vaccine in breastmilk production and the consequences on the baby. However, now according to the WHO and new research, lactating women can receive a COVID-19 vaccine.

Recent reports have shown that breastfeeding women who have received COVID-19 vaccines have antibodies that pass on to the baby via breast milk, helping in protecting the baby. 

 A study conducted in Israel with thePfizer-BioNTech vaccine, with 84 breastfeeding women, showed that IgA antibody (the first line of defence when exposed to an infection) secretion was present as early as 2 weeks after vaccination in the breast milk. This was followed by a spike in IgG antibody (important for remembering the virus to prevent future infections) 1 week after the second dose in the breast milk. This suggests a potential protective effect against infection in the infant as these antibodies are passed on to them via the milk. No mother or infant experienced any serious adverse event during the study period.

More data is needed to understand what protection these antibodies provide to the baby. Even though the studies on breastfeeding and vaccinations are not advanced, the present data shows no indication of harm to the mother or child.

Pregnancy and vaccinations 🤰🏾

As with many other vaccines, the effects of the COVID-19 vaccines on pregnant women have not been studied extensively yet. However, health professionals assess the risks of COVID19 vs. the COVID vaccine when deciding whether pregnant women should receive the vaccine. 

Pregnant women with any of the following conditions are at a higher risk of contracting severe COVID than women who are not pregnant: 

  • have underlying health conditions (for example diabetes, high blood pressure or asthma)
  • are overweight
  • are aged 35 years or over

Preliminary findings in a study conducted in the US on the effects of mRNA vaccine in pregnant women did not show obvious safety signals among pregnant women who received mRNA Covid-19 vaccines compared to the control group.

It must be noted that injection-site pain was reported more frequently among pregnant women than among non-pregnant women, whereas other side effects such as headache, chills, and fever were reported less frequently. However, a more detailed and longitudinal study is needed to understand the full impact of vaccination on pregnant women. 

We already know pregnant women are at a higher risk of getting severe COVID and also at a higher risk of delivering a baby prematurely. So in a country like Sri Lanka, where the transmission rate is high, the benefits of getting the vaccine far outweigh the risks. 

Fertility and vaccinations 🌸

Women who are planning to get pregnant in the near future can absolutely take the vaccine. There is no evidence of COVID vaccines affecting fertility or the chances of getting pregnant. So get your vaccine when it becomes available to you. 

If you want more detailed information on getting vaccinated you can speak to one of our on-demand GPs at any time via the oDoc app. If you or your loved ones are showing any COVID symptoms please consult a doctor via oDoc immediately or use the oDoc COVID symptom checker to understand what you should do next.

Sources

  1. Perl, S. H., Uzan-Yulzari, A., Klainer, H., Asiskovich, L., Youngster, M., Rinott, E., & Youngster, I. (2021). SARS-CoV-2–Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women.
  2. Vaccination Considerations for People Pregnant or Breastfeeding. (2021, June 16). Centers for Disease Control and Prevention. 
  3. Public Health Scotland. (2021, June 18). Pregnancy, breastfeeding and the coronavirus vaccine. The Coronavirus (COVID-19) Vaccine. 
  4. WHO. (2021, June 4). Episode #41 – Vaccines, pregnancy, menstruation, lactation and fertility. World Health Organisation.
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So, can we mix and match vaccines?

So, can we mix and match vaccines?

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As the first dose recipients of the AstraZeneca vaccine started to reach the 12-week mark in May, a lot of people were dismayed that they wouldn’t be able to receive the second jab in a timely manner. A lot of conversations began to revolve around “well, what happens to my immunity?” or “can’t we use another vaccine as a second dose?” and at the time, there weren’t much scientifically sound answers to ease people’s nerves. 

The dearth of the second jab of AstraZeneca vaccine for over 500,000 in Colombo was largely due to the Indian COVID surge shutting down Serum Institute exports in late March. As India hurried to absorb all its domestic production to stop a calamitous third wave, a large number of developing countries, including ours, were left without a way forward. 

In December, Russia & the UK began a study of the safety & efficacy of following up a first AstraZeneca dose with a Sputnik booster and in the UK & Spain, researchers started studying the effects of a follow-up Pfizer booster.

Short answer: The jury is still out on exact findings but some preliminary data is available: side effects were more pronounced in intensity (however not severe and no hospitalisations) and higher antibody levels were seen after a Pfizer booster. 

Want more details? Read on: 

What do we know about safety?

In a UK trial, of the ca. 460 people (median age of 50+ years) that received the AZ jab and then a Pfizer booster 28 days later saw greater intensity in post-second jab side effects than those that received a second AZ dose (“control group”). 

More people felt feverish, had chills, felt fatigued, had joint pain and muscle aches in the study group than in the control group. Most of these effects were felt in the first 48 hours after. Efficacy data has not yet been made available. 

Safety and efficacy data of a booster shot being administered after 84 days is expected in June.

What do we know about efficacy?

A study by the Carlos III Health Institute in Madrid enrolled 663 people who had received the AstraZeneca first dose to receive the Pfizer second dose after eight weeks. The control group did not receive any booster shots. 

The results showed a much stronger immune reaction producing a higher level of antibodies in the Pfizer group than they did with the first dose of AstraZeneca. No severe side effects were reported.

What about a Sputnik booster? 🇷🇺

In December 2020, the UK & Russia began to partner on a study to test safety and efficacy of mixing these two vaccines. On May 28th, Russia announced a hold on it’s mix and match trial with Sputnik as the national ethics committee awaited further data.

What about a Sinopharm booster? 🇨🇳

No data is available at the time of publication however Bahrain has allowed mixing with a second dose of SinoPharm. 

What are other countries doing?

Some countries have already begun allowing a second dose of mRNA to supplement the first dose of another brand. On 1st June, Canada’s National Advisory Committee of Immunization announced it would allow second doses of mRNA to be administered to those that received the first dose of another brand of vaccine. 

Bahrain, Finland, France and Norway had begun allowing second doses of mRNA to be administered to those with AstraZeneca first doses.

What about us in Sri Lanka? 🇱🇰 

The health authorities have not approved the mixing of vaccines in Sri Lanka at the time of publication. The government is attempting to procure the shortfall of AstraZeneca doses by any means possible and has signed an agreement with Pfizer for 900,000 doses for delivery in July. 

The recent crowdings and altercations at AstraZeneca vaccination drives serve to be more harmful than helpful when limiting the spread of COVID19. Until sufficient data is available and vaccines are approved & available for mixing, we believe it’s most prudent for those that received the first AZ dose to adhere to strict COVID19 protocols, limit travel as much as possible and avoid crowded gatherings. 

If you or a loved one have been diagnosed with COVID19 and are awaiting transfer to an intermediate care centre or government facility, oDoc Home Care is available for you. 

With oDoc Home Care, you receive daily calls from a medical doctor for symptom monitoring & medical advice, a wellness bundle including gloves & masks, a pulse oximeter and blood pressure monitors. Click here for more details. 

Sources

  1. Shaw, R., et al (2021) Heterologous prime-boost COVID-19 vaccination: initial reactogenicity data., The Lancet., 397:2043-2046. 
  2. Callaway, E (2021) Mix-and-match COVID vaccines trigger potent immune response, Nature Magazine
  3. Miller, A (2021) Canada recommends mixing and matching AstraZeneca, Pfizer and Moderna COVID-19 vaccines, CBC
  4. Explained: Which are the countries allowing you to mix Covid-19 vaccines?, Indian Express (2021)
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