COVID-19 vaccine reactions: Emergency procedure

Eight COVID-19 vaccines are licensed in the Philippines. Severe reactions to these and anaphylactic events occur very rarely. But to react early, an interdisciplinary team set up a concept for different risk groups.

The Philippine approach: prevention and treatment of COVID-19 vaccine reactions

Eight COVID-19 vaccines are currently licensed in the Philippines. Severe vaccination reactions and anaphylactic events occur very rarely overall. However, in order to be able to react early, an interdisciplinary team has set up a concept for the different risk groups.

Anaphylactic reactions after vaccination are rare but possible

The data on the individual COVID-19 vaccines is constantly growing. In general, the current vaccines are considered to be well tolerated - always provided that appropriate precautions and recommendations are followed for the individual agents and patient groups.

With regard to undesirable side effects, a distinction is made between vaccination reactions (vaccine reactogenicity), which in most cases subside by themselves within a few hours to days, and allergic reactions, which sometimes require intensive medical treatment.

Vaccination reactions include subsequent complaints:

• Local:
  • Pain
  • Swelling
  • Redness

• Systemic:
  • Fever and chills
  • Generalised muscle and bone pain
  • Headache
  • Fatigue and tiredness
  • Nausea and vomiting

Allergic reactions are defined as follows:

• Anaphylactic shock
• Urticaria, angioedema, maculopapular erythema
• Pruritus
• Respiratory difficulties
• Other hypersensitive reactions

Special precautions recommended for patients at risk

In this context, the Philippine Society of Allergy, Asthma & Immunology (PSAAI) has established different recommendations for the individual risk groups in order to best avoid serious anaphylactic reactions. People with the following risk factors are classified as moderate-risk patients who should be vaccinated under increased emergency preparedness:

• Known severe allergies (medications, food, latex, environmental factors, insects).
• Previous cases of acute allergic reactions to past vaccinations (within the first six hours after injection)
• Poorly controlled asthma
• Mast cell disorders
• Additionally, in adolescents between 12 and 17: previous myocarditis, pericarditis or other heart diseases

If at least one of the risk factors mentioned is present, it is recommended to consult an appropriate specialist in advance and to carry out the vaccination in a centre adequately prepared for intensive care emergencies.

In an emergency: Epinephrine (i.m.)

If a severe anaphylactic reaction to one of the vaccines does occur, the PSAAI recommends the following course of action:

• Local reactions:
  • Antihistamines (oral/ i.v.) and glucocorticoids (oral/ i.v.) and monitoring for 4 hours.
  • Discharge 4-6 hours after complete resolution of symptoms and referral to allergist.

• Severe, progressive systemic reactions:
  • 0.5 ml (1 mg/ml ampoule) epinephrine i.m. or 0.3 mg epinephrine Auto-Injector

• Intensive care monitoring with:
  • Airway management
  • Oxygen administration
  • Glucocorticoids
  • Antihistamines

The emergency procedure for children and adolescents is the same as for adults, but with a reduced epinephrine dose according to body weight: 0.01 mg/kg/dose (1 mg/ml ampoule).

Source:
Prof. Ang, Maria Carmen, Davao Medical School Foundation, APAAACI Online-Symposium 17, Guidance on Adverse Reactions to Covid 19 Vaccines, Oktober 2021