Conditions that, for real, mean you can’t get vaccinated for covid?
September 7, 2021 12:07 AM
For real, preferably with sources: for what conditions is there a reasonable medical consensus that a patient shouldn’t get *any* of the covid vaccines available in the US right now, ever?
There are an astonishing/demoralizing number of teachers in my district who insist that our covid leave policy is unfair and discriminatory, because it only provides extra leave for those covid-positive teachers who have been vaccinated. They want the district to change it to allow for medical exceptions to the vaccine.
I don’t want want to debate the policy, but I am genuinely curious if there are actually conditions for which there is a broad consensus that getting the vaccine is more of a danger than not. I know that for some treatments the vaccine timing might be a concern, but what would legitimately prevent you from *ever* getting any of the vaccines?
There are an astonishing/demoralizing number of teachers in my district who insist that our covid leave policy is unfair and discriminatory, because it only provides extra leave for those covid-positive teachers who have been vaccinated. They want the district to change it to allow for medical exceptions to the vaccine.
I don’t want want to debate the policy, but I am genuinely curious if there are actually conditions for which there is a broad consensus that getting the vaccine is more of a danger than not. I know that for some treatments the vaccine timing might be a concern, but what would legitimately prevent you from *ever* getting any of the vaccines?
This is a UK source, but may be of use - see page 25/26 of the COVID-19 green book, chapter 14a which lays out precautions and contraindications.
posted by knapah at 2:14 AM on September 7, 2021
posted by knapah at 2:14 AM on September 7, 2021
Ontario's Ministry of Health has said that the only things that constitute an actual medical exemption are 1) an allergy to an ingredient in the vaccine or 2) having experienced myocarditis or pericarditis after a first vaccine shot.
posted by synecdoche at 3:33 AM on September 7, 2021
posted by synecdoche at 3:33 AM on September 7, 2021
a relative of mine is part of a trial for MS treatment and they told her to wait until it was out of her system (3 mo) to get vaccinated.
posted by wellifyouinsist at 4:35 AM on September 7, 2021
posted by wellifyouinsist at 4:35 AM on September 7, 2021
There are some immunosuppressed conditions that mean you can get the vaccine but it won't necessarily give you any immunity.
posted by Hypatia at 5:30 AM on September 7, 2021
posted by Hypatia at 5:30 AM on September 7, 2021
The only person I know with an exemption (who would much rather be able to have the vaccine) is due to a severe PEG reaction.
posted by pixiecrinkle at 6:38 AM on September 7, 2021
posted by pixiecrinkle at 6:38 AM on September 7, 2021
There are some immunosuppressed conditions that mean you can get the vaccine but it won't necessarily give you any immunity.
I'm immunocompromised, and we're being told that they don't know if it gives us some immunity. In some cases (like mine), people show no antibodies, but no one is sure exactly what those tests mean or whether immunity works through other mechanisms. All of the people on my support board are reporting that their doctors say to get the vaccine anyway.
posted by FencingGal at 6:39 AM on September 7, 2021
I'm immunocompromised, and we're being told that they don't know if it gives us some immunity. In some cases (like mine), people show no antibodies, but no one is sure exactly what those tests mean or whether immunity works through other mechanisms. All of the people on my support board are reporting that their doctors say to get the vaccine anyway.
posted by FencingGal at 6:39 AM on September 7, 2021
It is my understanding that people who have received organ transplants may not be able to get the vaccine (via transplant recipients that I know), depending upon which anti-rejection drugs they are on. Some of the immuno-compromised people I know have gotten the vaccine, and others (on medical advice) have not.
DaughterR has a systemic (not allergic) reaction to shots/piercings, so she got her shots at her doctor's office, rather than a vaccination clinic.
posted by jlkr at 8:44 AM on September 7, 2021
DaughterR has a systemic (not allergic) reaction to shots/piercings, so she got her shots at her doctor's office, rather than a vaccination clinic.
posted by jlkr at 8:44 AM on September 7, 2021
“It is my understanding that people who have received organ transplants may not be able to get the vaccine (via transplant recipients that I know), depending upon which anti-rejection drugs they are on”
Nope - transplant immunosuppression reduces the efficacy of the vaccine, but the recommendation is to give a third dose to increase the chances of response, not to avoid vaccination. Mortality for renal transplant patients was several times that of matched patients on the transplant list, so it is vital they are vaccinated. None of the immunosuppressants interact with the vaccine (all solid organ transplants use similar immunosuppressive regimes). I’m a renal transplant physician.
posted by tinkletown at 1:20 PM on September 7, 2021
Nope - transplant immunosuppression reduces the efficacy of the vaccine, but the recommendation is to give a third dose to increase the chances of response, not to avoid vaccination. Mortality for renal transplant patients was several times that of matched patients on the transplant list, so it is vital they are vaccinated. None of the immunosuppressants interact with the vaccine (all solid organ transplants use similar immunosuppressive regimes). I’m a renal transplant physician.
posted by tinkletown at 1:20 PM on September 7, 2021
It is my understanding that people who have received organ transplants may not be able to get the vaccine (via transplant recipients that I know), depending upon which anti-rejection drugs they are on. Some of the immuno-compromised people I know have gotten the vaccine, and others (on medical advice) have not.
The only rumours I've ever heard about transplant patients not getting a vaccine is based on their dosing. At the time of transplant, you get hit with all the immunosuppressants they can shove into you, and these get tapered down over the first few weeks/months as they try to find the smallest dose (and best mix in the cocktail) that prevent your body attacking the transplanted organ while still allowing as much of your immune system as possible to function. In a case like this, then it might make sense to delay (not skip) the vaccine; if your immune system will be much stronger in a month because of the tapering, get the vaccine then so you have a stronger immune system to respond with. Similarly, I got a fairly intense course of anti-rejection treatment a couple of years ago, and I suspect that they might have advised the same then -- they were rebooting my immune system, wait for it to get back to nominal before you get the shot.
Here's an excerpt from a letter I got emailed to me the other day from my transplant team now that 3rd dose boosters are available here for immunocompromised patients (emphasis mine):
The only rumours I've ever heard about transplant patients not getting a vaccine is based on their dosing. At the time of transplant, you get hit with all the immunosuppressants they can shove into you, and these get tapered down over the first few weeks/months as they try to find the smallest dose (and best mix in the cocktail) that prevent your body attacking the transplanted organ while still allowing as much of your immune system as possible to function. In a case like this, then it might make sense to delay (not skip) the vaccine; if your immune system will be much stronger in a month because of the tapering, get the vaccine then so you have a stronger immune system to respond with. Similarly, I got a fairly intense course of anti-rejection treatment a couple of years ago, and I suspect that they might have advised the same then -- they were rebooting my immune system, wait for it to get back to nominal before you get the shot.
Here's an excerpt from a letter I got emailed to me the other day from my transplant team now that 3rd dose boosters are available here for immunocompromised patients (emphasis mine):
The third dose of vaccine has been shown to increase the protection against COVID-19 in transplant patients. In a recent trial published in the New England Journal of Medicine, third doses in immunosuppressed individuals suggest that they are well tolerated with no anticipated increased side effects. Based on the scientific evidence, the physicians and surgeons of the Southern Alberta Transplant Program strongly recommend that all transplant patients be vaccinated against COVID-19 with all three doses, since the severity of COVID-19 disease and the risk of death due to COVID-19 infection in the transplant population is far greater than in the general population.posted by Superilla at 1:24 PM on September 7, 2021
The CDC's only contraindication is allergy to the ingredients. They are extremely detailed (search the page for "contraindication") about a number of things that are NOT contraindications (dermal fillers should not stop you from getting vaccinated, as an example), including myocarditis or pericarditis.
This is on purpose, for exactly the situation you are talking about. It could not be more clearly defined: the only contraindication is an allergy to something inside that syringe. And that is only a contraindication for the vaccine that contains it - so if you're allergic to Pfizer or Moderna, get the J&J instead, or vice versa. There's no overlapping non-inert ingredients, only a vague relationship between PEG (in the mRNA) and polysorbate-80 (Janssen) so it might be possible to be allergic to both but someone should be required to prove it to claim a full exemption in the US.
Now, does that mean that nobody anywhere ever has a doctor - like an oncologist or transplant specialist - who wants (or at least wanted them, early on) them to slow-roll to wait out early results. I know of several people who got that advice from cautious doctors in good faith, as well as some people who've been told by their actual doctors to take Ivermectin and here's a letter of medical exemption, but that letter ought to be legally meaningless.
The school district's lawyers would have to decide whether to accept medical exemptions and what kinds, but they will not have backing of the CDC in case of being sued for killing people with too lenient an exemption-acceptance policy.
posted by Lyn Never at 1:31 PM on September 7, 2021
This is on purpose, for exactly the situation you are talking about. It could not be more clearly defined: the only contraindication is an allergy to something inside that syringe. And that is only a contraindication for the vaccine that contains it - so if you're allergic to Pfizer or Moderna, get the J&J instead, or vice versa. There's no overlapping non-inert ingredients, only a vague relationship between PEG (in the mRNA) and polysorbate-80 (Janssen) so it might be possible to be allergic to both but someone should be required to prove it to claim a full exemption in the US.
Now, does that mean that nobody anywhere ever has a doctor - like an oncologist or transplant specialist - who wants (or at least wanted them, early on) them to slow-roll to wait out early results. I know of several people who got that advice from cautious doctors in good faith, as well as some people who've been told by their actual doctors to take Ivermectin and here's a letter of medical exemption, but that letter ought to be legally meaningless.
The school district's lawyers would have to decide whether to accept medical exemptions and what kinds, but they will not have backing of the CDC in case of being sued for killing people with too lenient an exemption-acceptance policy.
posted by Lyn Never at 1:31 PM on September 7, 2021
The idea that transplant patients shouldn’t have vaccination is unfortunately a myth widely-touted by anti-vaxxers. Every national group I am aware of (UK, US, Canada, Germany) recommends it.
https://ukkidney.org/sites/renal.org/files/KQuIP/473%20Vaccine%20Facts%20Llet.pdf
posted by tinkletown at 1:33 PM on September 7, 2021
https://ukkidney.org/sites/renal.org/files/KQuIP/473%20Vaccine%20Facts%20Llet.pdf
posted by tinkletown at 1:33 PM on September 7, 2021
I've got a colleague who's still recovering from Bells Palsy he got last spring; he's been recommended by his doctor not to get vaccinated until he's at least a year past the original attack. The CDC's guidelines on that, as per the link above, is basically "insufficient data from the trials to determine a casual link; in the absence of evidence, you may get vaccinated but please report any bad effects to VAERS", which is a bit less forceful than a lot of the other conditions listed there.
posted by damayanti at 4:12 PM on September 7, 2021
posted by damayanti at 4:12 PM on September 7, 2021
Pregnant friend was instructed by her doc not to get the booster. She already had the 1st 2 shots before pregnancy.
posted by Miko at 4:53 PM on September 7, 2021
posted by Miko at 4:53 PM on September 7, 2021
I'm immunosuppressed--I get Rituxan infusions every six months to manage my MS. Rituxan is a B-cell depleting therapy (BCDT), and BCDTs are the worst of all the immunosuppressive meds in terms of decreased response to vaccines. And lucky us, people taking BCDTs are also more likely to get severely ill if they get covid. We're screwed both ways!
My neurologist encouraged me to get vaccinated as soon as it was offered to me (which, as a nurse working at the bedside in an acute care hospital, was late December). He figured, and I agreed, that even a suboptimal immune response to the vaccine was better than nothing at all, given how high risk I was for covid exposure at work and for severe disease if infected.
Neither he nor I had any concerns about the vaccine's safety. The trials were adequately powered and the data were incontrovertible.
I would have walked barefoot over broken glass to get vaccinated. I wept like a child when it was done. And when the FDA expanded the emergency use authorization to include a third dose for immunosuppressed people, I was at the pharmacy the very next morning.
posted by jesourie at 5:14 PM on September 7, 2021
My neurologist encouraged me to get vaccinated as soon as it was offered to me (which, as a nurse working at the bedside in an acute care hospital, was late December). He figured, and I agreed, that even a suboptimal immune response to the vaccine was better than nothing at all, given how high risk I was for covid exposure at work and for severe disease if infected.
Neither he nor I had any concerns about the vaccine's safety. The trials were adequately powered and the data were incontrovertible.
I would have walked barefoot over broken glass to get vaccinated. I wept like a child when it was done. And when the FDA expanded the emergency use authorization to include a third dose for immunosuppressed people, I was at the pharmacy the very next morning.
posted by jesourie at 5:14 PM on September 7, 2021
Ok, thanks all. This is basically what I thought; my colleagues are largely full of shit. Fingers crossed for a real vaccine mandate for all teachers and staff at some point (and for kids when they expand the reach to younger folks), but I’m not holding my breath in a purple city in an extremely red state.
posted by charmedimsure at 9:15 PM on September 7, 2021
posted by charmedimsure at 9:15 PM on September 7, 2021
This thread is closed to new comments.
Typically, medical exemptions are based on “contraindications” — reasons not to administer a product — cited by the FDA, along with guidance from the Centers for Disease Control and Prevention and other leading medical groups. In the case of the Pfizer vaccine, the list is quite short: The only contraindication listed by the FDA is a “known history of a severe allergic reaction (e.g., anaphylaxis) to any component of COMIRNATY” — in other words, if a person is severely allergic to an ingredient in the vaccine. (NBC, Sept. 2, 2021)
PEG and polysorbate are closely related to each other. PEG is an ingredient in the mRNA vaccines, and polysorbate is an ingredient in the J&J/Janssen vaccine. If you are allergic to PEG, you should not get an mRNA COVID-19 vaccine. Ask your doctor if you can get the J&J/Janssen vaccine. If you are allergic to polysorbate, you should not get the J&J/Janssen COVID-19 vaccine. Ask your doctor if you can get an mRNA COVID-19 vaccine. [...] If you have had an immediate allergic reaction—even if it was not severe—to a vaccine or injectable therapy for another disease, ask your doctor if you should get a COVID-19 vaccine. Your doctor will help you decide if it is safe for you to get vaccinated. (CDC)
Some physicians have cautioned patients in highly specific instances:
In certain circumstances, people may be advised by their doctor to receive a specific type of COVID-19 vaccine or to delay vaccination due to immunosuppressing medical treatment or surgery to a future date when immunization is more likely to have an effective immune response. (Yale Health, Aug. 18, 20201)
This Aug. 19, 2021 Forbes article mentions history of severe allergic reaction, and goes on: There are no known medical conditions which absolutely prevent a person from getting a Covid-19 vaccine. [...] “Our patients should not get live virus vaccines but that is not an issue with any Covid-19 vaccines that are currently approved,” said Gwen Nichols, MD, Chief Medical Officer of the Leukemia and Lymphoma Society (LLS). “Some physicians have told cancer patients particularly those receiving lymphocyte-depleting therapies (anti-CD20 antibody treatments, and others) to wait until completion of therapy to be vaccinated, but in light of the current surge, there are fewer reasons to hold off vaccination,” said Nichols.
posted by Iris Gambol at 1:02 AM on September 7, 2021