Is vaccinating young people with AstraZeneca and J&J risky?

Is vaccinating young people with AstraZeneca and J&J risky?

Is vaccinating young people with AstraZeneca and J&

The initiatives linked to open days aimed at young people with viral vector vaccines are being discussed. The risks associated with vaccines do not outweigh the benefits, some argue, while others also push us to consider the longer-term positives

(Photo: Cdc on Unsplash) The last few weeks have marked yet another turning point in vaccination campaigns, with the arrival of the first vaccine (Pfizer / BioNTech) approved for adolescents also in Europe and the expansion of vaccinations to all, albeit with some regional differences. A turning point that, compared to the initial phases of the bell - aimed at immunizing and thus protecting the elderly and fragile populations - now actually aims to involve the younger population. Not without some perplexity. And for different reasons.

Faced with this possibility, in fact, in recent days, the voice of the WHO had also been raised, inviting them to donate doses of vaccines rather than to proceed with vaccinations in younger populations, to light of the delays in the Covax program for the fair distribution of vaccines. The afterthought was that, by virtue of the fact that young people are generally less at risk of developing serious forms of the disease, in an (still) emergency phase like the current one, perhaps better to secure health workers and populations most at risk around the world. From an altruistic perspective, yes, but also for national gain, some ethics experts recall in an article on vaccinations in young people, published in The Conversation, also considering the risk that new, more transmissible variants with more viral circulation may emerge. Also from other fronts, by virtue of the same considerations, the thought had arisen that vaccinating the youngest was not a priority now, even if their role as spreaders of the infection made the discussion much more complex.

But the perplexities, especially in Italy in recent days, regarding vaccines and young people have also concerned another aspect, more related to the type of vaccine used in these age groups. In particular, the AstraZeneca vaccine and vaccination initiatives open to all adults, such as open days and open weeks, ended up at the center of the controversy. initiatives). Presumably interesting initiatives in the eyes of all also for the possibility of accessing green certification as soon as possible (the system that allows free circulation in Italy, starting 15 days after the first administration of the vaccine). But that risk overshadowing the discussions on whether or not it is appropriate to offer this vaccine to the youngest.

To take a clear stand against the AstraZeneca vaccine (but also against the J&J product, also a viral vector ) among the younger ones was the Luca Coscioni Association, with a letter also signed by some volunteer doctors, some of whom already signatories of a similar appeal. "The AZ open day initiative seems to be motivated by good intentions and is enjoying great success, but it is not in the best interest of young people. In subjects under 30 who do not have comorbidities, the lethality due to Covid-19 in Italy is close to zero and hospitalization is very rare, while the risk of Vitt [thrombocytopenic venous thrombosis, ed.] For them exceeds the benefit of the vaccine, and is sufficient to advise against vaccination with Az, in accordance with the Aifa recommendations ", reads the document, shared with the Prime Minister Mario Draghi, General Figliuolo and the presidents of the Regions:" It exploits their desire to resume a normal life, visit grandparents freely, move for work or study, go on vacation, etc., but the suspicion arises that in reality they are trying to dispose of the unused doses of AstraZeneca. "

At the center of the issue is the use of viral vector vaccines and the rare cases of thrombosis associated with it. Especially in light of the fact that although always rare, they write from the association, these problems could be less so than initially thought, violating the recommendations of the drug agency itself (for which they are recommended for over 60s). The latest data on coagulation problems associated with the vaccine released by the British authorities - updated about twenty days ago - speak of a risk for the general population of 1 in 100 thousand in the first weeks after vaccination (as also reported by the Aifa itself on the report on the subject), higher in younger populations: 1 in 50 thousand for the under 40s. To the point that vaccines other than AstraZeneca's Vaxzevria are recommended for this segment of the population, without excluding, however, reconsidering all the risks and benefits deriving from vaccination depending on the situation in which you are, the British authorities specify.

And this is another central point of the discussions against the use of AstraZeneca in young people: from several fronts, several experts such as immunologist Antonella Viola and some vaccinating doctors ask to focus on the risks and benefits deriving from vaccination. In the youngest, and especially in women, the risk of possible adverse events related to the vaccine is likely to be greater or comparable to the complications due to Covid-19, especially in light of the current Italian situation. In fact, as we said, the risks and benefits should not be considered in absolute terms, but must also be referred to the circulation of the virus, which modifies the risk profile deriving from the infection and its consequences.

And here a parenthesis opens. : when we talk about risks related to infection we refer in general to those of acute infection, and especially to serious ones that can be summarized (and are) as estimates of the risk of ending up in hospital, in a therapy department intensive or death. The vaccination campaign itself was designed to first offer protection to those who are most at risk of all this. A broader discussion on the subject, according to some, should probably also include long-term risks, such as long Covid, which can also affect young people and children. The list of symptoms cataloged as long Covid is very long, and it spares practically no body district, nor mental health. An interesting reflection on the subject is the one offered by the chemist and popularizer Dario Bressanini on his Instagram account, in which he invited us to reflect on the long-term effects linked to the long Covid-19 and saved thanks to the vaccine.

To return on the subject, among others, was also the president of the Gimbe Foundation, Nino Cartabellotta, who already a couple of months ago, at the outbreak of the AstraZeneca case, noted how for young people under 30 in conditions of low viral circulation the vaccine could be contraindicated, referring the major risks related to acute infection.

Benefit-risk profile of #AstraZeneca in a context of low viral circulation.

Source: #EMA 23 April 2021 EMzL3XG9uy

- Nino Cartabellotta (@Cartabellotta) June 7, 2021

Today in Italy the situation is comparable to that of a low viral circulation (just over 60 cases per 100 m ila people over two weeks, from Gimbe elaborations). The same coordinator of the Scientific Technical Committee Franco Locatelli mentioned the changed epidemiological picture by commenting on the case of the 18-year-old girl from Genoa suffering from thrombosis after the vaccine, not excluding new possible indications for AstraZeneca.

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