The certificate for vaccination exemptions arrives. This is what we read in the circular of the Ministry of Health regarding ‘COVID vaccination exemption certifications’, for those who have not been able to get vaccinated, temporarily or permanently, for overt diseases.
Vaccination exemption, when issued
The SARS-COV-2 vaccination exemption certification is issued “in the event that the vaccination itself is omitted or deferred due to the presence of specific documented clinical conditions, which contraindicate it permanently or temporarily”. This was established by the circular of the Ministry of Health. People who obtain an exemption from vaccination, it says, “must be adequately informed about the need to continue to maintain prevention measures” such as use of masks, distancing, avoiding gatherings. Until 30 September 2021, except for further provisions, the circular reads, the certifications may be issued directly by the vaccinating doctors of the vaccination services of the companies and bodies of the regional health services or by the general practitioners or paediatricians of free choice of the patient who operate as part of the national anti-SARS-CoV-2 vaccination campaign. The certification must be issued free of charge, taking care to archive the relative clinical documentation, including digitally, through the regional vaccination information services with methods defined by the individual Regions / PA. “A contraindication – reads the circular – is a condition in the recipient that increases the risk of serious adverse reactions. In general, a vaccination should not be administered when a contraindication is present because the risk of adverse reactions is greater than the advantages induced by vaccination. This assessment must be related to the specific type of vaccine to be administered. The presence of a contraindication to that specific vaccine does not exclude the possibility that other available vaccines may be administered. A severe allergic reaction after a dose of vaccine or to any component of the vaccine constitutes a contraindication to the administration of further doses of the same vaccine or of products containing the same components. This type of allergic reaction almost always occurs within 30 minutes of vaccination, even if cases of anaphylaxis occurring within 24 hours are attributable to the vaccine In the case of r and severe allergic action at the first dose of a COVID-19 vaccine, the possibility of using a different type of vaccine to complete immunization may be considered; however, given the possibility of cross-reactions between components of different vaccines, it is advisable to carry out an allergological consultation and an individual risk / benefit assessment “.
Vaccination in pregnancy
The anti-SarsCoV2 vaccination “is not contraindicated in pregnancy. If, after medical evaluation, the vaccination is postponed, the pregnant woman may be issued with a certificate of temporary exemption from vaccination”, the ministry specifies, underlining that “breastfeeding it is not a contraindication to anti-SarsCoV2 vaccination “.
Allergic reaction to the vaccine
In the event of a severe allergic reaction to the first dose of a COVID-19 vaccine, it is specified in the circular, “the possibility of using a different type of vaccine to complete the immunization may be considered; however, given the possibility of cross-reactions between components of different vaccines it is advisable to carry out an allergological consultation and an individual risk / benefit assessment “. The circular also examines the cases of Guillain-Barré syndrome. Guillain-Barré syndrome, it is explained, has been reported very rarely following vaccination with Vaxzevria (AstraZeneca). In the event of this syndrome arising within 6 weeks of the administration of the Covid-19 vaccine, without any other attributable cause, “it is prudent – it is read – not to carry out further administration of the same type of vaccine. In such situations, the use of a vaccine should be considered. of a different type to complete immunization “.
Vaccination, very rare cases of myocarditis
Furthermore, very rare cases of myocarditis and pericarditis have been observed after vaccination with COVID-19 mRNA vaccines (Pfizer and Moderna). “The decision to administer the second dose of Pfizer or Moderna vaccine in people who have developed myocarditis / pericarditis after the first dose – states the ministerial circular – must take into account the clinical condition of the individual and must be taken after cardiological consultation and a “careful risk / benefit assessment. In this situation, where it has been evaluated not to proceed with the second dose of COVID-19 mRNA vaccine, the use of a different type of vaccine should be considered to complete the immunization”.
Serological tests before vaccination
“It is reiterated that the execution of serological tests, aimed at identifying the antibody response against the virus, is not recommended for the purposes of the vaccination decision-making process; for this reason the presence of an antibody titer cannot in itself be considered, at the moment, an alternative to completing the vaccination cycle “. This is what is specified in the circular of the Ministry of Health ‘Certifications of exemption for vaccination against COVID’, signed by the director of Prevention Giovanni Rezza.
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