COVID-19: Vaccine Contraindications / Mortality Risk Factors in Nursing Homes / AstraZeneca-Oxford Vaccinations

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Here’s a look at some of the latest COVID-19 news:

Vaccine contraindications: The CDC says the two mRNA COVID-19 vaccines authorized in the U.S. are contraindicated in people with a history of the following: severe allergic reaction after prior receipt of an mRNA COVID-19 vaccine or its components; allergic reaction (of any severity) immediately after receipt of an mRNA COVID-19 vaccine or its components, including polyethylene glycol; or immediate allergic reaction (of any severity) to polysorbate. The CDC notes that polysorbate and polyethylene glycol are structurally related, raising concerns about cross-reactive hypersensitivity between the two. People meeting the above criteria should not receive either mRNA COVID-19 vaccine unless an allergist-immunologist determines they can do safely — for example, in a setting where they are observed after vaccination and advanced medical care is accessible.

Mortality risk factors in nursing homes: Among symptomatic nursing home residents with COVID-19, independent risk factors for all-cause mortality at 30 days include male sex, older age, and impaired cognition and physical function, according to a JAMA Internal Medicine study. The analysis included nearly 5300 adults with confirmed SARS-CoV-2 infection at 350 nursing homes across the U.S.; one fifth died within 30 days of their first positive SARS-CoV-2 result. Compared with residents aged 75-79, those aged 80-84 were 46% more likely to die, and those aged 85-89 were 59% more likely. Women were 31% less likely than men to die. In addition, those with moderate or severe cognitive impairment were over twice as likely to die as those with normal cognition. Mortality risk also increased as the ability to accomplish activities of daily living decreased. Commentators say the findings “offer a more comprehensive picture of COVID-19 prognosis in nursing home residents that might help clinicians care for this population.”

AstraZeneca-Oxford vaccinations: The U.K. on Monday began vaccinating people with the AstraZeneca-Oxford COVID-19 vaccine, according to media reports. U.K. health officials authorized the adenovirus-vectored vaccine at the end of December. It’s the first country to use the vaccine outside of clinical trials.

LINK(S):

CDC’s vaccine contraindications (Free)

JAMA Internal Medicine article on mortality in nursing homes (Free)

JAMA Internal Medicine commentary on mortality in nursing homes (Free)

CNN story on AstraZeneca-Oxford vaccinations (Free)

NEJM Journal Watch COVID-19 page (Free)

NEJM COVID-19 page (Free)

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