The UK vaccine advisory group, the JCVI, recommends that people aged 18 to 29 be offered an alternative vaccine where available. This graphic (UK risks) illustrates why. Note the importance of balancing harms.
What about if your exposure risk isn't low, but MEDIUM? Frontline workers, HCWs... The harms are static, but now COVID causes more harms. Vaccine benefit becomes more pronounced.
Now what if we're in a wave (which we are, in Canada). If all you have available is AZ vaccine, check out these risk/benefit numbers. (Also note that Canada has more than AZ available - our vaccine portfolio is impressive, when compared to other countries.)
Remember: I'm a thrombosis physician (and tweeter), not a public health expert, primary care physician, policy maker, epidemiologist. This isn't "flip flopping" or dithering by regulators: these are complex decisions being made in real time, based on evolving science.
It may feel scary, being caught in this swirl of info - but this means science, vaccine safety & surveillance, & regulation are all working. Let's watch how this info is put into the Canadian context. And remember: Canadian MDs know how to diagnose and treat these rare clots!
One last note before I go back to my real job: the slides above don't capture the risk to young people of getting long Covid after an infection, just ICU admission. And NB recent data: 1 in 3 Dx'd with neuropsych conditions post COVID.

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Keep Current with Menaka Pai, MSc MD FRCPC

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More from @MPaiMD

7 Apr
62 cerebral sinus (brain) clots, 24 splanchnic (abdominal) clots out of ~25 million AZ vaccine recipients. Serious clots, but rare. Europe's @EMA_News says benefits of AZ vaccines outweigh risks - pertinent for 🇨🇦 as we struggle with wave 3. Waiting for @MHRAgovuk to weigh in now
Above cases came from EU and UK reporting in March. However as of April 4th there were reports of 169 CSVT, 53 splanchnic clots out of 34 million AZ vaccine. @EMA_News states these updated numbers did not change their appraisal of risk:benefit.
@EMA_News felt parallels to HIT were a plausible explanation of pathophysiology.
Read 4 tweets
26 Mar
🚨🚨🚨 @COVIDSciOntario Science Brief and layperson’s guide for vaccine-induced prothrombotic immune thrombocytopenia (aka. VIPIT) following AstraZeneca #COVID19 #vaccination. Read the 🧵! 1/n
AZ #COVID19 #vaccine appears to be associated with immune thrombosis that mimics heparin induced thrombocytopenia. It’s rare: 1/125K to 1/1 mill @EMA_News @uni_greifswald @PEI_Germany 2/n
@COVIDSciOntario brief helps clinicians identify, diagnose / rule out, and treat rare serious clots of VIPIT. Please read - and check out the figures for easy clinical reference. covid19-sciencetable.ca/sciencebrief/v… 3/n
Read 11 tweets
19 Mar
Long 🧵 on vaccines and blood clots (from somebody who spends an inordinate amount of time thinking about, preventing & treating blood clots). #COVID19 #COVID19vaccine #hemetwitter #thrombosis 1/n
Yesterday @GovCanHealth, @MHRAgovuk, @EMA_News and my profession's organization @ThrombosisCan made clear statements that risks posed by AZ vaccine are far outweighed by its benefits. Does that square with media reports? Should we really get the first shot available to us? 2/n
I love my job as a blood and blood clot specialist. (LOVE IT!) So much of it focuses on talking to people about risks & how to stay safe DESPITE those risks. A lot of common medical procedures, drugs & life experiences [aging, pregnancy] increase your blood clot risk. BUT... 3/n
Read 13 tweets

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