So @EMA_News is finally doing some decent communication/visualization of risks/benefits of vaccination with AstraZeneca’s #covid19 shot.

Quick thread with their graphs:
@EMA_News They looked at hospitalisations, ICU admissions and deaths from #covid19 separately.

Also 3 scenarios for monthly infection rates:
low (55 per 100,000 people)
medium (401 per 100,000 people) high (886 per 100,000 people)

Here are the graphs for hospitalisations:
@EMA_News Here are the three graphs for ICU admissions:
@EMA_News Here are the three graphs for deaths from #covid19:
@EMA_News The graphs show very clearly how the benefits of the vaccine outweigh the risks much more clearly the higher the infection rates and the older the recipients.
This is not new.
But these graphs are exactly what I wanted people to have to understand risk-benefit calculations.
@EMA_News As I’ve said before:
These decisions are highly context dependent.
For young people in countries with low infection rates or with other vaccines available, the risk-benefit balance is a lot worse than for older people or younger people in countries with high-infections rates.
@EMA_News That also means that as immunization campaigns progress in countries and they move into younger age groups and (hopefully) infection rates are going down, the benefit-risk balance will become worse.
So Vaxzevria may be a help early on, but other vaccines will likely take over.

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More from @kakape

23 Apr
In the US the Advisory Committee on Immunization Practices (ACIP) is meeting at the moment to discuss data on the rare clotting disorders seen after immunization with J&J’s #covid19 vaccine and to make recommendations on future use of the vaccine.
I’ll tweet along a bit.
Outcomes from the rare clotting disorders are likely to improve from "recognition among physicians also recognition in the public that if you develop a severe headache, severe abdominal pain that you really need to see your doctor", says @mstreif1.
@mstreif1 As of 21 April, 15 confirmed cases of the rare clotting disorder (here called TTS, Thrombosis with Thrombocytopenia Syndrome) after about 8 million vaccinations with J&J’s #covid19 vaccine, says @CDCgov's Tom Shimabukuro
Read 50 tweets
20 Apr
“We have now heard of 8 cases of these very rare side effects as part of the rollout in the US, where the vaccine has been given to over 7 million vaccinees”, says EMA head Emer Cooke at press briefing on the safety review of J&J's #covid19 vaccine.
“This is a very rare effect but it also makes it very important for doctors and patients to be aware of the signs so that they can spot any concerns and seek specialist help as soon as possible”, says Cooke. "Early intervention by specialists can change the outcome."
"The scientific assessment that PRAC has concluded on today will allow vaccination programs in member states to take decisions on how to roll out this vaccine based on their national situation” (infections, hospitalizations, ICU admissions, vaccine availability), says Cooke.
Read 18 tweets
16 Apr
Getting a bit annoyed at everyone using numbers from yesterday’s Oxford pre-print to compare how often CVST occurs after mRNA vaccines and AstraZeneca vaccine.
We cannot directly compare these numbers because they came about in completely different ways.
The authors say so themselves IN the preprint:
"we cannot directly compare the risks of CVT associated with ChAdOx1 nCoV-19 with any of the other vaccines, or with COVID-19, since we are using data collected by the EMA monitoring system, not from the electronic health records..."
And yes, @UniofOxford press release does exactly that anyway:
"Compared to the AZ-Oxford vaccine, the risk of a CVT from COVID-19 is about 8 times greater."

This is one reason (of many) why we need science journalists and not just press releases.

ox.ac.uk/news/2021-04-1…
Read 5 tweets
15 Apr
There is an interesting new preprint out that will probably generate a lot of coverage at least in the UK. Essentially it argues that the risk of CVST is much higher from #covid19 than from vaccines.
Quick thread on this:

osf.io/a9jdq/
Here is an image from the paper that is likely to feature heavily in debates around this.
As you can see the risk of CVST here seems to be 8-10 times higher in people with CVST than in people who received mRNA vaccines or AstraZeneca.
BUT: A lot of caveats here.
First of all:
The paper really only makes a like-with-like comparison with mRNA vaccines (as authors pointed out in presser this morning too: “I think our data say actually nothing about the AZ vaccine.”).
That’s why the data on AstraZeneca is greyed out in that graph.
Read 11 tweets
14 Apr
Most fascinating bit of ACIP meeting so far is a detail on the 25-year old male in J&J trial, who developed CVST with hemorrhage after 8 days.
J&J representative says it was retrospectively determined that he was negative for anti-PF4 antibodies before vaccination, positive after
Case reports are fascinating.
Here are some details on the case from previous tweet.
(Short sentence on anti-PF4 antibodies is a bit misleading here: he was negative at baseline, positive post-vaccination according to the presentation)
Helpful timeline here:
Read 36 tweets
14 Apr
Denmark just announced they will not restart vaccinations with AstraZeneca’s #covid19 shots and instead rely on the other vaccines.

“Danish-Norwegian registry studies have revealed a higher than expected frequency in the number of specific side effects”

sst.dk/en/english/new…
As I have said before these decisions depend a lot on context. In this case:
- infections are low
- other vaccines available and
- oldest people largely vaccinated (so future vaccinees would be younger)

Different places will come to different conclusions and that’s reasonable.
"In the midst of an epidemic, it has been a difficult decision to continue our vaccination programme without an effective and readily available vaccine against COVID-19. However, we have other vaccines at our disposal, and the epidemic is currently under control.”
Read 4 tweets

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