FAQ related to the CORONA Vaccine

On December 18th, as a bedside nurse at The Brigham and Women’s, I received the COVID-19 vaccine. I was able to secure that spot on the 8th night of Hanukkah and I was drawn to how meaningful that was.

Hanukkah is a Hebrew word that means dedication. I could not be more grateful for the dedication of scientists from around the country to bring forth this much needed vaccine.

Hanukkah celebrates freedom, which feels particularly pertinent as well. I look forward to freedom from this past year’s unprecedented restraints.

This could also be thought of as a Christmas miracle! It is truly extraordinary that these vaccinations had such high rates of success in their trials and that we have been able to roll them out this promptly.

In 11 minutes, all the spots for the thousands of vaccinations that the Brigham and Woman’s received in this 1st shipment filled up. Healthcare workers across Brigham Health are speaking loud and clear that this vaccine is trustworthy and safe.

Today, I am happy to report that I feel completely fine. My arm was a bit sore at first, but it was nothing that a few Tylenol could not fix. Although, people have reported headaches and body aches as well. I am now anxiously awaiting dose number #2 which will be administered 21 days after dose number #1.

I feel a sense of responsibility to push out education to residents. The more we know about our bodies and our health the heathier we will all ultimately be.
Please note, these question and answers were complied from a list of frequently asked questions submitted by Brigham and Women’s Hospital nurses to the Chief of Infectious Diseases at BWH and a Professor of Medicine at Harvard Medical School. Responses below are not spoken on behalf of the BWH but rather as answers to our inquiries. As always, please speak with your doctor if you have specific questions related to your personal medical history.

· How does the vaccine work?
Two EUA (emergency use authorization) vaccines are currently being distributed by Modena and Pfizer. These vaccines work by getting the genetic code of the virus in the form of mRNA into the cells. The mRNA, essentially the coding for the virus’s protein is injected into your intermuscular space and the snippet of the virus gets it into the cell membrane because it is wrapped in a lipid nanoparticle. The mRNA seeks out the ribosomes in the cell’s cytoplasm. Those little organelles read it and produce purified spike proteins for SARS-COV2 2 which the body recognizes as foreign, so it creates antibodies to fight. In this case it is a IGg immune response, a longer lasting one. So next time you encounter the virus your immune response remembers, and a real infection does not occur.

· Once vaccinated can you transmit to other people who are not vaccinated if you encounter the virus?
This is an especially important question to which we do not yet have an answer. The studies were designed to show that the vaccines protect against becoming sick with COVID-19 but did not routinely collect swabs from patients to see if they had acquired the virus (there are plans to perform antibody testing on stored blood samples to see how many vaccine recipients might have seroconverted [developed antibodies to COVID-19], which could be evidence of asymptomatic infection). In theory, a vaccinated person could still become infected with SARS-CoV-2 (the virus that causes COVID-19) and transmit it to others. For this reason, it is important that people continue to wear masks and follow guidance regarding social distancing, etc. for the foreseeable future (until we see dramatic declines in the number of new cases).

· After I get the vaccine do I have to stay elsewhere to avoid exposure to others?
The COVID-19 vaccines do not contain any live virus and are non-infectious. Therefore, people who get vaccinated pose no risk to any household members.

· Should we get the vaccine knowing there are no studies on long-term effects?
Studies show that virtually all side effects of vaccines occur within the first few weeks (typically 1-2 days) of receiving the vaccine. No long-term effects were found in ~19,000 participants in the Pfizer vaccine trial, more than 9500 of whom have been followed for more than 2 months.

· Do you think mRNA vaccines are safer than traditional vaccines?
Based on their mechanism of action, and the available data from the Pfizer and Moderna studies, mRNA vaccines should be as safe as traditional vaccines (e.g., the flu vaccine) and may be safer than live virus vaccines.

· Are there studies on pregnant woman yet?
Pregnant women were excluded from the vaccine trials, although a small number of women became pregnant in the trials after receiving the vaccine.

· People in the UK had severe reactions. What type of severe reactions are they having?
Based on the limited information that has been presented, it appears that the two individuals in the UK who had a severe reaction had an “anaphylactoid” reaction, that is, a reaction like a severe allergy to penicillin or bee stings (hives, throat tightness). In the Pfizer trial, reactions consistent with hypersensitivity were seen in 5 of every 1000 people who got the placebo (saline), and 6 of every 1000 people who got the actual vaccine, a difference that is not statistically significant. To ensure the safety of people receiving the vaccine, the prescribing information (package insert) for the Pfizer vaccine states that appropriate medical treatment used to manage immediate allergic reactions must be immediately available in the event an acute anaphylactic reaction occurs following administration of Pfizer-BioNTech COVID-19 Vaccine.

· What are the other ingredients in the vaccine? Are there harmful metals as well?
The vaccine is made up principally of messenger RNA (mRNA) and lipids (which are used to coat the mRNA and allow it to be taken up by cells). Additional ingredients include salts (potassium chloride, sodium chloride, potassium phosphate and sodium phosphate) and a small amount of sugar (sucrose). The vaccine is diluted into saline for injection. There are no metals of any kind in the vaccine.

· I feel this was a very rushed vaccine and that why I do not want to take it.
Although the COVID vaccines have been developed in record time, no corners have been cut. The inclusion of tens of thousands of people in the vaccine trials is much larger than typical for most vaccines and provides sound evidence for their safety and efficacy.

· If you have comorbidities how do we know it is safe? The people in the trial were all healthy individuals.
That is a misunderstanding—people in the trials could not have an acute illness or be receiving cancer chemotherapy or other immunosuppressive treatments, but in the Pfizer trial 46% had one or more comorbidities (most often diabetes, chronic lung disease or hypertension) and nearly 35% were obese. The FDA analysis of Pfizer’s data showed that the vaccine was just as safe and just as effective in study participants with and without comorbidities and with and without obesity.

· This might be a silly question but can mRNA vaccines cause cancer or other illnesses?
No—mRNA vaccines do not cause cancer or other illnesses.

· How will we know we have made antibodies?
COVID-19 vaccines generate high titers of antibodies directed against the viral Spike, or S, protein. Such antibodies are detected by COVID-19 antibody tests current in clinical use. However, there is no plan at present to perform routine antibody testing after vaccination.

· If I had COVID and positive antibodies still since an prior infection? Also have continued symptoms and don’t want the risk of vaccine or second COVID infection.
COVID-19 vaccination is recommended even if you previously had COVID-19, so long as it was more than 90 days ago.
****There were people in the trial who fit that description (tested negative at screening by NP but found to be seropositive by antibody testing or developed COVID after 1st and before 2nd vaccination); they did fine. It is not that you must wait 3 months due to safety concerns; just that there’s no reason to vaccinate someone if they’re within 3 months of infection because that’s when they’d have highest natural immunity to re-infection.

· I have read you only get 3 months of coverage, is this true?
We know that antibodies induced by the vaccine last at least 5 months (the longest follow-up that has been reported) but need additional follow-up to learn exactly how long immunity will last. That is an important goal of the ongoing vaccine trials.

· I’ve read it is not as/effective for those >55 years old? Is this true? If so, why? What is the length of time persons who received it have been subsequently followed?
Older people often show less of a response to vaccines because the immune system weakens as we age. However, both the Pfizer and Moderna vaccines protected older participants against COVID-19 just as effectively as younger participants.

· How long before we can expect some antibody coverage following the vaccination?
The phase 3 trial of the Pfizer vaccine shows that people who received the vaccine began being protected approximately 10 days after receiving the vaccine. However, the second vaccination (given at day 21) was necessary for full protection. Similar data from the Moderna study are not yet available, but should be presented at the FDA vaccine advisory committee meeting later this week

Finally, when will I be able to get the vaccine?
Below: pictorial provided by Mass.gov is subject to change.