Webinar - COVID-19 vaccination for pharmacist immunisers - August 2021
The community pharmacy does not need to have a separate entrance and exit for people receiving vaccines. The pharmacist immuniser must conduct the vaccination in an immunisation service room, consulting room or immunisation area; this may be a dedicated space or an existing consulting room for the purpose of providing vaccination services. Refer to section 2.2 of the NSW Pharmacist Vaccination Standards for requirements. The pharmacist must also ensure compliance with all requirements specified by the Australian Government in relation to the COVID-19 vaccination program.
Pharmacies must have a COVID-19 Safety plan which should include maintaining physical distancing for all customers and patients, including during and following vaccination.
Intern pharmacists (pharmacists with provisional registration and who have completed the relevant immunisation courses including the Australian Government training modules) in NSW are authorized to administer the COVID-19 vaccines, but only under the direct supervision of a pharmacist immuniser who holds certification to vaccinate for the relevant vaccine.
This is to ensure that the patient has been thoroughly assessed for their suitability to receive a COVID-19 vaccine and to ensure the patient/parent/guardian is fully informed of benefits and potential harms of the vaccine prior to vaccination. The patient/parent/guardian must be advised to monitor for signs of an adverse event following vaccination and should be advised to seek immediate medical attention for any new or unexpected or severe symptoms, severe or persistent headache, stomach (abdominal) pain, chest pain, vomiting or visual symptoms, bruising or petechial haemorrhages, difficulty breathing, wheezing, a fast heartbeat or collapsing, chest pain, pressure or discomfort, irregular heartbeat, skipped beats or ‘fluttering’, fainting, shortness of breath or pain with breathing up to 6 weeks after vaccination with COVID-19 vaccine
The most common time period for onset of TTS symptoms is 4–30 days after vaccination.
The COVID-19 vaccines available in Australia are provisionally registered by the Therapeutic Goods Administration (TGA) and new evidence on benefits and potential harms is rapidly emerging.
The detailed consenting procedure before administering the COVID-19 vaccines is outlined in the NSW Pharmacist Vaccination Standards.
When vaccinating children in a school setting, all the same requirements for informed consent must be met.
Informed consent must be documented either:
The current advice from the Australian Technical Advisory Group on Immunisation (ATAGI) recommends that, if available, the same COVID-19 vaccine brand should be used for the two doses of the primary vaccination course. An alternative vaccine brand for dose 2 should be used if there are specific medical contraindications or precautions, or the same vaccine brand is not available in Australia.
While it is preferable to use the same brand for both doses of the primary course, an alternative brand can be used for the second dose for other reasons. For example, if a patient is unable to access, or not accepting of a second dose of the same brand, since there are emerging data supporting the safety and efficacy of mixed schedules.
The recommended interval for administration of a second COVID-19 vaccine dose using any alternative brand is 4 to 12 weeks after the first dose, regardless of first dose brand. An interval longer than 12 weeks is acceptable if the second dose cannot be administered during this time window.
ATAGI recommends that, when possible, pre-drawn doses in syringes should be used within one hour if kept at room temperature, and within 6 hours if kept at 2–8°C. This is to minimise any risk of infection. However, regarding the Novavax vaccine, data on stability of pre-drawn doses in syringes are absent, and storing pre-drawn doses of this vaccine in syringes is not preferred.
If the second dose of COVID-19 vaccine is overdue (i.e. past the recommended interval), The Australian Technical Advisory Group on Immunisation (ATAGI) have advised that it should be given as soon as possible and no further doses are required. The second dose will be effective regardless of how late it is given.
As with any other vaccines, vaccination should be deferred if the recipient is acutely unwell. This is a general precaution for all vaccines and will avoid potential misattribution of symptoms from the acute illness as being due to the vaccine or vice-versa.
NSW Health have issued a special License to supply by wholesale certain restricted substances in relation to the COVID-19 vaccine. This allows an authorized person who has been supplied the COVID-19 vaccine (under the Commonwealth Department of Health COVID-19 Vaccine program) to supply that vaccine to another authorized person operating at another COVID-19 vaccination provider (under the Commonwealth Department of Health COVID-19 vaccine program). You must alert the Commonwealth, keep records as required in the license, maintain cold chain and it must be supplied only to a site approved by the Commonwealth. These provisions apply only to COVID-19 vaccines.
An mRNA vaccine should be routinely offered to pregnant women at any stage of pregnancy, and to women who are breastfeeding or planning pregnancy. Pregnant women with COVID-19 have an increased risk of severe illness and adverse pregnancy outcomes.
Women who received their first dose of the AstraZeneca vaccine and are pregnant can receive dose two of either the AstraZeneca vaccine or one of the mRNA vaccines, although the mRNA vaccines are preferred.
There is a growing body of evidence supporting the safety of mRNA COVID-19 vaccines in pregnancy, there are still very limited data on the safety of viral vector vaccines (such as the AstraZeneca vaccine) in pregnancy and there is comparatively less data on the safety and efficacy of mixed vaccine schedules than completing the series with the same vaccine. Refer to COVID-19 vaccination – Shared decision making guide for women who are pregnant, breastfeeding or planning pregnancy.
Certain viruses, including the novel coronavirus, SARS-CoV-2, naturally mutate over time. Often these mutations don't impact how viruses affect us. However, some recent variants of SARS-CoV-2 are more easily spread and appear to be associated with increased numbers of cases.
Current evidence from clinical trials indicates that the antibodies induced from COVID-19 vaccines are likely to provide protection to a variety of mutations and minor changes. However, in some cases there may be an impact on how antibody developed from vaccines based on the original strain can 'neutralise' the virus.
Currently approved vaccines have been shown to be effective to provide at least some protection against new variants as these vaccines work to create a broad immune response. The mutations causing these variants should not make the vaccines ineffective.
Prophylactic use of paracetamol or ibuprofen is not recommended before receiving a COVID-19 vaccine. Antipyretics and analgesics can be taken after vaccination for management of vaccine-related side effects such as injection site pain, fever and myalgia, if required.
Pharmacists should refer any patients with a previous history of a serious adverse reaction or severe allergic reaction to a previous dose of COVID-19 vaccine or one of its ingredients to their general practitioner for assessment to determine whether it will be safe to receive subsequent COVID-19 vaccination.
People will develop an immune response within 2–3 weeks after the first dose of COVID-19 vaccine and will be partially protected. However, all people need a second dose to achieve maximum and longer lasting protection.
Patients who are infected and have only had one dose of vaccine, will still be able to have the second dose of COVID-19 vaccine, but should delay the second dose for 3 months. If concerned, they must be referred to their General Practitioner for consideration of their individual circumstances.
