A large-scale campaign to vaccinate the population against coronavirus continues in Russian regions. Almost all Russians can undergo the procedure, with a few exceptions. There are not many contraindications for health, but they still exist. We tell you who and under what circumstances can receive a medical exemption from vaccination.
Photo: Moscow 24/Anton Velikzhanin
For what diseases is medical treatment given?
According to doctor-allergist-immunologist Marina Apletaeva, direct indications for medical withdrawal are anaphylactic shock and Quincke's edema in a person's medical history. She spoke about this in an interview with Moscow 24.
Anaphylactic shock usually occurs as a result of a reaction to medications. If you have ever had such a condition in your life, then this may be a medical excuse from vaccination. Sometimes it happens that even novocaine, which is injected during tooth extraction, leads to anaphylaxis. Marina Apletaeva
doctor - allergist-immunologist
A predisposition to swelling of the larynx and the attack of suffocation caused by this are also considered sufficient grounds for refusing vaccination, Apletaeva emphasized. “The medical warning is due to the fact that these two conditions simply threaten a person’s life,” she said.
How to get a medical permit if you have antibodies
The presence of a high level of antibodies is not a basis for obtaining a medical exemption. In other words, if six months after an illness or primary immunization, an antibody test shows a sufficient antibody titer, he still needs to undergo immunization or revaccination.
This is explained by the fact that currently there is no single proven and generally accepted method for measuring the level of antibodies, which is sufficient to form stable immunity to coronavirus infection.
The situation is complicated by the fact that a system for assessing the effectiveness and speed of adaptation of antibodies to constantly mutating strains of coronavirus has also not been developed. We wrote in detail about the symptoms of the Indian strain earlier.
For what diseases will an adult be given a medical exemption from vaccinations?
The list of diseases for which vaccination is contraindicated is determined by the instructions for each vaccine. In addition, the list of such reasons may change over time.
For example, a number of chronic lung diseases are today considered an indication for medical treatment. The situation will remain this way until clinically valid data are obtained on the effect of vaccination on an organism with such a chronic disease. But a number of experts are already speaking out about the need for vaccination specifically for this category of patients, because Once infected, the disease can be fatal.
Are HIV and oncology indications for medical treatment?
The chief freelance specialist on HIV infection of the Ministry of Health, head of the Moscow City Center for Prevention and Control of AIDS, Alexei Mazus, previously stated that HIV infection is not a contraindication for vaccination against coronavirus. In his opinion, such people are at risk for severe development of the disease, and therefore should have priority in the matter of vaccination.
In turn, the chief oncologist of the Ministry of Health Andrei Kaprin said that patients whose cancer has gone into remission can get vaccinated. “We can already state that a patient who is in three months of remission can also be vaccinated,” he emphasized.
Doctor Apletaeva agrees with this. She explained that during the acute period of any disease, it is advisable not to vaccinate.
Photo: Moscow 24/Yulia Ivanko
“Especially if it is not a banal ARVI, but an immunodeficiency condition or an oncological process. If the process is inactive, then there are no obstacles. For immunodeficiency states, any viral disease can be much more dangerous than the consequences of a vaccine,” she emphasized.
Only the attending physician, who monitors the patient, knows his immune status, knows his clinical condition and test results at the moment, makes a decision on vaccination. Marina Apletaeva
doctor - allergist-immunologist
At the same time, the State Duma believes that it is necessary to define clear regulations for the provision of medical exemptions from vaccination against coronavirus. The Chairman of the Lower House of Parliament Committee on Information Policy, Alexander Khinshtein, intends to appeal to the Russian Ministry of Health with such a request. According to him, it became known from the media that cancer patients have problems obtaining medical exemptions from the procedure.
Doctors named the “iron” reasons for the medical exemption from vaccination against COVID-19
Food allergies (for example, to strawberries or honey), allergies to pollen or dust are not a contraindication to vaccination, allergist-immunologist Vladimir Bolibok told RBC. According to him, Russian coronavirus vaccines are hypoallergenic because their components do not mix with food, pollen, mold or household dust. “They do not contain antibiotics, preservatives, chicken egg components, yeast, bacterial lipopolysaccharides, that is, what is found in other vaccines and can cause cross-allergy,” he explains. Urticaria (dermatitis of allergic origin) is not a contraindication to vaccination, Oksana Drapkina, chief freelance therapy specialist at the Russian Ministry of Health, said earlier.
What vaccine manufacturers and the Ministry of Health say about contraindications due to allergies:
- "GamCovidVac" ("Sputnik V") : history of severe allergic reactions, hypersensitivity to any component of the vaccine or a vaccine containing similar components; with the introduction of the second component - severe post-vaccination complications due to the first component of the vaccine.
- "Kovivak" : a history of a serious post-vaccination reaction or complication to any previous vaccine, a history of aggravated allergic reactions (anaphylactic shock, Quincke's edema, polymorphic exudative eczema, a history of hypersensitivity or allergic reactions to the administration of vaccines, allergic reactions to vaccine components.
- "EpiVacCorona" : hypersensitivity to the components of the drug (aluminum hydroxide and others), severe forms of allergic diseases, reaction or post-vaccination complication to a previous vaccine administration.
Sources: instructions for the vaccines “GamCovidVac” (“Sputnik V”), “Covivak”, “EpiVacCorona”, recommendations of the Ministry of Health.
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The second serious contraindication is if a person has experienced a serious reaction to previously administered vaccines. This reaction may include high and prolonged fever, redness and swelling at the injection site measuring more than 8 cm.
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In general, a slight increase in temperature often accompanies vaccination and may not be a contraindication to vaccinations in the future, explains Kondrakhin. Only really high temperatures, above 40°C, matter. In addition, according to him, the vaccine is not always regarded as the cause of fever. “A strong general reaction is an increase in body temperature above 40°C in the post-vaccination period. In this case, an increase in temperature associated with vaccination occurs up to three days after vaccination with inactivated drugs and in the period from the fifth to the 15th day from the moment of administration of the live vaccine. Fever outside these periods is not associated with the vaccine,” the therapist said.
According to him, severe side effects that sometimes occur as a result of vaccines include collaptoid reactions (manifestations of vascular insufficiency, which in pathogenesis and clinical signs resemble shock. - RBC) and febrile, that is, caused by a sharp jump in body temperature, convulsions.
An allergic reaction to a previous administration of the same vaccine is also a contraindication, says allergist-immunologist Vladimir Bolibok.
“For example, we vaccinate children with DPT, if any reaction occurs (most often the pertussis component causes a reaction), then the next time the child is vaccinated with any other vaccine without the pertussis component,” the expert gives an example. In the case of a vaccine against coronavirus infection, you need to look at which vaccines and their components a person has already had an allergic reaction to before, and analyze each specific case, he believes.
In each case where people had reactions to other vaccines, it is necessary to investigate separately, Kondrakhin agrees. “In some cases, it is better to get vaccinated, because it will be difficult for a person to survive a new coronavirus infection,” warns the therapist.
According to the head of the temporary Covid hospital at the RZD-Medicine clinical hospital named after. ON THE. Semashko Professor Zaur Shugushev, the officially approved contraindications of the Ministry of Health do not change. “Severe allergic reactions, such as anaphylactic shock, severe systemic diseases, but not diseases that occur in a mild form,” Shugushev told RBC.
The Rassvet Clinic notes in its recommendations regarding vaccination against COVID-19 that anaphylactic shock to other vaccines in the past suggests an increase in the observation interval for such a patient from the standard 30 minutes to 2 hours.
The Moscow City Hall gave advice to people with a medical exemption from vaccination Society
Temporary contraindications to vaccination
Doctors consider the recommendations of the Ministry of Health, which speak of contraindications for those who have an exacerbation of a chronic disease or the acute phase of infectious diseases, to be temporary, explains the professor, head of the laboratory of vaccine prevention and immunotherapy of allergic diseases of the Federal State Budgetary Institution Research Institute of Vaccines and Serums named after. I. Mechnikov RAMS Mikhail Kostinov.
“They are given for two to four weeks and are associated with an exacerbation of any disease in a person. After he recovers, vaccination can be carried out in a week or two. And also, if a person now has a respiratory disease, a vaccine can be given two to four weeks after it,” says Kostinov. Kostinov names only a “severe allergy” in the form of anaphylactic shock to the first dose of the same vaccine as an absolute contraindication for vaccination against COVID-19.
What vaccine manufacturers and the Ministry of Health say about temporary contraindications:
- "GamCovidVac" (Sputnik V). Acute infectious and non-infectious diseases, exacerbations of chronic diseases - vaccination is carried out two to four weeks after recovery or remission. For mild acute respiratory viral infections and infectious diseases of the gastrointestinal tract, vaccination is carried out after the temperature has normalized.
- "Kovivak." Acute febrile conditions, acute infectious and non-infectious diseases. For mild ARVI, vaccination can be carried out after the temperature has normalized and/or the acute symptoms of the disease have disappeared. For chronic diseases, vaccination is carried out during the period of remission in agreement with the attending physician.
- EpiVacCorona. Acute infectious and non-infectious diseases, chronic diseases in the acute stage - vaccinations no earlier than a month after recovery or remission. For mild acute respiratory viral infections and infectious diseases of the gastrointestinal tract, vaccination is carried out after the temperature has normalized.
Sources: instructions for the vaccines “GamCovidVac” (“Sputnik V”), “Covivak”, “EpiVacCorona”, recommendations of the Ministry of Health.
A chronic disease in itself is not a contraindication, but its exacerbation during a certain period is a contraindication, agrees Tatyana Romanenko, head physician of the Your Doctor clinic. The category of patients with a temporary exemption from vaccination includes those who have had a coronavirus infection in the last six months, as well as those who have recently undergone surgery, says therapist Kondrakhin.
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A temporary medical exemption from vaccination can also be obtained by people who want to consult with a specialist about whether they can be vaccinated against COVID-19, says allergist Bolibok. So, for example, if you previously had allergies to vaccinations, then the issue should be resolved together with an allergist.
“Before the examination, the patient can say that he had a reaction to the previous administration of such and such a vaccine. And the therapist who examines the patient before vaccination can give a temporary medical exemption for a specific period until a specialist confirms or does not confirm this decision,” says Bolibok.
Contraindications that concern patients with chronic diseases can also be considered as a temporary exemption from vaccination; such people should discuss vaccinations with their attending physicians, says general practitioner Albina Strelchenko.
“Most chronic diseases are not a contraindication for vaccination. For example, a cardiovascular disease, a person suffers from arterial hypertension, the right therapy has been chosen for him, he complies with everything, why not vaccinate him? There are no contraindications,” she says. The same applies to diabetes, as long as the person follows the doctor's instructions.
However, in some cases you will still have to contact specialized specialists. “If, for example, there are systemic diseases, such as rheumatoid arthritis, people on hormones, constant changes in dosage, then, of course, only a specialist can do this. You need to look at who has what, the decision depends on the severity of the disease, its severity - there is no single template for everyone,” Strelchenko is sure. The same applies to cancer; in this case, only an oncologist can advise.
Pregnancy and breastfeeding
The period of breastfeeding and pregnancy were designated as contraindications in the instructions for all three Russian vaccines, the vector “GamCovidVac”, the peptide “EpiVacCorona” and the inactivated vaccine “Kovivak”, according to data from the State Register of Medicines.
However, on July 6, the latest recommendations from the Ministry of Health (.pdf) regarding vaccination against COVID-19 were published. The document no longer states that pregnancy is a contraindication for the use of the drug “GamCovidVac” (“Sputnik V”); this item was removed from the list of contraindications.
It is recommended to vaccinate pregnant women after the 22nd week, according to the fourth version of the guidelines (.pdf) of the Ministry of Health on organizing medical care for coronavirus infection for pregnant women and newborns, also published on July 6. For unvaccinated pregnant women who become ill with COVID-19, the incidence of premature birth and the risk of developing a sudden critical condition are higher. If a woman has any chronic diseases or obesity, the chance of developing severe COVID-19 increases.
There are no clinical data on the use of Sputnik V in breastfeeding women, so the risk for breastfed infants cannot be excluded.
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During pregnancy, women take a certificate from the obstetrician-gynecologist with whom they are registered, and provide this certificate to the employer or to the clinic, therapist Albina Strelchenko explained to RBC.
How to obtain a certificate of medical exemption
To begin your journey to obtain a certificate of medical exemption from vaccination, you should contact your physician, says Andrey Kondrakhin. “If a person has had an allergic reaction, then, as a rule, he already has a certificate. If this certificate is not available, then based on the extract that is in the medical history, the therapist makes his conclusion,” explains the doctor.
Is it necessary to get vaccinated if a person is at risk but has contraindications?
Photo: Moscow 24/Yulia Ivanko
General practitioner Lyudmila Lapa told Moscow 24 that vaccination is also contraindicated for people with protein allergies, as there may be an inadequate reaction to the vaccine. However, such patients can undergo special preparation for vaccination - premedication.
“In each specific case, premedication is different: if it is an allergy, then hormones are used. If blood clots form, then heparins are needed (a medicinal substance that prevents blood clotting. – Ed.). According to a certain scheme, a person is prepared for vaccination,” the therapist noted.
In addition, immunologist Apletaeva advised this category of Russians to get vaccinated only in medical institutions that have intensive care units, in which case they will quickly receive medical care.
Where can I get a medical exemption from vaccination?
List of entities that can issue the corresponding conclusion:
- a doctor performing an examination before the vaccination procedure;
- therapist at your clinic;
- specialized specialist: cardiologist, gynecologist, allergist and others;
- an insurance company that insures life and health.
The easiest way is to obtain the appropriate conclusion at the clinic at the place of attachment or at another medical institution authorized to issue such certificates.
In what cases is it better to temporarily postpone vaccination?
General practitioner Lyudmila Lapa explained that during an exacerbation of chronic diseases, as well as in case of any viral infection, Russians can receive a temporary medical withdrawal, which will be valid until the person recovers.
“If a person has an exacerbation or an active disease, then he has a fever, there is weakness, he has the right to be exempt from vaccination,” she emphasized.
This could be a cold, autoimmune processes, rheumatoid arthritis and other diseases. Lyudmila Lapa
general practitioner
Allergist-immunologist Marina Apletaeva added that vaccination should be temporarily postponed during seasonal allergies, which are observed from early spring and end in late autumn.
“If a person has an allergy during the flowering period of trees, for example in March, then in the summer he has no contraindications,” the expert noted.
What is a medical exemption from vaccination?
A medical withdrawal is a reason, an obstacle, a prohibition, due to which immunity appears, but not from the virus, but from the need to fight it, in our case, through vaccination.
The reason for medical withdrawal must be:
- Determined by the manufacturer, confirmed by the Ministry of Health of the Russian Federation;
- Indicated in the official source or in the instructions for use;
- Indicated by the opinion of your attending physician or specialized specialist.
The scheme works as follows: during the examination before vaccination, an acute respiratory viral infection is detected, the specialist examining you must issue a temporary medical exemption until recovery.
A number of other specialists who monitor the patient’s chronic diseases can do the same; a complete list of subjects who have the right to issue a challenge for medical reasons is in the list below.
The ban on vaccination can be temporary or complete.
What to do if you have a sore throat before vaccination?
Photo: portal of the mayor and government of Moscow/Yulia Ivanko
According to allergist-immunologist Apletaeva, a sore throat can be not only a sign of a developing disease, such as tonsillitis, but also a normal reaction of the body to a change in temperature. If a person has been sitting under air conditioning for a long time, then a sore throat is a consequence of a sharp temperature change, she explained.
“Such minimal changes in our health are not contraindications. You just need to be attentive to yourself. If in doubt, you need to see a doctor,” the specialist recommended.
Interlocutor Moscow 24 indicated that any active disease manifests itself with certain signs: temperature reaction, weakness and inflammation.
Is medical diversion possible when planning pregnancy?
Vaccination against Covid-19, carried out at the stage of pregnancy planning, does not increase the risk of complications in the perinatal period and during childbirth.
On the contrary, leading reproductive specialists recommend getting vaccinated in preparation for conception, so that in case of infection with coronavirus during pregnancy, reduce the risks of developing various complications and maternal mortality.
There are other expert opinions: vaccination against coronavirus for those preparing for pregnancy, on the contrary, is recommended for expectant mothers, because Immunity from a vaccinated mother is likely to be passed on to the baby.
How to sign up for vaccination?
You can get vaccinated by appointment at one of 100 points at city clinics. If you are assigned to a medical institution, you can register online on the mos.ru and EMIAS portals. If you do not have an attachment or compulsory medical insurance policy, sign up for vaccination by phone.
You can get vaccinated without an appointment in popular public places where mobile teams work. The Healthy Moscow pavilions are now open only for vaccination against COVID-19 and are open from 08:00 to 20:00. If at the end of the working day there is still a queue in the pavilion, reception will continue until everyone who comes has been vaccinated.
Healthy Moscow pavilions will be open only for vaccination against COVID-19
Deadlines for medical withdrawals from vaccination against covid
As mentioned earlier, a postponement or prohibition of a procedure can be temporary - until the reason for the prohibition is eliminated, and complete - for cases when such a reason cannot be eliminated.
Accordingly, with a temporary medical withdrawal, the period of delay from vaccination can last from two weeks to a month. With constant medical attention, the patient gets the opportunity not to get vaccinated forever: for example, if he has an allergy to a component of the vaccine, then the possibility of harming the health of the person being vaccinated will not go away over time.
Pregnancy and breastfeeding
In the instructions for use of the vaccines Gam-Covid-Vac-Lio, EpiVacCorona, CoviVac, Sputnik Light, vaccination during pregnancy and breastfeeding is contraindicated.
As for the Gam-Covid-Vac (Sputnik V) vaccine, on June 25, 2021, an amendment was made to the instructions for this vaccine, according to which pregnancy is excluded from the list of contraindications for vaccination (breastfeeding remains on the list of contraindications). At the same time, the above-mentioned latest recommendations of the Ministry of Health on vaccination do not mention this change, and pregnancy is still noted in the characteristics of the vaccine as a contraindication to vaccination.
We believe that in the matter of vaccination of pregnant women with Sputnik V, you should refer to the instructions for the vaccine in the latest edition (dated June 25, 2021), which states that the drug Gam-Covid-Vac (Sputnik V) should be used only in cases where “ when the expected benefit to the mother outweighs the potential risk to the fetus.”
Since only a specialist doctor (gynecologist) can assess such risks, the doctor (paramedic) conducting a preliminary examination before vaccination against COVID-19, when reporting pregnancy, can only allow the patient to undergo vaccination, in our opinion, if there is an appropriate conclusion (permission) from a medical specialist. And before such a conclusion (permission) is provided, a record of a reasoned medical withdrawal should be made.
