You can “opt out” of anti-Covid vaccination by obtaining a certificate of medical exemption

Will it be necessary to get vaccinated against the flu in the fall, and if so, how to properly combine the two vaccinations? Can they be fired if a person has not yet been vaccinated, and how to properly formalize a medical exemption from it? “RG” - The Week continues to publish answers to the most pressing questions about COVID-19 and vaccination.

In late summer - early autumn, flu vaccination is carried out annually - in the northern territories it starts earlier, in the south of the country - later. Last year in Moscow, for example, the vaccination campaign started on September 1. This year, many who have not yet received a COVID-19 vaccine will have to get both the COVID-19 and flu vaccines. Many people are concerned about how to properly combine these two vaccinations.

Rospotrebnadzor clarifies that flu vaccination against the backdrop of the ongoing COVID-19 epidemic is very important: a combination of two infections, if a person becomes infected with both, is a serious health risk. In the coming epidemic season, it is planned to vaccinate 60% of the country's population and 75% of people at risk, which, along with pensioners, includes workers of zoos, poultry farms and pig farms, as well as owners of poultry and livestock.

The main parameters of the influenza vaccination campaign in the fall of 2021 are presented in the draft resolution of Rospotrebnadzor, published on the federal portal of draft regulatory legal acts. As for the timing of the influenza vaccination, it is given no less than a month after the second dose of the coronavirus vaccine.

Why it is important to get vaccinated against the flu and why you need to pause between vaccinations, Natalya Pshenichnaya, Deputy Director for Clinical and Analytical Work of the Central Research Institute of Epidemiology of Rospotrebnadzor, told RG.

“Last year, the incidence of influenza was contained thanks to mass vaccination against this infection. Many were afraid of the overlap of two infections at once - influenza and coronavirus, which was fraught with serious complications. Therefore, all necessary measures were taken, a set of preventive and anti-epidemic measures were carried out, and flu vaccination coverage amounted to 59% of the Russian population, and a seasonal flu epidemic did not occur,” she explained.

In order for the upcoming season to avoid a surge in influenza incidence, at least 60 percent of the population must be vaccinated, the expert emphasized. It should be kept in mind that you can get vaccinated against influenza no earlier than a month after completing the full course of vaccination against coronavirus. The gap is necessary so that the immune system has time to develop antibodies to the pathogen.

“There is not much time left before the autumn rise in incidence, given that, for example, the introduction of a two-component coronavirus vaccine requires a month and a half. Therefore, it is better not to delay vaccination,” added Pshenichnaya.

Is it mandatory for ordinary people to be vaccinated by law?

According to the federal law “On Immunoprophylaxis of Infectious Diseases,” vaccination is voluntary.
Citizens have the right to refuse preventive vaccinations. They can get complete information from a specialist about vaccination and possible post-vaccination complications, but whether to get vaccinated or not is everyone’s choice. This applies to everyone - adults, schoolchildren, students. Before vaccination, you must sign a voluntary informed consent. In the case of children, vaccination is carried out with the consent of the parents. If a person refuses to be vaccinated, by law he must formalize his refusal in writing.

How to get a honey drain?

The issuance of a medical exemption against vaccination is carried out by specialists from relevant institutions, according to the reasons for receiving such a document. Not only a public clinic, but also a private medical institution can issue such a certificate.

A medical exemption from influenza vaccination for children and adults can only be issued if they have appropriate indications for this. When the patient has signs of relevant disorders, or a specialist suspects their presence based on indirect symptoms.

A certificate of medical exemption is issued free of charge.

The medical advice for vaccinations does not contain any special information, only general information:

• information about the patient (full name, age);
• date and place of issue of the document;
• grounds for medical withdrawal;
• duration of validity of the certificate, established in accordance with the current legislation of the Russian Federation (minimum for a month, maximum - for life);
• signature of the doctor who filled out the document;
• seal of a medical institution.

We recommend reading: Grippferon during breastfeeding

Most often, a medical exemption from a flu shot is issued for a period of two weeks to 1 month.

Sometimes, to prepare this document, the decision of one doctor is not enough; it requires the gathering of an entire commission, a council of specialists.

What should you do if your employer forces you to get vaccinated, although it is not required by law?

By law, vaccinations are voluntary. Refusal from vaccination must be made in writing. It serves as a supporting document, as it contains a reference to the law. If the employer tries to take any measures, you need to contact lawyers to find out the legality of his actions.

Are you fined for not getting vaccinations? On May 29, 2020, the Ministry of Justice of the Russian Federation posted on the official website the draft Code of Administrative Offenses, as amended. They include a fine for refusing vaccinations (for citizens - in the amount of five thousand to seven thousand rubles). Rospotrebnadzor explained that this fine applies only to people who are engaged in work from the Government’s list of mandatory vaccinations. These include doctors, teachers, those who work with human blood and biological fluids, who are engaged in agricultural, construction and logging work in areas unfavorable for infections, etc.

Special case: A university or school forces a student to get vaccinated

The parent must write an application addressed to the school principal to refuse all preventive vaccinations with reference to the federal law “On Immunoprevention of Infectious Diseases.” In case of adult status of the student (student), he writes the refusal in his own hand, addressed to the rector.

As long as the law provides for a citizen’s right to refuse vaccinations, any pressure from the school on a student is illegal. The exception is situations of mass infectious diseases or the threat of epidemics. In this case, the school has the right to temporarily refuse to admit students who do not have preventive vaccinations.

The editors of MedPortal express gratitude for the expert assistance in creating this material to Dr. Ekaterina Stepanova, from H-Clinic, an expert clinic specializing in the diagnosis and treatment of infectious diseases.

Go to the clinic website

What is a vaccine honey drain?

A medical exemption from vaccination is a refusal to vaccinate, which is not based on personal prejudices, but on clear medical contraindications confirmed by a specialist. Today, legislation allows the issuance of such a document for a period of no more than 6 months. When this period expires, the person receives a new conclusion; it may contain information about the possibility of carrying out the vaccination procedure, or extend the exemption from the flu shot.

You cannot confuse the two concepts, medical withdrawal and complete refusal to participate in vaccination. The refusal can be complete or partial; it must be justified by the presence of congenital diseases in the person, or a strong allergic reaction to a previous vaccination, which does not allow him to be vaccinated. Sometimes a person should not expose himself to danger by getting vaccinated, so it is preferable for him to refuse such a procedure. The failure may be temporary or permanent.

It is worth mentioning refusal due to one’s own convictions, when a person does not see the expediency of such a procedure and considers it dangerous for his own health. This refusal has a medical form; it remains entirely at the discretion of an adult (as for minor children, the parents decide on the possibility of their vaccination).

Influenza vaccination is a completely voluntary procedure; each person decides whether it is necessary for himself, because it is not included in the list of mandatory vaccinations.

You should not categorically refuse a decision, because each vaccine has its own properties, indications and contraindications. A decision on the possibility of giving such injections or completely denying them should only be based on truthful data obtained from official sources.

We recommend reading: Redness and thickening on the arm after a flu shot

Relative honey removal

How do I get a medical exemption from a flu shot for adults? To obtain this document, you should contact a medical institution, but first you should assess whether or not the person has indications for such a procedure.

Vaccination is postponed according to relative indications if:

• the person is at the stage of acute development of a viral or intestinal infection;
• the patient's existing chronic pathologies (for example, bronchitis, tonsillitis, pharyngitis) are aggravated.

When the forms of pathology are not very severe, vaccination is postponed until the patient’s condition returns to normal. If the disease is severe, then the vaccine can be given only after a month after complete recovery.

Absolute honey removal

Flu vaccination may have a medical exemption based on absolute contraindications. This means that it cannot be administered either now or in the near future, due to the presence of individual intolerance to the vaccine components.

Today, the following formulations are most actively used for vaccination: Vaxigrip, Grippol, Influvac. When a person has previously been given an infection, which resulted in the development of negative symptoms, he is not given subsequent vaccinations.

Some people are hypersensitive to the following components of the vaccine:

• formaldehyde;
• ovalbumin;
• chicken protein;
• neomycin;
• Octoxynol-9.

The presence of such components among the components of the vaccine in extremely low concentrations does not relieve a person (who is allergic to these substances) from the risk of developing a severe allergic reaction, including anaphylactic shock.

There are a number of indications classified as imaginary indications for signing a medical exemption:

• pregnancy, despite the wealth of information contained on Internet sources, is not a contraindication for the administration of the influenza vaccine. The drug, administered after the 14th week of gestation, does not have a teratogenic effect on the fetus, does not change the course of pregnancy, but effectively protects the woman from influenza infection;
• atopic dermatitis in infants, if it is not in the acute stage, allows the vaccine to be given (provided that the child is not intolerant to the components of the drug).

We recommend reading: Prevention of influenza in pregnant women

If contraindications to the influenza vaccine are not taken into account, serious harm to human health, even death, can be caused.

Sources

1. Federal Law “On Immunoprophylaxis of Infectious Diseases” dated September 17, 1998 No. 157-FZ.
2. FBUZ "Center for Hygienic Education of the Population" of Rospotrebnadzor. Medical treatment for vaccinations.
3. "MU 3.3.1.1095-02. 3.3.1. Vaccine prevention. Medical contraindications to preventive vaccinations with drugs from the national vaccination calendar. Guidelines" (approved by the Chief State Sanitary Doctor of the Russian Federation on January 09, 2002).
4. Bulletin of infectology and parasitology. Preventive vaccinations.

In what cases is it necessary to refuse vaccinations?

Medical refusal from vaccinations after ARVI is common; in addition to this standard indication, there is a list of recommendations; refusal is advisable (or there is a need to create, under the guidance of a specialist, an individual vaccination schedule).

1. Patients with HIV infection or other types of immunodeficiency.
2. People with cancer pathologies undergoing radiation or chemotherapy.
3. For allergy sufferers.
4. Frequently ill children with chronic pathologies of the respiratory system.
5. People with autoimmune pathologies.
6. Patients with severe neurological diseases.

The medical advice from vaccinations after ARVI, how many days it should last, is decided by the doctor observing the patient. As a general rule, at least 14 days must pass from the moment of recovery to administer the vaccine.

Principles for safe human vaccination:

• undergoing a personal examination by a doctor;
• preliminary general urine and blood tests;
• if necessary, obtaining opinions on medical exemption given by narrow specialists (allergist, neurologist, immunologist, pulmonologist, ENT doctor, nephrologist);
• For a patient with a weakened immune system, the possibility of vaccination should be determined by an immunologist.

Medical access is a real opportunity to vaccinate only when the body of a particular person is ready for such external intervention. It allows you to avoid unnecessary stress on the body and prevent the development of dangerous consequences.

Shpakovskaya district hospital

Medical exemption from vaccination against COVID-19: grounds, procedure, timing, categories of patients

Today, Russian legislation provides for scheduled and unscheduled vaccination. Vaccination to prevent COVID-19 is carried out on the basis of the vaccination calendar according to epidemic indications. The Ministry of Health in new temporary recommendations for vaccination against COVID-19 calls it “emergency” and indicates that the obstacle to such vaccination is medical contraindications, which are indicated in the instructions for each vaccine registered in the Russian Federation (Gam-Covid-Vac (Sputnik V) , Gam-Covid-Vac-Lio, EpiVacCorona, CoviVac, Sputnik Light). In what cases can a medical exemption from vaccination be issued and in what form, who is entitled to it and for how long? About this in our material.

According to the new recommendations of the Ministry of Health (letter of the Ministry of Health of Russia dated June 29, 2021 No. 30-4/I/2-9825), the Gam-Covid-Vac (Sputnik V) and EpiVacCorona vaccines are used in adults over 18 years of age, and the Gam-Covid-Vac vaccines Vac-Lio, CoviVac and Sputnik Light - in adults aged 18-60 years.

Citizens who do not have contraindications, a list of which is given in the instructions for use of vaccines, can be vaccinated. Now citizens who have recovered from COVID-19 or were previously vaccinated, as well as those who were previously vaccinated and then recovered from the disease, can also get vaccinated, with any of the named Russian vaccines, but in accordance with the instructions for use of the drug and 6 months after the disease or primary vaccination. The importance of timely vaccination is noted, regardless of the presence and quantity of antibodies.

This position of the Ministry of Health is based on WHO recommendations, at least as it is indicated in the new temporary recommendations. Previously, the Ministry of Health expressed the opposite opinion. In particular, the letter dated February 20, 2021 No. 1/I/1-1221 on the procedure for vaccination with Gam-Covid-Vac (Sputnik V) stated that citizens who have recovered from coronavirus, as well as those who have positive antibody test results (immunoglobulins of classes G and/or M to the SARS-CoV-2 virus) are not vaccinated.

In what cases can a medical exemption from vaccination against COVID-19 be issued?

The basis for a medical exemption from vaccination is the contraindications specified in the instructions for the vaccine and identified in the patient. The procedure for medical exemption from vaccination is not prescribed by law, but if you take into account the latest recommendations of the Ministry of Health, medical exemption from vaccination against the new coronavirus can be distinguished by the nature of the contraindications and the duration of the period of validity of the medical exemption.

Medical withdrawal due to absolute contraindications

All instructions for these vaccinations include a history of severe allergic conditions and hypersensitivity to vaccine components as contraindications. If we use the terminology of the methodological recommendations of the Russian Ministry of Health on contraindications to vaccination (letter of the Russian Ministry of Health dated August 23, 2021 No. 15-2/10/2-5896), severe reactions (temperature over 40 degrees and local reaction in the form of hyperemia and edema over 8 cm ), post-vaccination complications, including those following the introduction of the first component of the vaccine (anaphylactic shock, angioedema, etc.) and severe allergic reactions are absolute contraindications for all types of vaccines.

The instructions for the EpiVacCorona vaccine also include immunodeficiency (primary) and malignant blood diseases and neoplasms as unconditional contraindications.

In this regard, the doctor (paramedic) conducting a preliminary examination of a citizen, if the relevant information is available, will be required to issue a medical exemption from vaccination against COVID-19.

Temporary medical outlet

At the same time, exacerbations of chronic diseases, non-severe cases of acute respiratory viral infections or infectious and non-infectious diseases, which are indicated as contraindications to vaccination, are temporary and may be grounds for temporary medical withdrawal.

The instructions for vaccines provide a time frame for vaccination in people with signs of such diseases or conditions - 2-4 weeks after the onset of remission of a chronic disease or after recovery for the use of the Sputnik V, Gam-Covid-Vac-Lio, Sputnik Light and CoviVac vaccines, and no earlier than a month later - for the use of the EpiVacCorona vaccine. In these cases, the doctor (paramedic) conducting the examination, upon establishing such conditions, can issue a temporary medical exemption from vaccination for an appropriate period.

In fact, cases when patients receive immunosuppressive therapy are also considered a temporary medical exemption from vaccination. The new recommendations from the Ministry of Health indicate that such patients and patients with immunodeficiency may not develop a sufficient immune response. In this case, it is suggested that you stop taking medications that suppress immune system function for at least one month before and after vaccination due to the risk of decreased immunogenicity.

Another reason for medical withdrawal may be contact with patients with infectious diseases within the last 14 days or the presence of any symptom of the disease within the last 14 days. In this case, the doctor (paramedic) conducting the preliminary examination must give the patient a referral for PCR testing (or rapid test) for the presence of coronavirus. Accordingly, vaccination is not carried out until the test results are received.

Childhood as a contraindication to vaccination

Russian vaccines are currently intended to prevent COVID-19 only in adults. Age under 18 years is currently a contraindication for vaccination, as indicated in the instructions for all vaccines.

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.

Vaccination or medical exemption from vaccination based on the opinion of the attending physician

The same procedure seems applicable when a doctor (paramedic), conducting a preliminary examination before vaccination, is faced with the presence of severe chronic diseases of internal organs, malignant blood diseases and neoplasms in a patient.

Vaccination (with the exception of the EpiVacCorona vaccine, which according to the instructions is not used at all in patients with immunodeficiency and malignant blood diseases and neoplasms) in these cases, the instructions for vaccines are recommended “with caution” and depending on the degree of risk of the disease. The instructions also note possible risks for patients with autoimmune diseases.

Obviously, assessing such risks is advisable only if complete data on the patient’s disease is available, he is registered at a dispensary, and the course of the disease is monitored over time. Therefore, conclusions about assessing the risk of vaccination, about admission to vaccination or about medical withdrawal in the presence of these diseases (conditions) can only be made by the attending physician in order to avoid the unreasonableness of medical withdrawals.

It should also be borne in mind that medical institutions must keep records of workers at each facility with information on preventive vaccinations (card file of registration vaccination forms) and medical exemptions (refusals) from vaccinations (Resolution of the Chief State Sanitary Inspector of the Russian Federation dated June 4, 2008 No. No. 34).

Medical outlet form

Today, the format of a medical exemption from vaccination has not been normatively defined; in the latest recommendations on vaccination, the Ministry of Health recommends that doctors (paramedics) record a record of the results of the patient’s examination, as well as permission to administer the vaccine or an exemption from vaccination if there are contraindications in the medical documentation.

We would like to add that, in our opinion, when indicating in medical documentation a medical exemption from vaccination, it would be more correct to indicate the period until which it is valid (if the medical exemption is temporary), as well as its reason.

Link to the original: https://kormed.ru/novosti/medotvod-ot-privivki-protiv-covid-19-osnovaniya-poryadok-sroki-kategorii-patsientov/