COVID Vaccine exemptions
There are no heart conditions that make it medically unsafe for a person to have all of the COVID vaccines available in Australia. This is because we have different vaccines, with different ingredients, which work in different ways.
If someone can’t have a certain vaccine, they can have a different type of COVID vaccine.
Our doctors will not be issuing vaccine exemption certificates as there are no cardiac reasons for exemption from all COVID vaccines.
Serious side effects
All medications, interventions, therapies and surgeries carry a very small risk of serious complications. The COVID 19 vaccines are no different. COVID vaccines carry a risk of serious side effects or allergic reaction of about 1-2 per 100,000 people. This is much lower than many medications, and fairly similar to many other commonly used vaccines for other conditions. Unfortunately, no medication or vaccine has zero risk of side effects or allergic reaction.
The benefits of COVID vaccination are many times greater than the very small risks from vaccination.
People with heart conditions, and other background health conditions, are at higher risk of serious illness and death from COVID-19 infection. People with heart conditions and other background health conditions benefit more from vaccination and are not at higher risk of vaccine side effects. All COVID vaccines in Australia are very effective at preventing serious illness and death from COVID.
As our body mounts an immune response to the vaccine, it is not uncommon to notice some flu-like symptoms including fever, headache, sweats, chills, muscle and joint aches and pains, malaise and fatigue. Taking regular Panadol or Neurofen may be helpful in these cases. As for any new therapy, if you are experiencing symptoms after your vaccine that you feel are NOT expected or are beyond what you feel should be normal, then you should seek medical attention from your GP.
COVID vaccine type and adults with heart conditions
COVID vaccines are safe for people with heart problems. For example, you can have any type of COVID vaccine if you have any of the following:
- Prior myocarditis, pericarditis, or endocarditis (more than 6 months before vaccination)
- Coronary artery disease
- Myocardial infarction
- Stable heart failure
- Prior history of rheumatic heart disease (RHD)
- Kawasaki disease
- Congenital heart disease
- Cardiac transplant
- People with implantable cardiac devices.
There is no known heart condition where any particular COVID vaccine is preferred, except mRNA vaccines (Pfizer and Moderna) are not generally recommended for those who have had heart inflammation (myocarditis, pericarditis, or acute heart failure / cardiomyopathy) in the last 6 months. These people can have the AstraZeneca vaccine.
COVID vaccine and types for kids with heart conditions
Children and adolescents aged 12 years to 18 years with congenital heart disease are recommended to have the Pfizer COVID vaccine or Moderna COVID.
The risk of myocarditis related to the Pfizer vaccine for all patients in this age group (12-29 years) is low. For males it is estimated to be approximately 1 in 25,000 of those who receive the vaccine. For females the risk is even lower and estimated to be around 1 in 250,000 of those who receive the vaccine1,2. Usually, myocarditis related to the vaccine is mild and resolves with simple measures such as oral fluids, ibuprofen and monitoring.
**We recommend that any child or adolescent who has had myocarditis or pericarditis within the last six months discuss the timing of vaccination with their cardiologist**
If persistent chest pain occurs within the first two weeks following vaccination, please attend your regular general practitioner with your child for an examination, ECG, and blood tests if required for troponin, ESR and CRP (3). Any cases of suspected pericarditis or myocarditis will be discussed with the paediatric cardiologist on call at the John Hunter.
COVID Vaccinations for 5-11 year olds
We recommend the Pfizer vaccine for all our paediatric patients ages 5 – 11 years with congenital cardiac disease, without requirement for a paediatric cardiology consult beforehand, excluding those who have had current or recent (i.e., within past 3 months) myocarditis or pericarditis due to causes other than vaccination, or acute rheumatic fever or acute rheumatic heart disease (with evidence of active inflammation) or acute decompensated heart failure who do require consult.
The risk of myocarditis related to the Pfizer vaccine for all patients in this age group is extremely low. For males the incidence of myocarditis is estimated to be approximately 1 in 250,000 of those who receive the vaccine. For females this is even lower and estimated to be around 1 in 500,000 of those who receive the vaccine.
If you have more specific concerns about your child that have not been addressed here, or by your GP, we would be happy to schedule you an appointment with one of our paediatric cardiologists
Clotting and COVID vaccines
The clotting problem due to some COVID vaccines is like an allergic reaction. The risk of clotting with COVID vaccines is not related to:
- History of blood clots in legs or lungs
- Family history of blood clots
- History of heart attack, blockages in arteries, or stroke
- Current or past low platelet count
- Taking blood thinners of any type (aspirin, clopidogrel, ticagrelor, warfarin, apixaban, rivaroxaban, dabigatran)
- Increased clotting tendency that is not immune mediated
There are rare clotting problems where AstraZeneca is not recommended:
- a history of cerebral venous sinus thrombosis (CVST)
- a history of heparin-induced thrombocytopenia (HIT)
- a history of idiopathic splanchnic (mesenteric, portal, splenic) thrombosis
- a history of antiphospholipid syndrome with thrombosis.
People with a history of these conditions should have Pfizer or Moderna vaccines.
The contraindications to COVID vaccines are:
AstraZeneca: Anaphylaxis to a previous AstraZeneca dose or to an ingredient; clotting disorder after a previous Astrazeneca dose, or any other serious adverse event attributed to a previous Astrazeneca dose.
Pfizer: Anaphylaxis to a previous Pfizer dose or to an ingredient; myocarditis and/or pericarditis attributed to a previous dose, or any other serious adverse event attributed to a previous dose.
If you have a contraindication to one COVID vaccine, you can have a different COVID vaccine.
If you have further questions, they can be addressed in a formal consultation.
Source: Australian Technical Advisory Group on Immunisation (ATAGI) Clinical guidance on use of COVID-19 vaccine in Australia in 2021 (v7.2)
Our doctors strongly recommend you get whatever COVID vaccine is available to you as soon as possible.