If I’ve had Covid-19, do I still need to be vaccinated? 14 questions about Covid-19 answered

As Covid-19 cases continue to rise across the country, the ministerial advisory committee (MAC) on Covid-19 vaccines has issued responses to questions about the coronavirus and vaccination process.

The questions include how long you should wait after getting the flu or any other vaccine before going for a Covid-19 jab, and whether it is safe to get the Covid-19 vaccine while pregnant or breastfeeding.

The country is in the second phase of the nationwide vaccine rollout, with teachers getting the Johnson & Johnson (J&J) vaccine from this week. The vaccination of teachers will continue until July 8.

Acting health minister Mmamoloko Kubayi-Ngubane announced on Friday that registration for Covid-19 vaccinations would open to over-50s from July 1, and their jabs would begin from July 15.

HERE ARE 14 QUESTIONS ABOUT THE VACCINE ANSWERED:

Does being vaccinated mean I can ignore Covid-19 precautions?

Unequivocally not. All Covid-19 precautionary measures must still be strictly adhered to for several reasons. Firstly, the immune response elicited by the vaccines does not kick in immediately. With the J&J vaccine there is some response two weeks after vaccination but is properly effective only after four weeks.

The Pfizer vaccine should be regarded as effective two weeks after the second dose. Secondly, and very importantly, no vaccine is 100% effective. Therefore, even vaccinated people are at risk of infection and mild to severe disease. If a vaccinated person is infected, we don’t know if the vaccine will prevent transmission of the coronavirus to an uninfected person.

We will only be able to return to our pre-Covid-19 life once herd immunity has been reached and the circulation of the coronavirus has been controlled.

If I have had Covid-19, do I still need to be vaccinated?

Yes, because 95% of infections in SA are of the relatively immune-resistant variant.

The B.1.351 virus variant means high levels of neutralising antibodies are needed for protection. Nearly everyone who recovers from Covid-19 has some degree of immunity which, for most people, will protect them against reinfection. However, some people with a weaker immune response may become reinfected, especially if their initial infection occurred during the country’s first wave.

In addition, we don’t know how long natural immunity last. The Pfizer and J&J Covid-19 vaccines used in SA have been engineered to boost the antibodies and T cells that were stimulated after natural infection. Therefore, vaccination is still recommended.

Why does the Pfizer vaccine require two doses while the J&J vaccine requires one dose?

These two dosing strategies have been shown to be effective in their respective clinical trials. The J&J vaccine has been shown to elicit an immune response for many months after a single dose while the strong immune response with Pfizer was seen after the second dose.

If I had a choice, which vaccine should I choose?

Both vaccines provide good protection, particularly against severe disease and hospitalisation. The best decision is to take the vaccine which is most immediately available and get vaccinated as soon as possible.

If I have been vaccinated and come into contact with an infected person, do I need to be quarantined for 10 days?

Healthcare workers who regularly come onto contact with potentially infected patients must ensure their personal protective equipment (PPE) is satisfactory to avoid the need for quarantine.

Non-healthcare workers need to quarantine even if they have been vaccinated, especially if they have received only one dose of the Pfizer vaccine or within four weeks of being vaccinated.

If I am not feeling well, should I keep my vaccination appointment or postpone?

If your symptoms are suggestive of Covid-19, you should be tested rather than go for vaccination. However, if your symptoms are mild and not suggestive of Covid-19 there should be no reason to postpone a vaccination appointment.

If I have recovered from Covid-19, how long should I wait before being vaccinated?

The recommendation is at least four weeks.

The recommended interval between the first and second doses of Pfizer in the US is three weeks. The SA health department is recommending a six-week interval.

Clinical trials of the Pfizer vaccine were carried out with a three-week interval and consequently US regulatory authorities have maintained that recommendation.

However, the UK extended the interval to 12 weeks, primarily to vaccinate and provide some degree of protection to as many people as possible with at least one dose. An added advantage was that the longer interval produced a stronger immune response than the three-week interval, something observed with other Covid-19 vaccines.

South Africa has taken a middle path, aligned with the World Health Organisation (WHO), to delay the second dose for six weeks for an enhanced immune response and best coverage.

Should I do an antibody test after vaccination to confirm I have immunity?

This is not recommended by the MAC nor by other international bodies. Routine antibody tests are unreliable to establish vaccine-mediated immunity, although they may have a role in determining whether someone has previously been infected.

A negative antibody test after vaccination may not necessarily indicate a lack of immunity. In future, certain types of antibody tests might be used to indicate the need for repeat vaccination.

If I have had an antibody test which indicates I have antibodies, would I still need to quarantine if I have been in contact with an infected person?

Yes. The routine tests for antibodies are not reliable indicators of protective immunity. You could still get infected, especially if you were in contact with an infected person within four weeks after receiving your vaccination.

What side-effects can I expect from the vaccine?

Most people will not experience any side-effects. Some people may experience tenderness or a rash at the injection site. Occasionally, for a day or two and rarely longer, there may be a headache, feeling out of sorts, muscle pain or even a slight fever, which can be controlled with something like paracetamol.

However, if you are concerned about any adverse event you should report it to a health facility where you will receive treatment for the adverse event and the event will be reported.

Recipients should be aware of the possible association and seek immediate care for signs and symptoms suggestive of thrombocytopenia or thrombotic complications:

• unremitting, severe headache occurring during this time frame;
• focal neurologic symptoms such as weakness in legs, blurred vision and new onset seizures;
• new onset, persistent and unexplained abdominal pain; and
• chest pain, shortness of breath and/or leg pains.

All serious adverse events reported to the national department of health will be shared with the SA Health Products Regulatory Authority (Sahpra) and will be presented at the National Immunisation Safety Expert Committee (NISEC) for causality assessment.

Alternatively, SA is using the “MedSafety” App which health workers are encouraged to use to report adverse events rather than using paper-based reporting. This data is shared with Sahpra and the health department.

If I have had allergic reactions in the past (for example, allergic reactions to previous vaccination or medication, foods, pets, grass and so on), should I get vaccinated?

Severe allergic reactions (anaphylaxis) with the Pfizer vaccine have been reported but these have been extremely rare and calculated at 11 per one million doses. Around three-quarters of these have occurred within 15 minutes of vaccination. It would therefore be important for such individuals to alert the staff doing vaccinations about their allergy history, and they should wait at the vaccination site for 30 minutes instead of the usual 15 minutes after vaccination.

The risk of blood clots after the J&J vaccine is less than one per million doses and has not, to date, been reported after receiving the Pfizer vaccine.

A frequent question about vaccination comes from patients with chronic underlying medical conditions. This should be discussed with the attending doctor. In general terms, the Covid-19 vaccine can be given, and in most of these cases should be given to people with underlying medical conditions, especially where the immune system may be suppressed by illness or chemotherapy. Such individuals are often at increased risk of severe Covid-19. This must be discussed with the attending doctor.

If I have had the influenza or any other vaccine, how long after should I wait before getting the Covid-19 vaccine?

A waiting period of a few days is recommended.

Can I have the Covid-19 vaccine if I am planning to become pregnant?

Once this younger age group of women is included in those who can access vaccines, the answer is yes and this is encouraged. We know pregnant women are at higher risk of severe Covid-19 disease and of preterm delivery, and for this reason it is good to be protected against Covid-19 before becoming pregnant.

Can I have the Covid-19 vaccine if I am pregnant or breastfeeding?

Once this younger age group of women is included in those who can access vaccines, the Pfizer and  J&J vaccines should be offered to all pregnant women based on benefit risk.

Pregnant women with comorbidities such as obesity, diabetes and hypertension in pregnancy should be prioritised for vaccination and can be offered a vaccine if they have a comorbidity that is in a priority group for vaccination.

Healthcare workers are encouraged to discuss the risks and benefits of the Covid-19 vaccination with their patients. These discussions should include limited but reassuring safety data for the vaccines in pregnant and breastfeeding women, the strong immune response conferred to mothers following vaccination and the benefits of immune transfer to the neonate.