Link to Green Book Chapter on COVID

The following FAQs relate to the Pfizer/BioNTech and the Oxford AstraZeneca COVID-19 vaccine. The following FAQs will be frequently updated as new information becomes available. Any printed version of these FAQs will become outdated. Please note that some numbering on the document below may appear to skip a number. This is due to the FAQs being a work in progress. As answers become available, the document will be updated. 1. Pregnancy and Breastfeeding Question Answer The are not routinely recommended in pregnancy.

Both the Pfizer/BioNTech or Oxford AstraZeneca vaccine can be considered for use in pregnancy 1.1 Can I have the when the potential benefits of Pfizer/BioNTech or Oxford outweigh the risks of the vaccine. Pregnant AstraZeneca vaccine if I am women should discuss this with their healthcare pregnant? provider.

If you are eligible for and have been offered a COVID-19 vaccine, the decision whether to have the vaccination in pregnancy is your choice. If you are considering the COVID-19 vaccine, please read this information sheet from RCOG. If you find out you are pregnant after the first dose, routine advice is to complete the 1.2 What if I have started the pregnancy before finishing the recommended vaccine course and then I schedule. You should be offered vaccine as soon become pregnant? as possible after your pregnancy. You can discuss further with your healthcare provider. There is no need to avoid pregnancy after 1.3 Do I need to avoid receiving the vaccine. You should ideally pregnancy after receiving complete both doses before becoming the vaccine? If so, for how pregnant. long?

This is the most updated advice from MHRA and

the JCVI from 30 December. The available data for both vaccines does not indicate any safety concern or harm in 1.4 I am trying to become pregnancy. pregnant and received the Pfizer/BioNTech or Oxford AstraZeneca vaccination not If this was your first dose, you should complete knowing that I was pregnant. the pregnancy before finishing the recommended schedule.

Please inform your midwife you have received the vaccine whilst pregnant. If you are offered the vaccine you should have 1.5 I am trying to become the vaccine before becoming pregnant. It is not routinely advised to come forward to be pregnant. Should I have the vaccinated if you are pregnant. vaccine?

You may have either vaccine whilst breastfeeding.

There is no known risk associated with giving non-live vaccines 1.6 Can I have the vaccine if I am whilst breastfeeding. However breastfeeding? Safety data have not yet been accrued.

This is based on the most recent advice from 30 December 2020. 2. Current/Past COVID-19 and the vaccine Question Answer If you are seriously debilitated, still under 2.1 I have prolonged COVID investigation or if your condition has recently symptoms/Long COVID, should I deteriorated you should consider deferring your get the vaccine? vaccine. Otherwise yes, you may have it. No. If you have been identified as a close contact or have been told to self-isolate then you should 2.2 I am self-isolating, should I not be attending for vaccination and should get the vaccine? defer your appointment until after this period.

Yes. There is no evidence of any safety concerns from vaccinating individuals with a past 2.3 I have had COVID-19 in the history of COVID-19 infection or with detectable past (greater than 4 weeks ago) . should I get the vaccine?

There are clinical trials being undertaken to

determine if past infection protects against further infection. Vaccination should be deferred until at least four weeks after the onset of your symptoms. If you 2.4 I have had a confirmed are asymptomatic, then this is four weeks from COVID diagnosis within the past your first PCR positive specimen. four weeks.

You don't need another primary dose of the vaccine if you have been diagnosed with COVID- 2.5 I have been diagnosed with 19 following your first vaccine dose. You should wait at least 4 weeks from your symptom onset COVID-19 after my first dose of (or, if you're asymptomatic, 4 weeks since your vaccine. Do I need the first dose positive result) before receiving your second again? dose.

The vaccines generally take 14 days to become fully effective. No, the vaccine can't cause 'false positive' COVID-19 PCR tests. It is not a live vaccine and 2.6 I have had a COVID-19 cannot cause you to develop COVID-19. If vaccine and now my COVID-19 your vaccine was within 14 days of your positive swab is positive but I am test, it is most likely that you were already asymptomatic. Has the vaccine incubating COVID-19 infection at the time of caused this? vaccination. The vaccine cannot stop you from developing COVID-19 if this is the case. If you have a minor illness without fever or systemic upset this is not a contraindication to vaccination.

If you have symptoms consistent with COVID-19 (see NHS inform website) then you should isolate and arrange testing and not attend for 2.7 I am not feeling well. Should vaccination. I get my COVID vaccine?

If you have a more severe illness then immunisation should be postponed until after recovery. This is to avoid wrongly attributing any symptoms to the vaccine.

3. Contraindications to vaccination Question Answer Any person with a history of anaphylaxis (serious ) to a previous dose of the 3.1 I have had anaphylaxis to vaccine, or to a component of the vaccine, vaccines, medicines or food. should not receive it. Should I receive the COVID-

19 vaccine? The Pfizer vaccine contains

(PEG) which is from a group of known allergens commonly found in medicines, and also in household goods and cosmetics. Known allergy to PEG is extremely rare but would contraindicate receipt of the Pfizer vaccine. People with known PEG allergy or immediate onset anaphylaxis to multiple classes of drugs or an unexplained anaphylaxis should not have the Pfizer vaccine. The AZ vaccine may be an alternative.

People with a history of anaphylaxis to food, an identified drug or vaccine or an insect sting can receive any Covid-19 vaccine (as long as they are not allergic to any component of the vaccine).

This advice is based on close surveillance by MHRA of the initial rollout of the Pfizer vaccine.

When you attend for your vaccine your vaccinator will ensure it is safe for you to receive the vaccine.

People who cannot be vaccinated with either the 3.2 Who should not receive the Pfizer or AstraZeneca vaccine are those with an vaccine? anaphylactic reaction to a previous dose of the COVID-19 vaccine, or one of its ingredients.

If you are pregnant or breastfeeding, discuss the risks and benefits of vaccination with your healthcare provider prior to vaccination.

The Pfizer-BioNTech vaccine can be used 3.3 What is the age range in those aged 16 and above. Trials are underway of people who can get the in children under 16. The AstraZeneca vaccine COVID vaccine? Can children get can be used in those aged 18 and above. There is the COVID vaccine? no upper age limit.

Unlike some other vaccines, eggs are not used in the preparation of either the Pfizer- 3.4 I am allergic to eggs, can I BioNTech or AstraZeneca vaccine. You can still still have the COVID vaccine? have either COVID-19 vaccine with a history of egg allergy.

3.5 I have asthma/ hayfever, can I still have either COVID- 19 vaccine? Yes.

3.6 I am on steroids can I still receive either COVID- Yes. 19 vaccine? 3.7 I have recently received chemotherapy/radiotherapy. Yes. Can I still receive either COVID- 19 vaccine? 3.8 I am on medication for anxiety/depression. Can I Yes. There are no known interactions receive either COVID- of either vaccine with any drugs. 19 vaccine? If you usually receive vaccines intramuscularly, then it is likely you will be able to have the COVID-19 vaccine by the same route. If you take medication to prevent or minimise bleeding, e.g. for haemophilia, your vaccination should be scheduled for a time shortly after you've had that medication. 3.9 I have a bleeding disorder. Can I get the vaccine? If you are stable on anticoagulation medicine e.g. apixaban, or warfarin with a stable INR, you can have the vaccination, followed by firm pressure at the site without rubbing for at least 2 minutes. There will be a risk of haematoma and bruising at the site. As this is a venom allergy and not an allergy to a 3.10 I have an allergy to bee COVID-19 vaccine or one of its ingredients, yes stings (or other venom allergy). you can receive the vaccine. Can I receive the Pfizer- BioNTech or This is advice from the British Society for Allergy AstraZeneca vaccine? and Clinical Immunology. 4. I have taken part in the Oxford AstraZeneca COVID-19 Question Answer If you are participating in a of COVID- 4.1 I have been in a COVID-19 19 vaccines then provision will be made for you vaccine trial - which vaccine to be unblinded to assess whether further should I get? vaccination is required. The trial team will contact you before your vaccination date with instructions on how to access this information.

5.Infection Control

Question Answer No. Even if you have had the vaccine, at 5.1 Can I decrease precautions present the required infection control once I have had the vaccine? precautions do not change.

Yes. If you are looking after immunocompromised patients then it is important you get the vaccine to protect them 5.2 I work with from COVID-19. immunocompromised patients; should I have the vaccine? There is no risk of causing harm to others by getting the COVID-19 vaccine.

5.3 Can I still care for COVID-19 positive patients even if I do not have the vaccine? Yes.

6. I am immunosuppressed or shielding Question Answer Yes, you should have the vaccine. The types of vaccines being used do not pose any increased risk to those who are immunosuppressed. 6.1 I have immunosuppression. Should I have the vaccine? The vaccine may be less effective in those with immunosuppression and so it is important to continue to follow any guidance you have been given around protecting yourself against COVID-19. If you have been advised to shield, you should continue to shield as long as the additional 6.2 I am shielding. Should I protective (lockdown) measures are in place in continue to shield following the area where you live or work. This advice vaccination? applies regardless of whether or not you have received your first dose of COVID-19 vaccination. 7. Prioritisation of those vaccinated Question Answer • Vaccinators • Care home staff working in residential homes for the elderly. 7.1 Which groups will be • Healthcare staff (including GP, Dental, vaccinated first? Pharmacy and Optometry contractors) in direct face-to-face contact with patients with a focus on those working in COVID-19 zones and those aged over 60 • Inpatients and long-stay patients aged over 80

8. COVID-19 vaccines and other vaccines

Question Answer You should not have any other vaccines 7 days before, or 7 days after, either dose of your 8.1 I have just had my flu COVID vaccine. vaccine: how long do I need to wait to have the COVID vaccine?

8.2 I didn't feel well after my flu Mild symptoms following vaccination is common vaccine. Should I miss the COVID and a sign of a normal response. Previous mild vaccine? vaccine reactions are not a contraindication to COVID-19 vaccination. Any person with a history of immediate-onset anaphylaxis to either COVID- 19 vaccine, or one of it's ingredients, should not receive either COVID-19 vaccine. Yes, as long as the flu vaccination is more than 7 8.3 Can I get the flu vaccination days after 1st dose of COVID-19 vaccine, and less in between dose 1 and dose 2 of than 7 days before the 2nd dose of COVID-19 the COVID vaccine? vaccine.

9. Appointments/Staff Question Answer The vaccine will be administered by experienced 9.1 Who will administer the and trained vaccinators within NHS Lothian. vaccine? 9.2 Can I go to any vaccine location? Yes

Discuss rearranging your appointment with the 9.3 I will be on annual leave call centre. when second dose is due Ideally the two doses should be given at around 12 weeks apart. The majority of staff vaccines will be provided at the workplace so you will be released from your shift to get the vaccine.

9.6 Will I get time off work for my vaccine? You should always agree with your line manager if your appointment time is when you are on duty

You should contact your manager six weeks before your return to work to arrange a vaccination if this has not already happened in a community roll out programme. 9.7 I am on maternity leave, what do I do about the vaccine? If you want to you can still make an appointment for a staff vaccination clinic, but you should read the guidance on the vaccine in pregnancy and breastfeeding before you do. If you are on sick leave, check with your GP about whether you should receive the vaccine depending on the health concern. 9.8 I am on long term sick leave

If your GP advises that the vaccine is appropriate, you should contact your manager six weeks before your return to work to arrange a vaccination if this has not already happened in a community roll out programme. 10a. COVID-19 Vaccine Safety

Question Answer No. Neither the Pfizer/BioNTech vaccine nor the AstraZeneca vaccine are live vaccines.

10a.1 Is this a live vaccine? The AZ vaccine uses an adenovirus, but as it cannot replicate it is not a live vaccine. The Pfizer/BioNTech vaccine trials took place in the , Germany, Turkey, South Africa, Brazil and Argentina 10a.2 Which countries tested the vaccine? The AstraZeneca vaccine trials took place in the UK, South Africa and Brazil.

Young people under the age of 18, who are employed in, studying or in training for health and social care work should be offered the Pfizer- BioNTech vaccination alongside their colleagues. As the vaccine is expected to have a similar safety profile and immune response in this age group, extending the offer of vaccination to 10a.3 I am under 18. Can I these staff is considered reasonable. Young receive the vaccine? people who are taking part in health and social care work as volunteers, interns or for the purposes of work experience, should make all efforts to avoid exposure to infection; vaccination would only be considered for those in longer term placements and for those individuals where future employment in that setting was likely. The AstraZeneca vaccine is not licenced for those aged under 18. Yes, both vaccines are safe. The vaccines have been through the Medicines & 10a.4 Is the Pfizer-BioNTech or Healthcare products Regulatory Agency AstraZeneca vaccine safe? How (MHRA) approval process. Clinical trials have do we know that the vaccine is shown the vaccines to have no serious adverse safe? events.

Both vaccines require the use of modified genetic material from the SARS-CoV-2 virus in 10a.5 Does the Pfizer- their production process. BioNTech or AstraZeneca vaccin e contain genetically modified (GM) material? The vaccine does not contain any live virus or organisms. 10a.6 Do the COVID- No, neither vaccine contains thiomersal. 19 vaccines contain thiomersal? 10b. COVID-19 Vaccine Efficacy

Question Answer Both the Pfizer/BioNTech and the AstraZeneca vaccine are effective from 14 days after the first 10b.1 How long does it take dose. Enhanced protection is offered after two after receiving the vaccine for it doses of vaccine. to be effective? Please see The Green Book Chapter 14a section on Vaccine Effectiveness for further information. Two doses of either vaccine are required 10b.2 When will my second for maximum protection. The second vaccine dose be due? should be between 4 and 12 weeks of the first dose. This is updated advice from the UKs Chief Medical Officers on 31st December 2020. Please see The Green Book Chapter 14a section on Vaccine Effectiveness for further information. For maximum protection, the schedule requires 10b.3 Will a vaccine booster be two doses. Current guidance does not required? recommend booster doses beyond the initial two doses.

Both the Pfizer/BioNTech vaccine and the AstraZeneca vaccine have been shown to have high levels of effectiveness. 10b.4 What is the efficacy of the vaccine? Please see The Green Book Chapter 14a section

on Vaccine Effectiveness for further information.

For both vaccines, efficacy is very high after first dose ( >70%)

A two-dose vaccine schedule is currently advised to provide longer term immunity.

10b.5 How effective is one dose The evidence is that the Pfizer vaccine provides of the vaccine? around 90% protection from 2 weeks after the first dose and continuing for a further 2 weeks. This is very likely to be sustained for several weeks thereafter. Evidence from the AZ vaccine is that delaying the second dose until around 12 weeks is likely to give a better boost to the immunity and there is no reason why the Pfizer vaccine should be any different. Most vaccines give a better immunity boost when the second dose is given later.

The vaccines greatly reduce the risk of COVID-19 10b.6 Can I still get COVID-19 if I but no vaccine is 100% effective so there is still a have the Pfizer-BioNTech or small risk of getting COVID. AstraZeneca vaccine?

It takes around 14 days after vaccination for it to

be effective. There is no need for tests. The clinical 10b.7 How will I know if the trials have proven that the both vaccines work. vaccine works or is working? Are No vaccine is 100% effective so there is still a risk antibody tests needed? of getting COVID-19 even if you have had the vaccine but the risk is greatly reduced.

10b.8 If I have the vaccine will it No. This is not a live vaccine and therefore you give me COVID-19 and can I give cannot develop or transmit COVID-19 from it. it to anyone else?

10b.9 How long will the This is not yet known and will be the subject of coverage provided by the further study. vaccine last?

It is best to get to get a vaccine as soon you are offered one to protect yourself as soon as 10b.10 I want a specific vaccine possible. (e.g. AstraZeneca), can I wait for it? COVID-19 prevalence remains high in NHS

Lothian.

10c. COVID-19 Vaccine Side Effects Question Answer 10c.1 What are the side effects Local reactions are common after vaccination from the vaccine? with either the Pfizer-BioNTech vaccine, or the AstraZeneca vaccine.

Local reactions most commonly involve pain at the injection site, usually without redness and swelling. Systemic symptoms reported are generally mild and short lived. These included fatigue and headache.

Mild fever within 48 hours following a COVID-19 vaccination is a common, expected reaction and isolation is not required unless COVID-19 is suspected. 10c.2 Will everyone who Not necessarily. Most, but not all, people who receives the vaccine experience are vaccinated will experience mild side effects. side effects?

10c.3 How long do the side effects last? The majority of side effects are mild and short lived.

10c.4 Can I use paracetamol or Yes, unless you have a contraindication to these ibuprofen after getting the medications. vaccine?

Most symptoms from the vaccine are mild. If you 10c.5 What do I do if I feel have a fever you can take paracetamol. unwell after the vaccine? Severe reactions are extremely rare. If you develop symptoms of a severe reaction you should call 999. Long term side effects are not anticipated with 10c.6 Does the Pfizer- either vaccine. As with any new medical product BioNTech/AstraZeneca vaccine a yellow card notification have long term side effects? (https://yellowcard.mhra.gov.uk/) should be completed if any side effects are experienced.

This will help monitor for any unexpected side effects. A monitoring programme has been set up by the MHRA to monitor for any unexpected side effects from either vaccine.

11. General Staff Queries Question Answer 11.2 Who will The vaccine will be administered by experienced administer the vaccines? and trained vaccinators within NHS Lothian.

Staff cannot be compelled to have the vaccine, 11.3 Is the COVID vaccine but it is strongly encouraged to protect staff, mandatory for staff? their families and patients. 11.4 If staff are seen as very At present all COVID-19 related precautions will high risk to COVID-19 continue to apply to vaccinated staff. This will be disease and currently not reviewed as the vaccination programme working, will the vaccine mean progresses and will be subject to national that they are now safe to return guidance. to work if vaccinated?

11.6 Will receiving the vaccine mean that staff can ignore Test and Protect isolation No. requirements?

11.7 If staff decline vaccination and are then contacted by Test and Protect to isolate, will Scottish Government still fund Yes. for them to receive full wages?

11.8 Will staff testing, regardless Staff testing will continue to take place of vaccination status, still take at present. place? You can review the post-vaccination advice 11.9 Who do I contact if I sheet given at the time of your vaccination, am worried post immunisation or call the Scottish COVID-19 Vaccination Helpline on 0800 030 8013 (available 8am – 8pm 7 days a week).

If you need medical advice following your vaccine please contact your GP, the vaccinating clinic or if it is a life-threatening emergency dial 999. 11.10 If I get the vaccine will I be able to travel overseas freely? At present having the vaccine will have no effect on travel restrictions. 11.11 If I get a COVID-19 vaccine No. Neither vaccine can cause false positive test and then get tested could the results. test have a "false positive"? For general enquiries related to COVID-19 , please visit NHS Inform information on COVID 19 Vaccine or call the 11.12 Where can I get more Scottish COVID-19 Vaccination Helpline on 0800 information about the COVID- 030 8013 (available 8am – 8pm 7 days a week). 19 vaccines?

11.13 Will a vaccine passport be This information is not yet available as a decision required for travel? has not been made by the government.

The Pfizer-BioNTech vaccine has a 15 minute observation period post-vaccination to ensure no evidence of allergy or anaphylaxis. 11.14 Is the observation period The AstraZeneca vaccine has no mandatory post-vaccination the same observation period post-vaccine, but we advise for both vaccines? that those vaccinated do not drive for 15 minutes following vaccination to minimise the risk of fainting. 12. Care Homes Question Answer 12.3 Will new staff At present this is not a requirement, but staff will be offered vaccination and encouraged to starting require to have the take up the offer. vaccination before commencing employment? 12.4 Will staff who have been vaccinated still have to be Staff testing will continue to take place at tested each week? present.

12.5 Once vaccinated will staff members have some freedom Currently after vaccination, the around their lives outside of same Government restrictions, recommendation work? s and COVID-19 precautions apply.

12.6 Will all new residents have vaccine offered? In the longer term many people likely to be moving into care homes will already have been vaccinated. In the short term we will develop a system to offer vaccination to new residents. 12.9 Is care home vaccination an No. Care home residents and staff are UK top extension of clinical trials? priority because of their increased risk of death. Yes.

12.10 Are there online Public Health Scotland resources are available resources for care homes? here.