Should Seniors with Health Issues Get the COVID Vaccine? - Family Medicine

Dr. Xiao Yongxun reply Family Medicine

---

Dear Ms.
Mtyofcyc:
1.
Patients with hypertension, diabetes, heart disease, liver disease, and other conditions are generally advised to receive the COVID-19 vaccine.
This is especially true for males over the age of 65, and those residing in nursing or long-term care facilities with these conditions, as they are at high risk for severe illness following COVID-19 infection.
Vaccination has been shown to effectively reduce hospitalization and severe cases, and most literature strongly recommends vaccination.
Patients with hepatitis B or C who are undergoing treatment typically do not need to stop their medications before receiving the vaccine; however, if you have any concerns, it is advisable to discuss them with your hepatologist or gastroenterologist.
Some studies indicate that patients with cirrhosis who receive at least one dose of the vaccine 28 days prior can reduce their risk of infection by 64.8% and completely avoid hospitalization or related death.
2.
Who may be allergic to the COVID-19 vaccine? Individuals who have previously experienced severe allergic reactions (anaphylaxis) to any COVID-19 vaccine or its components.
For example, the Polysorbate-80 component in the AZ vaccine is a surfactant commonly found in food, cosmetics, and pharmaceuticals.
Reported allergic reactions include those to biologics or monoclonal antibodies (rituximab, tocilizumab, infliximab, etanercept, adalimumab, bevacizumab, omalizumab), vaccines (Gardasil for cervical cancer, hepatitis B, influenza, pneumonia PCV13, DTaP), injectable steroids (Depo-Medrol), asthma inhalers (Budesonide), and injectable vitamin A.
Caution should be exercised when considering vaccination for individuals with a history of severe allergic reactions to these medications.
The PEG (polyethylene glycol) component in the BNT and Moderna vaccines is also found in many cosmetics and medications (Niflec, Depo-Medrol, Depo-Provera, Micera, Neulasta, Herceptin...), so individuals with a history of severe allergic reactions to cosmetics or related medications should carefully assess the risks of vaccination.
There may be cross-reactivity between PEG and Polysorbate.
For instance, individuals allergic to Polysorbate-80 in the hepatitis B vaccine may also react to PEG in the Moderna vaccine (not necessarily due to the Polysorbate component in the AZ vaccine).
The buffer component TROMETAMOL in the Moderna vaccine has been reported to be associated with MRI contrast agents (gadolinium-based contrast agents = GBCA) and iodine-based contrast agents for CT scans (Ultravist, Omnipaque, Iopamiro, Isovue, Visipaque, Xenetix, Optiray), but neither the Taiwan nor the CDC in the United States lists it as a contraindication.
Therefore, it is recommended that individuals known to be allergic to TROMETAMOL or MRI contrast agents (GBCA) or iodine-based CT contrast agents consider receiving a non-Moderna vaccine.
3.
In fact, current research on individuals who experienced allergic reactions or anaphylaxis after the first dose of an mRNA vaccine shows that only 20% exhibited mild allergic reactions after the second dose, which can be managed with antihistamines and emergency medications.
4.
General food or drug allergies (not related to the COVID vaccine or its components) are not contraindications for vaccination; however, if there is a history of any anaphylaxis, it is advisable to discuss and evaluate the necessity of vaccination with your family physician.
5.
Personally, I believe that the global pandemic of COVID-19 came very suddenly, and the vaccines currently in use worldwide do not have complete long-term trial data; hence, various governments have sought Emergency Use Authorization (EUA) from pharmaceutical companies.
Regardless of what experts or physicians say, there are still risks, large or small.
From a national perspective, vaccination can prevent most severe illnesses or deaths; not getting vaccinated eliminates the risk of vaccine side effects or accidents, but one must face the possibility of severe illness or death if outbreaks occur domestically.
Some media in our country lack scientific reasoning and critical thinking when reporting on vaccine-related information; therefore, if you find it difficult to discern the truth or identify logical contradictions, it is advisable to follow the guidance of the Central Epidemic Command Center, which brings together the country's leading medical and public health experts to provide the most evidence-based recommendations.
6.
If you have further questions, please discuss them in detail with your family physician or attending physician.

---

Reply Date: 2021/08/09