Recommendations for COVID-19 vaccination for special groups

Vaccination against the novel coronavirus (hereinafter referred to as COVID-19 vaccine) is the most important means to actively build herd immunity and control the spread of COVID-19. my country has adopted the independently developed COVID-19 vaccine to implement free vaccination for all people. As of June 15, 2021, 101,048,900 doses have been administered [1]. my country has successfully developed and marketed three types of COVID-19 vaccines, namely inactivated vaccines, recombinant (subunit) protein vaccines, and adenovirus vector vaccines. These vaccines have their own characteristics and advantages and disadvantages.

Can certain unhealthy people, especially those with immune disorders, be vaccinated? How safe is the vaccination? When should it be administered? What kind of vaccine should be administered? What should be noted?

The Chinese Society of Infectious Diseases and the Chinese Society of Rheumatology organized relevant domestic experts to formulate the "Expert Recommendations on COVID-19 Vaccination for Special Populations (Patients with Chronic Liver Disease, Tuberculosis and Rheumatic Immunology)" (hereinafter referred to as the "Recommendations") [2] to address the issue of COVID-19 vaccination for some patients with chronic diseases who are immunocompromised, namely patients with chronic liver disease, tuberculosis and rheumatic immune diseases. The recommendations analyze the particularities of different populations and clearly provide recommendations on the selection of vaccine types:

Chronic liver disease: The recommendation for vaccine selection for people without cirrhosis is, "More than 900 million people have completed vaccination with the inactivated novel coronavirus vaccine, and preliminary data on people with chronic liver disease have been reported. Adenovirus vector vaccines have been used in parts of my country and abroad, and mRNA vaccines have been widely used abroad. Domestic application experience is limited, and evidence-based medical data for Chinese patients has not yet been obtained." The recommendation for vaccination of patients with cirrhosis is, "Based on the safety characteristics of previous vaccines of the same type, it is recommended to first vaccinate with inactivated vaccines. Recombinant subunit vaccines may also be considered, and the risks and benefits of mRNA and adenovirus vector vaccines should be carefully evaluated."

"Chronic liver disease" is a general term. In terms of etiology, the clinical characteristics of chronic viral hepatitis (including CHB and CHC), alcoholic hepatitis, autoimmune liver disease and fatty liver hepatitis are very different. At present, there are only safety reports on the inactivated new crown vaccine for patients with fatty liver disease. The liver damage mechanisms of viral hepatitis and autoimmune liver disease include immune damage and peroxidation caused by excessive oxygen free radicals. Chronic viral hepatitis also has cellular immune deficiency, and autoimmune liver disease has immune disorders. Therefore, once nucleic acid vaccines and adenovirus vector vaccines are administered, the risks and benefits are difficult to judge for the time being, so they are not recommended for the time being.

Tuberculosis: Tuberculosis is a common chronic infectious disease. Mycobacterium tuberculosis is a special intracellular parasite. Once infected and developed, it not only requires a combination of multiple drugs for antibacterial treatment, but even short-term therapy needs to last for half a year. Most anti-tuberculosis drugs have adverse reactions, especially drug-induced organ damage, such as liver damage, skin damage, etc. In addition, tuberculosis is more likely to be complicated by HIV infection or autoimmune diseases. Therefore, from a safety perspective, the inactivated new crown vaccine still has fewer risks [3]. In addition, the "Recommendation" also clearly stated: "For patients with active tuberculosis who have not yet been treated and those in the intensive stage of anti-tuberculosis treatment, it is recommended that they be vaccinated after the anti-tuberculosis treatment enters the consolidation stage and the condition stabilizes."

Rheumatic and immunological diseases: Rheumatic and immunological diseases are autoimmune diseases involving organs and tissues throughout the body. They are disorders caused by "excessive" immune function of the body, with damage to micro-blood vessels as the main feature. There are multiple specific or non-specific autoantibodies and overexpression of inflammatory factors in the body. It is now clear that the occurrence of rheumatic and immunological diseases is closely related to pathogen infection, and once patients with rheumatic and immunological diseases are infected, the immune response may be too strong. In addition, patients may also be allergic to a variety of drugs, including anti-infectives. Therefore, this group of people need to be vaccinated with the new crown vaccine when their condition is effectively controlled. The "Recommendation" clearly states: "Adult patients with rheumatic and immunological diseases are recommended to be vaccinated with inactivated vaccines first. Other types of vaccines should be carefully considered, such as recombinant subunit vaccines, adenovirus vector vaccines, mRNA vaccines, etc."

It is recommended that the above patients be vaccinated after evaluation by a specialist physician. Routine precautions should not be relaxed after vaccination and the underlying disease should continue to be treated.

References:

1. National Health Commission of the People's Republic of China. COVID-19 vaccination status [EB/OL]. (2021-06-20) [2021-06-23].
http//www.nhc.gov.cn/xcs/yqjzqk/202106/a170c7ae7fda4809af3961dc6d79c2ff.shtm1.

2. Chinese Society of Infectious Diseases, Chinese Society of Rheumatology. Expert recommendations on COVID-19 vaccination for special populations (patients with chronic liver disease, tuberculosis, and rheumatic autoimmunity)[J]. Chinese Journal of Infectious Diseases, 2021, 39(07): 398-403.

3. Yin Rong, Niu Yunchao, Miao Xiaohui. Interpretation of "Expert Recommendations on COVID-19 Vaccination for Special Populations (Patients with Chronic Liver Disease, Tuberculosis and Rheumatism)"[J]. Chinese Journal of Infectious Diseases, 2021, 39(10): 588-590.