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Astrazeneca crisis - are educators and teachers now backing up again?

BERLIN. Another vortex with the corona vaccinations: The Astrazeneca vaccine should generally only be used for people aged 60 and over. This was decided by the federal and state health ministers in the evening. In Germany, among other things, educators and (primary) school teachers who were raised in the vaccination priority are vaccinated with the vaccine. Heinz-Peter Meidinger (66), President of the German Teachers' Association, already warns: "If Astrazeneca can generally no longer be vaccinated, the vaccination prioritization of teachers threatens to fail completely!"

Actually, the corona vaccinations with the preparation from Astrazeneca should finally pick up speed - but now there is a precautionary brake. The federal and state health ministers decided on Tuesday that the preparation should generally only be injected into people over 60 - unless younger people want it at their own risk after clarifying with the doctor. There was already some back and forth with the means of the British-Swedish manufacturer: approved, then restricted, expanded again, suspended, resumed. The “vaccination campaign” is not getting any easier.

The German Teachers' Association has described the change in the age limit for vaccination with Astrazeneca as a "catastrophic setback for the vaccination of teachers, which is just getting underway". Against this background, association president Heinz-Peter Meidinger called for a quick opportunity for teachers under 60 to be vaccinated with Biontech / Pfizer and soon with Johnson & Johnson. "If this exchange does not take place immediately, there will be no more vaccinations for teachers in April," said Meidinger. In addition to the rising incidence, this would also massively endanger the chances of keeping schools open.

What is the problem?

Again it is about abnormalities with cases of blood clots (thromboses) in cerebral veins in a temporal context to vaccinations, which were mainly reported in younger women. It was only in mid-March that the federal government suspended all Astrazeneca vaccinations following a recommendation by the responsible Paul Ehrlich Institute (PEI) - like several other countries. After renewed tests by the European Medicines Agency (EMA), the federal and state governments gave the green light again after a four-day break - but combined with new warnings for doctors and patients about the risk of thrombosis.

What exactly is it about?

There are suspected cases of a special form of very rare cerebral vein thrombosis (sinus vein thrombosis) in connection with a lack of blood platelets (thrombocytopenia). The Paul Ehrlich Institute, which collects such reports, states in its safety report that there is “a noticeable accumulation” close to vaccinations with Astrazeneca.

How many suspected cases have there been so far?

31 suspected cases of sinus vein thrombosis after vaccination with the corona vaccine from Astrazeneca were reported to the institute by noon on Monday. Thrombocytopenia was also reported in 19 cases. The outcome was fatal in nine cases.

What do we know about these suspected cases?

With the exception of two cases, all reports concerned women aged 20 to 63 years. The two men were 36 and 57 years old. According to the vaccination rate monitoring of the Robert Koch Institute (RKI), 2.7 million first doses and 767 second doses of Astrazeneca were inoculated up to and including Monday.

How common is this complication?

About one case per 100,000 Astrazeneca vaccinations was reported to the Paul Ehrlich Institute (as of March 19). That is little, but more often than would be expected, because it is even rarer in the normal population: "This very rare coagulation disorder occurred more frequently among the vaccinated than would be expected numerically due to the rarity of this coagulation disorder without vaccination."

How do such thromboses arise?

According to Andreas Greinacher from the University Medical Center Greifswald, in rare individual cases the body's immune response could activate the blood platelets. Other researchers also suspect that the formation of the clot could take place via a strong immune response and the resulting antibodies that attach to the blood platelets and activate them.

Is the vaccination the cause?

"At the present time it is not clear whether there is a causal connection between the vaccination and the reports of immune thrombocytopenia," says the PEI. So far there is no evidence that the occurrence of these coagulation disorders was caused by the vaccine. However, further research would be carried out to clarify this.

How have the authorities assessed the matter so far?

For the European Authority EMA, the benefits of the vaccine are significantly greater than the risks. However, it was decided to include a warning in the technical information and instructions for use for these very rare occurrences.

Why are there no complaints from other countries?

According to the Paul Ehrlich Institute, more suspected cases are reported to Astrazeneca than for the other vaccine products. From this one could "not necessarily infer a higher reactogenicity of the vaccine," reports the institute. The increased reporting rate could "also be related to the increased media attention".

How about in the UK, where a lot of Astrazeneca is used?

According to the Medicines Regulatory Authority (MHRA), four cases of cerebral vein thrombosis had occurred in the UK by mid-March, none of which are said to have been fatal. In total, millions of people have already been vaccinated with the vaccine. More than 30 million people in the UK have now received a first dose - either Biontech or Astrazeneca. Since the vaccination campaign is already well advanced, 50 to 59 year olds are currently being vaccinated. The UK had never paused vaccinations with Astrazeneca. Given the large number of doses given and the frequency with which blood clots occur naturally, there is no need to stop, the MHRA said.

What role does the age group play?

The age recommendations for Astrazeneca have already changed. The Standing Vaccination Commission (Stiko) had initially only recommended the drug for people under 65 - due to a lack of study data for older people. A little later, however, this was canceled and the vaccination recommended for everyone over the age of 18. In the light of the most recent cases, the panel decided not to recommend the drug until the age of 60 - and the health ministers followed suit. Because of the Stiko recommendation, older people have so far been given Biontech / Pfizer, while younger people have been given Astrazeneca - including nursing staff, teachers at primary schools and kindergarten teachers. Baden-Württemberg is the only federal state so far to also vaccinate teachers from secondary schools - also with Astrazeneca.

What's next?

The implications for the progress of the corona vaccinations and trust are still unclear. Astrazeneca plays an important role, also for the greater involvement of doctors' practices, which is aimed at after Easter. The countries should now be able to invite 60 to 69 year olds to Astrazeneca vaccinations. Generally - based on age - it is still the turn of the over 70s. More than 56 million cans are expected throughout the year. The board of directors of the German Patient Protection Foundation, Eugen Brysch, demanded: "So that the vaccination campaign can finally get going, vaccinators must be given the freedom to choose the serums." However, this should not mean giving up the ethical order in which vaccinations are offered. "Otherwise immobile, seriously ill and people in need of care will get under the wheels." By Sandra Trauner and Sascha Meyer, dpa

Germany suspends vaccinations with Astrazeneca! Tens of thousands of teachers and educators affected