COVID-19: Vaccine information for health professionals

Find useful resources, guidance and the latest information on the COVID-19 vaccine for the health sector, DHBs, health providers and vaccinators.

Last updated: 13 May 2021

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Vaccine operating guidelines

The COVID-19 Vaccine Operating Guidelines help District Health Boards (DHBs) and health providers maintain public safety and make sure that consistent and equitable COVID-19 vaccination practices are in place across New Zealand.

The Operating Guidelines provide guidance on establishing and managing a COVID-19 vaccination site and includes guidelines for the vaccination workforce.

COVID-19 Vaccine Operating Guidelines (PDF, 905 KB)
COVID-19 Vaccine Operating Guidelines (Word, 2.6 MB)
Version 11.0 – last updated 13 May 2021


Clinical guidance and resources

Latest clinical updates from the newsletter

These clinical updates are from the fortnightly newsletter that's published by the COVID-19 Vaccine and Immunisation Programme, specifically for the health and disability sector.

The newsletter includes the latest COVID-19 vaccine information. You can sign up for the newsletter and see previous issues:

Vaccine updates – health sector newsletter

12 May 2021: reporting adverse events, vaccinator training/processes, improvements for CIR

These clinical updates come from Issue 9 of the COVID-19 vaccine updates for the health sector newsletter. You can read Issue 9 to see full health sector vaccine updates. 

Issue 9, 12 May 2021 – vaccine updates for the health sector newsletter

Enhanced reporting for Adverse Events Following Immunisation (AEFI)

Our enhanced reporting mechanisms for COVID-19 vaccines are working well, and vaccinators are encouraged to provide as much information as possible when recording events. 

Vaccinators can record adverse reactions that occur during the 20 minute observation period post-vaccination in the in the COVID Immunisation Register (CIR). It’s important to complete all the tick boxes and provide written text when completing reports.

Adverse events occurring after the 20 minute observation period should be recorded via the online reporting form. This form is published on the Centre for Adverse Reactions Monitoring (CARM) website and is designed to make reporting of AEFIs easier. Please use this form to report all suspected AEFIs for COVID-19 vaccines that you are made aware of. You do not have to be certain that the vaccine caused the event in order to report.

The COVID-19 Vaccine Independent Safety Monitoring Board (CV-ISMB) has also been established to support the review of safety information for COVID-19 vaccines. The board consists of a panel of experts from clinical medicine, microbiology and biostatistics and provides recommendations and advice to CARM, Medsafe, CVIP and the Ministry of Health.

Changes to vaccinator training and vaccinator processes 

As part of the New Zealand COVID-19 response it is essential that all immunisation vaccinations continue to be delivered with a particular need for influenza vaccinations to be provided as rapidly as possible. There are several vaccination processes that have been amended to enable vaccinations to proceed and be given as safely and efficiently as possible, including: 

  • Removal of requirement for offsite vaccinators to carry oxygen.
  • A new Influenza and Pandemic Response Vaccinator Training Course.
  • Advice on expired or expiring CPR certificates.
  • Clinical assessments of new vaccinators.
  • Changes to the observation period post influenza vaccination – 13 years and above.

For a full list of the changes see the April update:

COVID-19 response – Changes to vaccinator training and vaccinator processes 

More improvements for CIR 

There are further improvements to the COVID Immunisation Register (CIR). 

  • Where a user attempts to record a second dose of the Pfizer-BioNTech Vaccination within 21 days of the first dose recorded in the CIR they will be presented with a warning. Users have the option to close the warning if they choose not to proceed, or click ‘Acknowledge’. 
  • Where a warning is Acknowledged, this will be recorded on the Immunisation Activity as ‘Early Vaccination Acknowledgement’. The warning must be acknowledged in the ‘Reception Arrival’ step as well as when the Vaccinator proceeds with the Vaccination Event in the CIR.
  • Where a patient has had their first Pfizer Vaccination overseas, this can be recorded in the CIR. This will then allow users to record a second Vaccination when appropriate.
  • There are a few key usability enhancements which will be included in this release:
  • Antigen Batch Number: The Antigen Batch number will include guidance on the correct format to enter.
  • Needle Type: The Needle Type picklist has been updated so the most commonly used needle types are at the beginning of the list
  • Case Reason: Users will have the ability to update the ‘Case Reason’ on the Immunisations Case for a patient. 

You will find release notes detailing these changes on the home screen of CIR Production and Classroom – please read these before starting your next shift.
 

28 April 2021: blood clots

These clinical updates come from Issue 8 of the COVID-19 vaccine updates for the health sector newsletter. You can read Issue 8 to see full health sector vaccine updates. 

Issue 8, 28 April 2021 – vaccine updates for the health sector newsletter

No blood clots with bleeding concerns for Pfizer vaccine

Medsafe advise there are currently no concerns of blood clots with bleeding (Thrombosis with Thrombocytopenia Syndrome; TTS) with the Comirnaty (Pfizer/ BioNTech) vaccine.

Medsafe have completed an initial evaluation of international reports of a rare syndrome of blood clots (thrombosis) occurring with bleeding (due to thrombocytopenia) and platelet factor 4 antibodies. To date, all the cases that have been reported after vaccination are linked to the first dose of Vaxzevria (AstraZeneca) or the Janssen COVID-19 vaccines.

These vaccines are not currently used in New Zealand. There have been reports of blood clots internationally after vaccination with Comirnaty – however, Medsafe’s assessment is that there is no indication that these cases are in any way similar to the TTS cases reported with the other COVID-19 vaccines.

This assessment was endorsed by New Zealand’s COVID-19 Vaccine Independent Safety Monitoring Board (CV-ISMB) on 22 April 2021. Up to 22 April 2021, the Centre for Adverse Reaction Monitoring (CARM) has received three cases of thrombosis (one stroke, one deep vein thrombosis and one cerebral venous sinus thrombosis).

There was no evidence of bleeding in any of these cases. Following review by CARM and the CV-ISMB, none of these cases was considered to be related to vaccination.

Medsafe have issued a Monitoring Communication in regards to this topic via their website.

Medsafe monitoring communication: COVID-19 vaccine blood clots

14 April 2021: vaccine spacing, adverse reactions, clozapine, influenza programme, consent

These clinical updates come from Issue 7 of the COVID-19 vaccine updates for the health sector newsletter. You can read Issue 7 to see full health sector vaccine updates. 

Issue 7, 14 April 2021 – vaccine updates for the health sector newsletter

Vaccine Spacing

With the COVID-19 vaccine programme gaining significant momentum, and the immunisation of border and MIQ workers nearing completion, our focus is now turning to the vaccination of frontline health care workers.  Some of you may have already received the first dose of the Pfizer/BioNTech vaccine (Comrinaty), so this is an opportune time to remind everyone that the vaccination involves the administration of two doses.

Between the two doses, there must be a minimum gap of 21 days. They do not need to be administered exactly 3 weeks after the first dose; however, the second dose booking should be arranged as close as possible to the 3-week mark.

More information on vaccination timings can be found in the Immunisation Handbook 2020 which provides clinical guidelines for health professionals on the safest and most effective use of vaccines in their practice.

Chapter on COVID-19: Immunisation Handbook 2020

Adverse reactions

Medsafe has published a first summary of Adverse Events Following Immunisation (AEFI) with COVID-19 vaccines, an overview of vaccine reports will be published weekly on the Medsafe website.

The adverse events were reported through the COVID-19 Immunisation Register (CIR) and reports from Healthcare professionals and consumers directly to the Centre for Adverse Reactions Monitoring (CARM). Most reports received via the CIR have occurred during the observation period and appear to be either hypersensitivity reactions or anxiety related (e.g. fainting, dizziness).

In the last couple of weeks we are seeing more reports of symptoms occurring in the days/hours following vaccination which have generally been flu like symptoms (e.g. fatigue/tiredness, headache and fever); where these symptoms have been more severe it has generally been following the 2nd dose which is expected from what has been seen in the clinical trials that the second dose  is more reactogenic. All events described are what we would expect with the Pfizer-BioNTech (Comirnaty) vaccine. 

The current reporting rate in New Zealand is ~0.8% which is slightly higher than overseas (Australia ~0.5% and US/UK ~0.2-0.3%), however is line with the general reporting of adverse drug reactions for medicines in New Zealand. We encourage reporting of AEFI within the initial observation period after COVID-19 vaccination in the CIR and any other suspected AEFI with COVID-19 vaccines to be reported using the COVID-19 reporting form on the CARM website.

Please use this form to report all suspected AEFIs for COVID-19 vaccines that you are made aware. You do not have to be certain that the vaccine caused the event in order to report.

For more information on the expected adverse reactions, please see the data sheets and consumer medicine information for approved COVID-19 vaccines. 

COVID-19 vaccine and clozapine

Following reports of discussions relating to vaccinating people who are on clozapine, IMAC is providing the following advice:   
An IMAC literature review shows no signal regarding safety of Pfizer vaccine and neutropenia in mental health patients on clozapine. COVID vaccine should not be withheld to these patients. 

  • The review shows there are no known interactions between COVID vaccination and neuropsychiatric medications.
  • The review also argues that the neutropenia associated with clozapine is a risk for severe COVID so COVID vaccine should be given as a matter of urgency.
  • In the UK, Pfizer data shows 14 neutropenias and 1-2 pancytopenia/myelosuppressive adverse events in the 3 months since end of Dec amongst 25 million doses of vaccine – both Pfizer and AZ
  • Neutropenia/agranulocytosis — Clozapine-induced agranulocytosis was estimated to occur at a rate of approximately 0.8%. A much higher rate than that seen by the Pfizer data 
  • This is why these patients are monitored intensively for neutropenia with monthly testing especially in the first year of treatment.
  • There may be temporal association of neutropenia in 14 cases but any neutropenia is not causally associated with the COVID vaccine.

Influenza programme

The annual influenza immunisation programme is going ahead, with a focus on people who are eligible for a funded vaccination. This includes pregnant women, people aged 65 and over, people with certain chronic health conditions and children aged 4 and under with serious respiratory illnesses.
There remains a public health risk of influenza even with the current border settings and it is important we continue the programme to ensure background immunity is maintained and our most vulnerable are protected.

PHARMAC advises that plenty of vaccine will be available to New Zealanders, with a record number of 2.4 million doses being brought into the country.

The programme will begin as scheduled on 14 April for those aged 65 and over. This year there is a vaccine for people aged 65 and over, Fluad Quad, and we received feedback from providers last week that stock had arrived as planned. The vaccine supplier has confirmed that the vaccines for people aged under 65 will be available from 17 May 2021. As with Fluad Quad, distribution of these vaccines will begin ahead of this date to ensure that all providers have stock ready to begin.

Please go to influenza.org.nz for further information about the vaccines for this season. HCL advises vaccines for people aged under 65 will be available to order from 27 April.   

COVID-19 vaccinations are the priority - people should have their COVID-19 vaccination first if they have an appointment booked for it. 

If they are aged 30 or under, check if they are up to date with their measles, mumps and rubella (MMR) vaccine. If they do not have an appointment to get their COVID-19 vaccination, they can get their MMR (if they need it) and influenza vaccinations first.  Please book these in.

We recommend a gap of around two weeks between influenza and COVID-19 vaccinations, and four weeks or more between measles, mumps and rubella (MMR) and COVID-19 vaccinations. 

The gap can be reduced to two weeks when giving the MMR vaccine after the second dose of the COVID-19 vaccine.

Please note that while a two-week gap between influenza and COVID vaccines is recommended, there are no clinical safety concerns should the gap between vaccines be less than two weeks. MMR and influenza vaccines can be given at the same time.

From May and June, the COVID-19 and influenza immunisations will be available to a wider group of people within the same time frame. You can use the guidance distributed alongside this year’s Influenza Toolkit, out shortly, on how to manage MMR and flu immunisations around the COVID-19 immunisation programme taking into account the recommended gaps between vaccines. 

Consent

The use of a verbal consent for the Comirnaty™ vaccine and any future COVID-19 vaccines that may be approved for use by Medsafe has now been given the green light.  However, there has been no change for Tier 1 consumers (border workers and MIQ staff and their household contacts) where written consent will still be required.  This is because these workers are less likely to be able to perform their work safely without being vaccinated and may therefore feel a greater sense of responsibility or pressure to accept the vaccine as distinct from the general population - having a written record of Tier 1 consumers’ informed consent reflects their particular risk exposure and employment situation. 
For the vast majority of COVID-19 vaccinations, however, written consent is no longer required. Instead, we are using a technology-enabled verbal consent process that meets the legal requirements of the of the Health and Disability Commissioner’s Code of Consumer Rights. This means that vaccinators and administrators in the majority of cases no longer need to scan and upload consent forms to the COVID Immunisation Register (CIR).
Apart from the Tier 1 consumers, there are a couple of other exceptions: 

  • Written consent must be obtained where there are significant risks to the consumer, per clause 7(6) of the Code (e.g. a significant risk of adverse reactions)
  • Written consent may be obtained if this is the DHB or provider’s preference, for example, in aged residential care settings.

Immunisation handbook

The Immunisation Handbook 2020 has a specific chapter about COVID-19 vaccines, including detailed clinical guidance.

The handbook provides clinical guidelines for health professionals on the safest and most effective use of vaccines in their practice.

These guidelines are based on the best scientific evidence available at the time of publication, from published and unpublished literature.

Immunisation Handbook 2020

Immunisation Advisory Centre (IMAC)

The Immunisation Advisory Centre (IMAC) has been contracted by the Ministry of Health to provide education, training and support to all health professionals and allied workforces during the COVID-19 vaccine rollout. 

Support is available via the IMAC website or 0800 IMMUNE. You can find out more about becoming a COVID-19 vaccinator or how we will build our COVID-19 vaccinator workforce. 

COVID-19 education – vaccinator information (IMAC)
COVID-19 education – for health and allied workers (IMAC)

Medsafe vaccine approval and data

Medsafe have approval status updates and datasheets for the COVID-19 vaccines.

Approval status of COVID vaccine applications
Pfizer COVID-19 vaccine – Consumer medicine information summary (Medsafe)
Pfizer COVID-19 vaccine – New Zealand data sheet (Medsafe)


Āwhina app for vaccine updates

The Āwhina app puts tailored COVID-19 information in the hands of health workers.

We’re using the app to alert vaccinators and their supports to clinical, critical or time-sensitive updates. The app allows us to send immediate push notifications to vaccinators and supports.

Anyone can download Āwhina. It will be particularly useful for vaccinators, practice managers or anyone involved in the vaccination programme.

Find out more and download Āwhina


Vaccine training

The Immunisation Advisory Centre (IMAC) are running:

  • COVID-19 vaccine training for GPs
  • COVID-19 educator training module for vaccinators
  • a train the trainer programme supporting the current immunisation workforce with information to support their teams in training later.

Webinars and Q&A sessions

IMAC are also hosting a range of webinars and weekly drop-in online Q&A sessions to share what they know on COVID-19 vaccines and the rollout with health professionals.

See upcoming events and register – IMAC

The COVID Vaccine and Immunisation Programme run fortnightly webinars for primary and community care (Thursday mornings, 11am-12noon), providing updates and highlighting areas of work within the programme.

If you would like to receive an invitation to these webinars, that are run via Microsoft Teams, please email [email protected] 

Join the vaccinator workforce

We’re looking for additional vaccinators to support the COVID-19 vaccine rollout. If you’re a retired health professional or not currently working in the health workforce and want to volunteer, you can register your interest.

COVID-19 Surge Workforce database
Email: [email protected]


COVID-19 Immunisation Register (CIR)

The web-based national COVID-19 Immunisation Register (CIR) is up and running. It’s being used by vaccinators to record COVID-19 vaccinations. Once a vaccination has been entered into the CIR, automatic notifications are sent to Patient Management Systems (PMS). 

The CIR is only for COVID-19 vaccinations and all other vaccinations should continue to be recorded on the National Immunisation Register.

Accessing the CIR

Vaccinators need their own individual work email addresses to use CIR. You can’t use a practice-wide email address. This is because important information such as login credentials, password resets and important vaccinator updates are communicated via the email you provide, so a shared email address won’t work.
 


Reporting Adverse Events Following Immunisation (AEFI)

We encourage you to report any AEFI experienced by people who have had the COVID-19 vaccine.

  • If it’s within the initial observation period – report this in the COVID-19 Immunisation Register.
  • If it’s any other suspected AEFI – report this using the COVID-19 reporting form on the Centre for Adverse Reactions Monitoring (CARM) website. You don’t have to be certain that the vaccine caused the event in order to report it.

Medsafe safety reports

Medsafe then closely monitors and releases a safety report showing the AEFI data each week. This shows the most common side effects that people in New Zealand experience after getting the COVID-19 vaccine.

Medsafe safety reports: Adverse events following immunisation with COVID-19 vaccines

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