Should I stay or should I go? Observation post-vaccination during the COVID-19 pandemic and the law of unintended consequences
Gerard Ingham
A B * and Rebecca Kippen B
A Springs Medical, 10 Hospital Street, Daylesford, Vic., Australia.
B School of Rural Health, Monash University, Bendigo, Vic., Australia.
Australian Journal of Primary Health 28(6) 542-548 https://doi.org/10.1071/PY22074
Submitted: 5 April 2022 Accepted: 5 August 2022 Published: 8 September 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY)
Abstract
Background: Standard practice after all vaccinations in Australia is to observe patients for 15 min. During the coronavirus disease 2019 (COVID-19) pandemic, could the risk of contracting and dying from COVID-19 acquired in the waiting room be greater than the risk of dying from post-vaccine anaphylaxis when leaving immediately?
Methods: The risks are modelled for a patient aged 70+ years attending for annual influenza vaccination in a typical Australian general practice clinic. The risk of death from anaphylaxis is estimated based on known rates of anaphylaxis shortly after influenza vaccination. The risk of acquiring COVID-19 during a 15-min wait and then dying from that infection is estimated using the COVID-19 Aerosol Transmission Estimator and COVID-19 Risk Calculator.
Results: Other than at times of extremely low COVID-19 prevalence, the risk of death from anaphylaxis for a patient aged 70+ years leaving immediately after influenza vaccine is less than the risk of death from COVID-19 acquired via aerosol transmission during a 15-min wait. The risk of death from COVID-19 is greatest for the unimmunised and when masks are not worn.
Conclusions: A more nuanced approach to advice post-vaccination is recommended that considers current COVID-19 prevalence and virulence, the characteristics of the waiting room, the risk of anaphylaxis, and the patient’s susceptibility to death from COVID-19. There are many circumstances where it would be safer for a patient to leave immediately after vaccination.
Keywords: anaphylaxis, COVID-19 aerosol transmission, COVID-19 transmission modelling, delivery of health care, immunisation in general practice, immunisation programs, mask wearing, pandemic, post-vaccination observation.
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