ATAGI issues advice on sedation for COVID-19 vaccination

Jolyon Attwooll

12/04/2022 3:58:43 PM

The advice, which is intended to be ‘general in nature’, was discussed at the advisory group’s most recent meeting.

Pfizer COVID-19 vaccination
ATAGI has stated sedation with vaccination can be considered ‘in special circumstances’.

The Australian Technical Advisory Group on Immunisation (ATAGI) has issued new advice for using sedation when carrying out COVID-19 vaccinations.
The advisory group states sedatives should not be used as a ‘first line option’ in most cases but says they could be a possibility under ‘a tiered approach’.
Patients with severe anxiety or needle-phobia as well as certain groups with behavioural disorders would be among those who could be vaccinated under sedation ATAGI says, but only ‘in special circumstances’ where no other options remain.
‘Many individuals with anxiety or behavioural disorders can be safely vaccinated in the community using non-pharmacological techniques, such as a low-sensory stimulation environment, presence of comfort person/object, distraction with music, video or toys, relaxation techniques and cognitive behaviour therapy [for anxiety/needle-phobia],’ the advice says.
‘Possible indications for sedation include people with severe anxiety or needle-phobia and developmental or behavioural disorders, where non-pharmacological measures to facilitate vaccination have been exhausted.’
The published advice is described as ‘general in nature’, with authors noting that some health services have developed guidelines on using sedation with COVID-19 vaccination or are currently formulating them.
More detailed clinical guidance should be put together in partnership with anaesthetic groups as well as relevant local health services and specialists, ATAGI states.
Adjunct Associate Professor Bob Davis, Chair of RACGP Specific Interests Disability, said the advice makes sense and will contribute to providing even more protection.
‘The COVID situation has highlighted the need to consider the special situation of people with intellectual disability and make appropriate adjustments so that they have equitable healthcare,’ he told newsGP.
Associate Professor Davis believes the unique circumstances of the spread of COVID-19 have changed the balance of risks and benefits for GPs when they are considering sedation for vaccination.
As well as the illness itself, he also highlighted the potential social challenges for some patients with a disability if they are obliged to isolate.
‘If we weren’t in the middle of a pandemic with this particular infection, if it was happening at relatively minor rates, then the urgency of vaccination wouldn’t be there,’ he said. ‘But clearly, with the [case] numbers that we have out in the community, it is.’
Sedation requires informed consent either from the patient, or from a parent, guardian or substitute decision maker if they cannot give it themselves.
‘Sedation should not be used as a measure to enforce compliance with vaccination requirements,’ the advice notes.
The advisory body says all of the current COVID-19 vaccines approved for use in Australia are considered ‘safe and suitable’ for use with sedation and can be considered for co-administration with other vaccines, including influenza.
‘There are no theoretical concerns regarding immunogenicity or effectiveness of COVID-19 vaccines if administered under various methods of sedation,’ the advice reads.
‘There are no concerns about the safety of COVID-19 vaccines if administered following use of various medications beyond the safety and risk of sedation itself.’
ATAGI says vaccination could also be considered opportunistically if a patient is undergoing sedation for separate elective surgery – as long as they are not acutely unwell.
The type of sedative and sedation should be worked out case-by-case, the advisory group also recommends. The patient’s medical history, available resources and the relevant local sedation procedure guidelines should all be considered.
‘While there are no data on the safety of specific sedative agents given concurrently with any specific vaccine, there are also no theoretical safety concerns,’ ATAGI states.
According to the advice, COVID-19 vaccines can be administered regardless of whether the patient is under light or deep sedation.
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