Is it time for the post-vaccine wait to go?

For GP Dr Gerard Ingham, the standard practice of monitoring patients for 15-minutes post-vaccination may no longer be in their best interest.
 
Despite acknowledging the small – but real – risk of adverse reactions like anaphylaxis, he believes the current pandemic environment poses a much greater danger, particularly for patients who are vulnerable to COVID.
 
By following the normal procedure, Dr Ingham has already had patients inadvertently exposed to COVID-positive people in his waiting room post-immunisation.
 
And with vaccination – and potentially community transmission – set to ramp up as we head into autumn and winter, he is questioning whether a change should be made in a new pre-print article co-authored with Monash University’s Associate Professor Rebecca Kippen.
 
‘During a pandemic, the risk of catching COVID in the waiting room and dying from it may often be higher than the risk of dying from anaphylaxis if leaving immediately [after vaccination],’ Dr Ingham told newsGP.
 
‘Both risks are tiny, but we found the risk of staying can be several hundred times higher for some people.’
 
In their paper, which is yet to be peer-reviewed, Dr Ingham and Associate Professor Kippen modelled the risk of contracting and dying from COVID for an average over-70s patient attending a typical general practice for their annual influenza vaccine this autumn.
 
The modelling found the risk of anaphylaxis post-influenza vaccination is less than the risk of death from COVID acquired via aerosol transmission during the standard 15-minute wait, with the risk being greatest for the unimmunised and when masks were not worn.
 
They also found it only became safer for those aged 70 or older to remain in the waiting room once the level of active COVID in the community was as low as one in 4000 people, which according to Associate Professor Kippen, ‘isn’t expected to happen any time soon’.
 
But despite the results, Dr Ingham says he has experienced significant ‘pushback’ from journals for questioning standard practice.
 
‘I have never before experienced the difficulties I have confronted with my latest work,’ he said.
 
‘The paper has been rejected by a couple of journals already.
 
‘But there is no evidence for current practice [in the pandemic context] – only expert opinion.’
 
Current advice from the Australian Technical Advisory Group on Immunisation (ATAGI) is for the same 15-minute observation period to be applied to COVID-19 vaccinations as for other vaccines.
 
Meanwhile in the UK, expert opinion is what led to the 15-minute wait being temporarily scrapped.
 
‘In the UK, they have abandoned the 15-minute wait post-COVID booster so immunisation clinics can be more efficient,’ Dr Ingham said.
 
‘Their chief medical officers concluded that if there are fewer people in the waiting room, then greater throughput can be achieved thus achieving a greater good.’
 
Back on home soil, Australian GPs have been, and continue to be, an integral part of the national COVID-19 vaccination rollout with more than 35 million doses being administered in primary care settings to date.
 
But many clinics have also had to make physical and logistical changes to adhere to ATAGI’s advice of a 15-minute observation period post vaccination.
 
As we head into an uncertain winter, Dr Ingham hopes his pre-print will spark debate around best practice while he awaits formal publication.
 
‘The pandemic has normalised the practice of releasing pre-prints of papers about COVID-19,’ he said.
 
‘If I await the normal academic process, the findings of our research looking into immunising during this autumn will be out of date by the time of publication.’
 
He also believes that advice given after vaccination should be individualised for each patient.
 
‘If the level of COVID is high in the community and the patient doesn’t have a history of severe allergic reactions, our findings suggest they are often safer to go,’ he said.
 
‘I also suspect many GPs and pharmacists are not following ATAGI advice currently.’
 
ATAGI was contacted for comment but did not respond prior to publication.
 
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