Dr Maura Abbott Explains How Vaccine Form Determines Patient Contraindications

The form a vaccine takes—inactive or live attenuated—will dictate who can or should not receive a coronavirus disease (COVID) 2019 vaccine and why immunocompromised patients require special consideration, noted Maura Abbott, PhD, AOCNP, CPNP, RN, assistant professor of nursing at the Columbia University School of Nursing.

Transcript

For whom might a coronavirus vaccine be contraindicated?

Yes, there is potentially some persons in which this [vaccine] may not be used. It’ll basically be determined by the form that the vaccine ends up being. And again, there's multiple vaccines that are being trialed right now, so there may be different formulations of the vaccine. Again, we don't know this.

And so just to give an example, the flu shot is an inactive vaccine. So what that means is that the particles of the virus that are in the shot are dead; they cannot replicate and you cannot get the flu from the flu shot. You might have a reaction, because that's your immune system building immunity to the flu, by getting the flu shot—sore arm, a little bit achy there—but you don't get the actual flu from the flu shot.

A little bit different are live attenuated vaccines. So that's like the chickenpox vaccine. Those vaccines have a weakened and live strain of the virus, and it's attenuated. So, it's been manipulated so that it's less likely to replicate and the person really doesn't get the chickenpox from it. But there is a chance that you could get like a localized chickenpox reaction or a not-feel-good, have a fever, something like that. Those kind of vaccines we don't give to persons who have some sort of immunocompromised system.

So for instance, in my patient population, cancer patients, we don't give them live attenuated vaccines because they're at risk for actually developing chickenpox from the chickenpox vaccine, because it's not completely dead; it still has a component of being able to replicate, the virus can replicate.

If it turns out that the COVID vaccine is an inactivated vaccine, unless there's a component to the vaccine that somebody is allergic to that we know about, it’s generally safe for everybody. For those who are immunocompromised, it may not be as effective in because they can't build an immune response. But it wouldn't be contraindicated. Different if it was live attenuated. Potentially, that would not be given to persons who are immunocompromised, for the risk of them actually developing COVID disease.