The vaccines for COVID-19 used in Iceland are safe and provide the best possible protection against the disease. The object of the vaccination is to protect individuals from contracting COVID-19 and prevent the spread of the pandemic.
Four different vaccines from four different manufacturers are being used in Iceland. The Directorate of Health website has further information on the efficacy of the vaccines. Þroskahjálp (National Association of Persons with Intellectual Disabilities) have prepared a pamphlet in easy-to-read language on the use of vaccines for COVID-19.
AstraZeneca
The AstraZeneca vaccine contains a cold virus that has been inactivated so that it cannot reproduce and genetic material added for the same protein as our bodies produce after the mRNA vaccination.
The vaccine is transported and stored under the same conditions as the vaccines we use in routine primary care. There are 10 doses in each vial and they must be used within a few hours of opening the vial. Therefore, the vaccine is ideal for rural areas.
Allergic reactions are not as common for this vaccine as for the mRNA vaccines. An unusual type of blood clot has been reported as a serious but rare side effect in many European countries, which is why its use has been discontinued for women under 55 and for people with a previous history or risk of blood clots.
AstraZeneca is registered for individuals aged 18 and over. To begin with, there was uncertainty about efficacy in those aged 65 and older due to the small number of participants in that age group in pre-marketing research, but the data available is now adequate following research in the UK. Studies on vaccinating children have begun. It is now given to women 55 and older who are not at risk for phlebothrombosis or blood clots, and to men of all ages who meet the same criteria.
It takes 12 weeks to finalise the vaccination. The period between injections can be shorter, but this provides the best protection.
Janssen
The Janssen vaccine contains a cold virus that has been inactivated so that it cannot reproduce and genetic material added for the same protein as our bodies produce after the mRNA vaccination.
The vaccine is transported frozen but can be stored at the vaccination site under the same conditions as the vaccines used daily in primary care. There are five doses in each vial and they must be used within a few hours of opening the vial. Therefore, the vaccine is ideal for rural areas.
Allergic reactions are not as common for this vaccine as for the mRNA vaccines. Blood clots of the same type known with the AstraZeneca vaccine have occurred where millions of doses have been used but are extremely rare.
The vaccine has a marketing authorisation license as a one shot vaccine and is the only such vaccine used in Iceland. One dose of Janssen significantly reduces the risk of infection, serious illness and death from COVID-19 disease. Therefore, it can be well suited for individuals who are difficult to reach for re-vaccination due to residence, work or otherwise. It is being investigated whether a booster dose further strengthens the defense.
Janssen is used for individuals 18 years or older, but studies on vaccinating children have begun. The vaccine is given to those that might not be able to receive two doses in Iceland, such as individuals who work in Iceland but reside in a foreign country or work in a foreign country but reside in Iceland.
This vaccine is not recommended for immune compromised individuals or pregnant women.
Moderna
The Moderna vaccine is a so-called mRNA vaccine. It contains no virus, but rather genetic material in a lipid particle. The body reads the genetic material and produces proteins that the immune system learns to recognise.
The vaccine must be transported and stored in the dark and 11 doses can be extracted from each vial with the right equipment. The vaccine must be used immediately after mixing without delay. Therefore, it is best to use the vaccine in urban areas where large groups of people can be called in.
Allergic reactions are more common than with some other vaccines.
The vaccine is allowed to use for individuals 12 years or older. The vaccine is used for groups that need to be vaccinated as soon as possible.
Four to five weeks should elapse between doses and no more than five weeks.
Pfizer/BioNTech
The Pfizer/BioNTech vaccine is a so-called mRNA vaccine. It contains no virus, but rather genetic material in a lipid particle. The body reads the genetic material and produces proteins that the immune system learns to recognise.
Must be transported in very cold conditions but can be stored in a refrigerator for a few days before use. Six doses can be extracted from each vial with the right equipment. The vaccine must be used immediately after mixing and therefore it is best to vaccinate a group of people simultaneously.
Allergic reactions are more common than with some other vaccines.
The vaccine is used for individuals 12 years or older. Three weeks should elapse between doses and no more than six weeks.
Side-effects after COVID-19 vaccination:
All immunizations can cause discomfort that are called adverse effects or more commonly side-effects. Most side-effects are a result of the activation of the immune system, which is the purpose of the immunization. These symptoms are usually the same for all vaccines:
- Fever >38°, chills, body aches
- Local symptoms at injection site
- Tiredness, feeling unwell, headache, stomach/intestinal symptoms
These symptoms usually arise within 24 hours of the vaccination and rarely last longer than 24-48 hours except for local symptoms and lymph node swellings (see below). Symptoms often arise more quickly after a repeat dose of the same vaccine. Local symptoms can be simple ache but sometimes include itching, redness or swelling. These symptoms often last longer than 24 hours, even up to a week. It is not necessary to report these symptoms to the primary health care or the institution that performed the immunization, or to the Icelandic Medicines Authority (IMA), unless they are unusually severe. Paracetamol or ibuprofen can be used in the package recommended doses for those individuals who can tolerate those medicines, if necessary to reduce discomfort after vaccination.
Lymph nodes nearest to the injection site, usually under the injected arm, are a well known but rare side effect related to the activation of the immune system. If they are more widespread it is advisable to contact a health care provider, for example in primary care, who will assess whether an examination or treatment is necessary and report to the IMA.
Possible side-effects of COVID-19 vaccines apart from immune activation:
These side-effects should be reported to the IMA in all cases because of the additional monitoring in effect for these new products. Be aware that connection to the vaccination has not been confirmed for all such symptoms but if occurrences are well documented it may be possible to confirm or refute a causal relationship with the vaccination. When causal relationships are confirmed it may be possible to define those who are at risk of such side-effects and plan for appropriate response or make additional recommendations regarding vaccination of such individuals.
Comirnaty/Pfizer BioNTech vaccine: (see product information)
- Anaphylaxis or other acute allergic symptoms
- Facial nerve palsy (Bell palsy)
- Other sudden, new onset symptoms that may be related to the vaccine
Moderna vaccine: (see product information)
- Anaphylaxis or other acute allergic symptoms
- Facial nerve palsy (Bell palsy)
- Other sudden, new onset symptoms that may be related to the vaccine
Astra Zeneca vaccine: (product information is being updated)
- Anaphylaxis or other acute allergic symptoms
- Blood clots with low platelets (Thrombosis with Thrombocytopaenia Syndrome; TTS) – rare but believed truly related to vaccination although the mechanism is still unknown. New onset symptoms that should prompt an urgent medical assessment if arise within 14 days of vaccination include:
- Difficulty breathing/dyspnoea
- Sudden new and severe pain in the head, chest or abdomen
- Pain and swelling of a limb other than the one injected with the vaccine, without preceding injury
- Neurological symptoms such as blurry vision
- Petechiae and purpurae/blood spots or bruises on the skin other than around the injection site
- Other sudden, new onset symptoms that may be related to the vaccine
Janssen vaccine
- Anaphylaxis or other acute allergic symptoms
- Other sudden, new onset symptoms that may be related to the vaccine
Notification to the Icelandic Medicines Authority:
Anyone can notify the IMA of a suspected adverse effect of a medicine, including vaccines. Family members or staff in long-term care facilities can send notifications on behalf of vaccinated inhabitants of such facilities. It is most important to notify the IMA if suspected side-effects are new (not included in the product information above), previously described but of uncertain incidence (according to the product information) or serious (requiring treatment beyond the simple fever reducing pain medicines discussed above). Notifications can be made to health care providers who then report to the IMA, by email or directly on the IMA website.
