TRANSCRIPT: COVID-19 Vaccine 301

Dr. Jeff Balser:

Hi everyone.

Thanks for joining the third video in our series about COVID-19 vaccines. Our goal is to provide you with timely and clear information, including how the vaccines work, why we are confident the vaccines are safe, and why it is so important for as many of our people at VUMC as possible to be vaccinated.

We now have several weeks of immunizing the VUMC workforce with the Pfizer vaccine. To date, over 15,000 of our colleagues have received the first dose of the vaccine, and we are just beginning to give the 2nd dose to our healthcare workers at greatest risk for COVID-19 exposure.

However, we still have many people at VUMC who have not yet registered for the vaccine, including frontline staff who are exposed to patients. So today, we're going to talk more about the vaccine, and answer some specific questions people have raised. For example, should a woman be vaccinated if she is pregnant or breastfeeding, or even thinking about getting pregnant?  

Once again, Dr. William Schaffner, our very own trusted and world-renowned infectious disease expert is here. And he is joined today by Dr. Jennifer Thompson, one of our leading specialists in Maternal Fetal Medicine.

Dr. Schaffner?

Dr. William Schaffner:

Thank you Dr. Balser, and hello everyone.

In Vaccine 101 and 201 we discussed vaccines and provided information from our VUMC experts to show that COVID-19 vaccines are safe and effective. Our goal continues to be to keep you and those around you safe from the coronavirus. (You can watch 101 and 102 or read the transcripts here.)

Today we want to provide some specific information for women based on questions we have received – think of this as Vaccine 301.

When we last talked, we were preparing to start vaccinating and how exciting is it that we have already vaccinated over 15,000 workforce members. I got my vaccine and I only had a minor sore arm, but I also felt a sense of relief that we have finally started on a path to build protection against this virus. I look forward to getting my second dose in just a few weeks.

I cannot stress enough the importance of getting the vaccine. Understandably, we get a lot of questions from people on if they should or should not get the vaccine.  

Broadly speaking everyone should get the vaccine unless you fall into one of these groups: if you are under the age of 16, people with a history of serious reaction (such as anaphylaxis) to a vaccine ingredient and people who received a monoclonal antibody infusion for treatment of COVID-19 within the past 90 days.

One other group of individuals who should consult with their health care provider before getting the vaccine is if you have a documented history of bleeding or platelet disorders. Other than that, as long as you are not sick at the time of vaccination, we hope you schedule and get your vaccination.  

I’d like to address specific vaccine questions that we have heard from women to address their concerns about getting the vaccine.

First, I want to stress an important point that we covered in vaccine 201 about what an mRNA vaccine is and its safety. mRNA stands for messenger RNA. You can think of it as an instruction manual teaching the body how to build proteins. In the case of the COVID-19 vaccines, the mRNA teaches your immune system to make specific antibodies that prevent the spikes on the outside of the COVID virus from attaching to your cells. If the virus can't attach to cells, it can't make you sick.

We have heard concern from women that will it change their DNA and will it affect the DNA of a fetus or that it will cause sterility. mRNA does not interact with or change your DNA, thus it's very safe. mRNA goes nowhere near the DNA and once it delivers its message, it disintegrates and is eliminated from your body.  

To further expand on these topics, I am joined by my VUMC colleague Dr. Jennifer Thompson, a practicing physician in Maternal Fetal Medicine with expertise in infectious disease for women.  

Jennifer, the first question is should women get the vaccine if they are pregnant?  

Dr. Jennifer Thompson:

Bill, thank you for having me and I appreciate you bringing me here to discuss these very important questions for women. We know there are valid questions out there and I first want to let women know that the American College of Obstetricians and Gynecologists convened a group of experts to review COVID-19 vaccine safety issues and concluded the vaccine should be available to pregnant and lactating women. A full summary of their recommendations can be found on their website.  

Now to answer your question. Yes, women who are pregnant should be offered the vaccine assuming they meet all other criteria for vaccination. I am recommending to my patients that they get the vaccine when they are eligible. The risk of not getting the vaccine could be far greater if you become infected with the virus and become seriously ill.

We know that pregnant women who develop symptomatic COVID-19 infection have increased risk of serious disease including increased risk of hospitalization, ICU admission, mechanical ventilation, and death compared to symptomatic nonpregnant individuals. There have been some very sad stories from colleagues across the country of pregnant women who became infected and seriously ill and sadly ultimately passed from complications of the virus.

Pregnant women were excluded from the vaccine trials; however there were a small number of study participants who inadvertently became pregnant during the study. To date there have been no safety concerns in those women or their pregnancies. While safety data on the use of COVID-19 vaccines in pregnancy are not currently available, there have been no safety concerns from studies of the Pfizer and Moderna COVID-19 vaccines.

Additionally, data from the developmental and reproductive animal studies for both the Pfizer and Moderna vaccines are available and did not show any concerns of adverse effects. It is also important to note that the vaccine can be administered in all trimesters of pregnancy. At this time, we have no evidence to suggest that the vaccine can cross the placenta and affect a fetus.

Receiving the vaccine will prevent you from getting COVID-19 and reduce the risk of developing severe disease in pregnancy.

Dr. Schaffner: How about women who are breastfeeding, should they get the vaccine?

Dr. Thompson:

Women who are lactating should get the vaccine assuming they meet all other criteria. Any concerns regarding the safety of getting the vaccine do not outweigh the potential benefits of receiving the vaccine and protecting yourself from serious illness.  

Additionally, there is no need to avoid initiation or discontinue breastfeeding if you receive a COVID-19 vaccine.

Women who receive the vaccine who are lactating may provide benefit to their newborns through the antibodies stimulated by the vaccine passively transferring to the breast milk. This passive transfer may provide immunity to their child as well.

Dr. Schaffner: So, here is the last question, how about women who are thinking about having a child someday and are nervous about getting the vaccine?

Dr. Thompson:

Vaccination is strongly encouraged for non-pregnant individuals assuming they meet all other criteria for vaccination. It is also recommended that individuals who are actively trying to become pregnant or are contemplating pregnancy and meet the criteria for vaccination get the vaccine. It is also not necessary to delay pregnancy after completing both doses of the COVID-19 vaccine.

I also want to address another concern I have heard and that is does an mRNA vaccine cause sterility?

There is no data to suggest this is the case. Given the mechanism of action and the safety profile of the vaccine in non-pregnant individuals, COVID-19 mRNA vaccines are not thought to cause an increased risk of infertility. If an individual becomes pregnant after the first dose of the COVID-19 vaccine series, the second dose should be administered as indicated.

I want to close by stressing the importance for all women to consider getting the vaccine if they meet the criteria. Considering your own personal risk is also important. Given the increased risk of severe COVID-19 infection in pregnancy, I have been recommending the vaccine to my patients. I got the vaccine and am so thankful to know that I am building immunity and protecting myself and my family from serious illness.  

It is understandable to have questions and even maybe reservations about getting this vaccine, but this is an effective vaccine and will protect you. If you continue to have concerns, I encourage you to talk with your healthcare provider about those concerns so you can make an informed decision.

Dr Schaffner:

Thank you, Jennifer. This is great information and the takeaway is for your protection from COVID-19 and serious illness you should get the vaccine.  

This virus does not discriminate and can affect anyone young or old. The risks of not getting vaccinated and becoming infected and seriously ill are far greater than getting the vaccine to build your immunity.

Once you are vaccinated please enroll in the V-Safe program from the CDC. You can find it on the CDC website. This important program allows you to tell the CDC about any side affects you may encounter after getting the vaccine and helps ensure the ongoing safety of the vaccine through feedback from those who got it.  

Remember, you'll likely experience some mild to moderate side effects after the vaccination, such as a sore arm, maybe some fever, muscle aches, headache, or fatigue. These side effects are all good signs because they show that your body is building immunity.

Finally, please enroll (for VUMC employees only) and get your vaccine, and if you have any questions, refer to the VUMC coronavirus webpage for up to date answers to common questions.

Best wishes and stay safe!