With the province moving to a 16-week interval between the first and second dose of COVID-19 vaccines, breast-imaging professionals and radiologists across Canada are recommending screening mammograms be performed four to six weeks after either jab.
A recommendation drawn up in early February, suggested patients and providers consider screening prior to the first dose of a COVID-19 vaccine or four to six weeks after the second dose. But with the new delay between the first and second dose, Dr. Jean Seely said she is concerned the initial recommendation may pose a risk to women who really need a mammogram, especially with breast cancer screenings already delayed due to the pandemic.
“We are seeing a lot of the impact of the delays of people not getting screened,” said Seely, president of the Canadian Society of Breast Imaging (CSBI) and head of the breast imaging section of the department of medical imaging at The Ottawa Hospital. “To be vaccinated is also very important and doing both is really critical from a public health standpoint.”
Mammograms are just one of a number of treatments or procedures, from chemotherapy to spleen removals, whose timing may be impacted by COVID vaccinations.
The Moderna and Pfizer vaccines can cause swelling in the lymph nodes in the underarm and collarbone area; 11.6 per cent of recipients of the Moderna vaccine aged 18 to 64 experienced this following the first dose, with 16 per cent reporting new lumps after the second shot. While swelling of the lymph nodes on the same side a patient received a COVID-19 jab is “a sign the vaccine is working,” it could lead to a false reading on a mammogram, Seely said.
“If it persists after six weeks, then we would worry about the possibility of it being related to cancer,” she said.
Like with breast cancer, lung cancer and melanoma can spread to neighbouring lymph nodes, which is why recommendations coming out of other countries like the United States suggest lung cancer screenings be delayed by up to six weeks as well, Seely noted.
In addition to cancer screenings, undergoing chemotherapy, other types of vaccines and even having a spleen removed or getting a case of the common cold can all affect the best timing to receive a COVID-19 jab.
People undergoing chemotherapy for cancer should wait until the end of their planned cycle to schedule a COVID-19 vaccination, ideally between two to four weeks after their last dose of treatment, said Dr. Gerald Evans, an infectious disease specialist at Queen’s University.
“We know chemotherapy can impact the immune system in terms of reducing the cells that need to respond to the vaccine,” Evans said.
Sometimes a COVID-19 vaccine can be administered to a patient who has two to three chemo-free weeks before their next cycle begins, but a conversation between the patient and their oncologist needs to take place first.
There are some other unique circumstances that can impact vaccine timing, Evans explained. For example, people who need to have their spleen removed should be vaccinated a couple weeks prior or four weeks after the surgery, because the spleen carries a lot of “effector cells,” which produce a response to a stimulus like a vaccine.
People who are dealing with an acute infection or inflammatory condition — like a common cold — can wait a week or so before receiving the vaccine to allow for the best immune response. Those who have actually had COVID-19 should be recovered before sitting down for a vaccine, Evans said.
Currently, no data exists on the simultaneous administration of COVID-19 vaccines with other vaccines. In the absence of evidence, The National Advisory Committee for Immunization (NACI) recommends waiting for a period of at least 28 days after each COVID-19 vaccine dose before receiving another vaccine. The recommendation is a precaution to minimize potential adverse events, like interference in the immune response of each vaccine and unwanted or unexpected health effects, said Dr. Susy Hota, medical director of infection prevention and control at the University Health Network in Toronto.
“Would it reduce the effectiveness? Would it actually enhance it? Or do nothing? We just don’t know,” she said. “If you have a side effect that’s more serious, you’d want to know which vaccine caused it. There could be components in those vaccines you need to avoid.”
One exception to the rule is post-exposure prophylaxis or PEP, a short course of HIV medicine taken very soon after a possible exposure to prevent HIV infection.
Some physicians may suggest tapering down their patient’s use of immunosuppression medications, like Prednisone, to give them the best possible chance of a good immune response to the vaccine, Hota explained. Patients on anticoagulants (medicines that prevent blood clots) who can safely hold off on taking them can reduce the risk of bruising and bleeding after a vaccine, but immunizations are typically given to people on standard doses of anticoagulants without any harm at all.
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“It’s hard to put out a blanket statement. These are all critical judgments that should be made by a patient’s physician,” she said.
While it’s not unusual for issues related to immunizations to arise — much like concerns raised in Europe about blood clots with the AstraZeneca vaccine — Hota said it’s important not to jump to conclusions.
“Don’t freak out about it. We need to investigate it,” she said. “But we can expect more cautious recommendations, like waiting, to loosen over time as we get more comfortable with the vaccine.”
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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
