International Recommendations for COVID-19 Vaccination in People with Bleeding Disorders

The World Federation of Hemophilia (WFH), European Association for Haemophilia and Allied Disorders (EAHAD), European Haemophilia Consortium (EHC) and US National Hemophilia Foundation (NHF) recommend hemophilia treatment centers, in cooperation with patient organizations, to inform patients with bleeding disorders about COVID-19 vaccination. They should be particularly instructed on the following points:

• People with bleeding disorders are not at increased risk of contracting COVID-19 or having a more severe course, and thus are not a priority group for vaccination.
• The vaccine is administered intramuscularly (i.m.). It is advisable to use the smallest possible needle (for some vaccines the needle size cannot be chosen). After administration, pressure should be applied to the injection site for 10 minutes to prevent bleeding and swelling, and the site should be observed for 2–4 hours for any bruising. Discomfort in the arm 1–2 days after administration is not a concern unless it worsens or is accompanied by swelling. Adverse effects (e.g., hematoma, allergic reaction) should be reported.
• In case of an allergic reaction (fever, warmth, redness, itchy skin rash, shortness of breath, facial or tongue swelling), the vaccinated person should immediately go to the nearest emergency department. Patients with known allergies to clotting factors with polyethylene glycol (PEG) should consult their doctor about vaccine selection, as some vaccines contain PEG.
• Hemostatic treatment availability should be ensured before vaccination. In people with moderately severe/severe hemophilia, it is recommended that the vaccine be administered after FVIII or FIX application (unnecessary for those with FVIII/FIX levels ≥ 10%). For patients treated with emicizumab, FVIII administration is not necessary.
• Patients with von Willebrand disease (vWD) type 1 and 2 should receive treatment according to VWF activity levels (VWF:RiCo) after consulting their center, and patients with vWD type 3 should receive a von Willebrand factor injection before vaccination.
• All patients with rare bleeding disorders should be vaccinated. During anticoagulant therapy, INR should be determined 72 hours before vaccination and administered only when the result is stable within the therapeutic range.
• Vaccination does not have contraindications related to hemophilia or other bleeding disorders or their treatments. People with hepatitis C or HIV infection should also be vaccinated. Relative contraindications may include pregnancy and breastfeeding.
• The Pfizer/BioNTech vaccine manufacturer advises special recommendations for individuals with a history of severe allergic/anaphylactic reactions.
• Patients enrolled in clinical trials should inform the investigator about vaccination.

Information may be further updated on the respective organizations' websites.

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Source: COVID-19 vaccination guidance for people with bleeding disorders. World Federation of Hemophilia, 2020 Dec 22. Available at https://news.wfh.org/covid-19-vaccination-guidance-for-people-with-bleeding-disorders