Mark Jaben

DOCTOR’S ORDERS — Haywood County Medical Director Dr. Mark Jaben frequently addresses the Haywood County Board of Commissioners during their twice monthly meeting.

Haywood County Medical Director Dr. Mark Jaben answers questions about the COVID-19 vaccine. Send questions to news@themountaineer.com

Q: Our son-in-law, a practicing dentist, refuses to get the COVID vaccines because he is allergic to sulfa drugs and shellfish. Also, one of his patients came in last week with lockjaw, which he blamed on the vaccine. Any way to assure him his fears are unrealistic?

A: Currently, the only reasons to not get either the Pfizer or Moderna vaccines is an allergic reaction to one of the components or a severe adverse reaction to a dose of either vaccine.

Neither an allergy to shellfish or sulfa drugs have been a contraindication. However, for people who have had a reaction to food or drugs, it is recommended they be observed for 30 minutes after receiving either vaccine. Everyone currently providing vaccines have measures in place to treat anaphylaxis if it occurs.

Here are links that list the ingredients of both vaccines.

Moderna- https://www.fda.gov/media/144638/download

Pfizer- https://www.fda.gov/media/144414/download

As of January 29 in the US, the incidence of anaphylaxis, the most severe adverse reaction, is on the order of 2-6 per million doses given. That means 999,994 out of a million people receiving either vaccine, will not have such a reaction. To date, in Haywood County, after 10,000 + people have been vaccinated, there have been no cases of anaphylaxis.

There have no reported cases of tetanus related to either of the current vaccines.

Tetanus, what some refer to as ‘Lockjaw,’ is caused by the toxin from the bacteria Clostridium Tetani. People get this from a contaminated wound, which is why your doctor asks about immunization status if you have a laceration or other wounds. Immunization for this is contained in a DT or DPT shot, and after a full course of 3 doses and a booster every ten years, this is essentially prevented for life. This disease sometimes starts as spasm of the jaw muscles, but proceeds to spasms all over the body. The incidence in the US has dropped markedly since 1900 and since survellaince started in 1947, incidence has plummetted. There were no reported cases in 2018 and 2019. No data is available for 2020 yet.

So could the patient your son-in-law saw in his office actually have had tetanus. I suppose so, but I hope not as it is a miserable, deadly, and totally preventable illness. And there are many other causes for a person having their jaw ‘locked up,’ like temperomandibular joint syndrome (TMJ syndrome), dislocation or partial dislocation of the temperomandibular joint, or dental abscess to name a couple. These are much more common.

Q: I had my second COVID vaccine on 2/11/21 at the fair grounds. Congratulations to all for a well oiled operation. On my vaccination card a sticker was placed to show the second dose. It says COVID VAX 0.3ml Pfizer EL3247. To the right of that on the sticker it says Exp: 5/31/21. My question: What does this date mean?

A: The sticker has the lot number and the expiration date of that lot. The vaccine must be used by then, which has not been an issue for us.

Q: Can a person who got the first vaccine at another site in North Carolina get the second vaccine in Haywood County? The person had one shot, a week later tested positive and by the time recovery +30 days happened, the first site no longer offers the vaccine Pfizer.

A: Second dose allotments are allocated based on the number of first doses given. There are not any just sitting around. This is why we have been advising people to be sure that wherever you get your first dose, they give you an appointment date for your second dose right then and there. It is also why we advise people not to accept a first dose appointment if you cannot guarantee you will be available on the second dose date.

In this case, who could have known you would contract COVID after the first dose, or that it would take so long to get well, or the place would no longer have access to the vaccine. I am glad that you are well now. There has been guidance that the second dose can be given up to two weeks after the recommended time for a second dose, although there is no data to say it will be as effective given then. It sounds like you are well past that point. I would need to know more to give you advice at this time.

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