The recent approval of the COVID-19 vaccines marks a milestone in the fight against the novel Corona virus (SARS-CoV-2). Currently, both mRNA- (BNT162b2, mRNA-1273) and vector-based vaccines (AZD1222) have received approval by the United States Food and Drug Administration (FDA), and the European Commission (EC, EMA). Large-scale vaccination programmes are being rolled out world-wide and medical societies and governmental organisations have prioritised health care personnel (HCP) to receive the vaccination as soon as it becomes available.

For HCP working in the endoscopy unit, aerosol-generating procedures (AGP) may lead to a particularly high risk of exposure to the virus [1]. Thus, there will likely be numerous questions that will arise regarding the consequences of COVID-19 vaccinations in the endoscopy unit. What effects will the vaccine have on infection prevention and control (IPC) practices? Should personal protective equipment (PPE) recommendations be revised / updated? Should vaccination be mandatory? Following vaccination, are regular serological checks of antibody titres warranted? What is the risk of COVID-19 viral transmission by HCP post-vaccination? As well as many others!

The clinical studies which led to the approval of BNT162b2 (BioNtech/Pfizer) and mRNA-1273 (Moderna Tx) demonstrated a high vaccine efficacy of up to 95% in the prevention of COVID-19[2,3]. However, breakthrough infections, although rare, did occur, and the studies did not address the prevention of asymptomatic infection. Moreover, immunisation efficacy may be variable, and there are theoretical possibilities that viral mutations could lead to a diminished vaccine efficacy. Finally, it is unclear how long the acquired immunity will persist, and what the possible long-term side effects of the vaccine may be.

This notwithstanding, the ESGE strongly recommends all endoscopy HCP to undergo a full immunisation regime with a vaccine approved by the EC and/or the FDA, and that is available for use. Vaccination of HCP and patients will reduce the in-hospital spread – from infected patients to HCP as well as between HCP. However, due to the possibility of immunized persons acting as carriers of the virus, and the lack of data on long-term vaccine efficacy, IPC and PPE recommendations from ESGE must remain unchanged at the moment, even for HCP and patients who have undergone vaccination. This ESGE position statement will be updated as more long-term data on vaccine efficacy and safety become available.

References:

1. Gralnek IM, Hassan C, Beilenhoff U, et al. ESGE and ESGENA Position Statement on gastrointestinal endoscopy and the COVID-19 pandemic. Endoscopy 2020; 52: 483-490

2. Baden LR, El Sahly HM, Essink B et al. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med 2020, DOI: 10.1056/NEJMoa2035389:

3. Polack FP, Thomas SJ, Kitchin N et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med 2020; 383: 2603-2615