Portcullis Surgery

Portcullis Surgery

Portcullis Lane, Ludlow, SY8 1GT

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Telephone: 01584 872 939

Fax: 01584 879 031

portcullis.surgery@nhs.net

A Summary of Third dose guidance and eligible groups

A summary of guidance for Third dose vaccines for immunosuppressed individuals, booster vaccines and eligible groups for both.

SW Shropshire PCN is now offering clinics for immunosuppressed patients who require a third vaccine. Our first clinic was held yesterday and was very successful with more than 100 patients receiving their third dose vaccine.

The JCVI has published eligibility criteria and we are working with the whole local system to ensure that everyone who requires a third vaccination is notified. Please do not call the practice to enquire about this vaccine at this busy time. WE WILL CALL YOU.

The timing of the dose can be adjusted to when immunosuppression is at a minimum (e.g. before starting chemotherapy).

Therefore, patients who are currently undergoing chemotherapy or radiotherapy should seek advice from their consultant or nurse specialists in order to determine the best timing for their third vaccine.

You should then email the practice to let us know when is the best time for your vaccine on portcullis.management@nhs.net

This information is sourced from NHSE, the JCVI:

The booster campaign will be delivered alongside existing requirements to:

  • Offer an evergreen offer to those who have not yet had their first or second dose.
  • Vaccinations for 12-15 year olds (including those who are at higher risk) and
  • Third doses as part of the primary vaccination course for immunosuppressed individuals.

The vaccination of 12-15-year-olds will be done in schools and that will be starting later this month. Parents will receive more information about this shortly.

The detailed information about the 6 month Booster campaign information is given following the following link:

Booster guidance and eligible groups

The detailed information about third dose vaccinations is given below:

THIRD DOSE VACCINES (IN ADDITION TO POSSIBLE BOOSTERS IN THE NEXT SIX MONTHS)

The Joint Committee on Vaccination and Immunisation (JCVI), an independent body of experts, have recommended that a third (booster) dose of vaccine for patients with severe immunosuppression during the time that they received their previous vaccinations.

 

Immunosuppression is a reduced capacity of the body’s immune system to recognise and fight infections. It also causes a reduced response to vaccinations because the body doesn’t produce sufficient antibodies. Immunosuppression may be temporary or permanent, depending on the situation of the individual.

 

There is evidence that some severely immunosuppressed individuals showed a weakened immune response to the vaccine. This means that they may be less well protected than would be expected.

 

The conclusion of the JCVI is that a 3rd booster dose would help this group of patients by producing an enhanced response to the vaccine therefore the guidance states:

Individuals age 12 and over with severely weakened immune systems should have a third Covid vaccine dose usually at least 8 weeks after the second dose

Timing

The timing of the dose can be adjusted to when immunosuppression is at a minimum (e.g. before starting chemotherapy)

Patients who are currently undergoing chemotherapy or radiotherapy should seek advice from their consultant or nurse specialists in order to determine the best timing for their third vaccine. You should then email the practice to let us know when is the best time for your vaccine.

Preferred vaccine

mRNA vaccines (Pfizer and Moderna) are the preferred vaccine for 3rd doses.

This is a summary of the JCVI list of eligible individuals

  1. Immunodeficiency states:
  • acute and chronic leukaemias and lymphomas under treatment or within 12 months of achieving cure
  • chronic lymphoproliferative disorders and haematological malignancies such as lymphoma, CLL, myeloma, Waldenstrom’s macroglobulinemia and other plasma cell dyscrasias
  • HIV/AIDS with a current CD4 count of <200 cells/µl
  • lymphopaenia <1,000 lymphocytes/ul or a functional lymphocyte disorder
  • stem cell transplant in the previous 24 months
  • stem cell transplant more than 24 months ago but ongoing immunosuppression
  • persistent agammaglobulinaemia (IgG < 3g/L)
  1. Immunosuppressive or immunomodulating therapy at the time of vaccination:
  • those who have received immunosuppressive therapy in the previous 6 months for a solid organ transplant
  • people who have had targeted therapy for autoimmune disease, such as JAK inhibitors or biologic immune modulators in the previous 3 months (6-months for rituximab)
  • those who have had immunosuppressive chemotherapy or radiotherapy in the previous 6 months
  1. Individuals with with chronic immune-mediated inflammatory disease who were receiving immunosuppressive therapy prior to vaccination:
  • high-dose steroids (≥ 20mg prednisolone per day) for more than 10 days in the previous month
  • long-term moderate dose steroids (≥10mg prednisolone per day for > 4 weeks) in the previous 3 months
  • non-biological oral immune modulating drugs in the previous 3 months, such as methotrexate >20mg per week, azathioprine >3.0mg/kg/day, 6-mercaptopurine >1.5mg/kg/day, mycophenolate >1g/day
  • certain combination therapies at individual doses lower than above, including those on ≥7.5mg prednisolone per day in combination with other immunosuppressants (other than hydroxychloroquine or sulfasalazine) and those receiving methotrexate (any dose) with leflunomide in the previous 3 months
  1. High-dose steroids (equivalent to >40mg prednisolone per day for more than a week) for any reason in the month before vaccination
  • Individuals who had received brief immunosuppression (≤40mg prednisolone per day) for an acute episode (for example, asthma / COPD / Covid-19) and individuals on replacement corticosteroids for adrenal insufficiency are not considered severely immunosuppressed sufficient to have prevented response to the primary vaccination

BOOSTER VACCINES

The guidance states:

“JCVI advises that for the 2021 COVID-19 booster vaccine programme individuals who received vaccination in Phase 1 of the COVID-19 vaccination programme (priority groups 1 to 9) should be offered a third dose COVID-19 booster vaccine.

This includes:

  • those living in residential care homes for older adults
  • all adults aged 50 years or over • frontline health and social care workers
  • all those aged 16 to 49 years with underlying health conditions that put them at higher risk of severe COVID-19 (as set out in the green book), and adult carers
  • adult household contacts of immunosuppressed individuals”

Vaccine type:

 

the JCVI ‘advises a preference for the Pfizer-BioNTech (BNT162b2/ Comirnaty®) vaccine to be offered as the third booster dose irrespective of which product was used in the primary schedule. Alternatively, individuals may be offered a half dose (50µg) of the Moderna (mRNA-1273/Spikevax®) vaccine, which should be well tolerated and is also likely to provide a strong booster response. Where mRNA vaccines cannot be offered e.g. due to contraindication, vaccination with the AstraZeneca (ChAdOx1-S/Vaxzevria®) vaccine may be considered for those who received AstraZeneca (ChAdOx1-S/Vaxzevria®) vaccine in the primary course

 

Co-administration of COVID-19 and influenza seasonal vaccines:

 

the JCVI guidance states that “where operationally expedient, COVID-19 and influenza vaccines may be co-administered”.

 

Therefore, systems should consider co-administration OR seek to co-administer in any instances where it improves experience and uptake of both vaccines, reduces administrative burdens on services or to reduce health inequalities (eg in HHs, residential care homes and roving models).

 

 

 

 

 

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