Portcullis Surgery

Portcullis Lane, Ludlow, SY8 1GT

Telephone: 01584 872 939


We are OPEN, CLICK the link for non-urgent queries https://florey.accurx.com/p/M82043

Booster 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 third dose vaccinations is given following the link below:

A Summary of Third dose guidance and eligible groups

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


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).


The timing will be at least SIX MONTHS after the SECOND DOSE.

For the vast majority of our patients this will be no earlier than mid October. Please do not call the practice to enquire about this vaccine at this busy time. WE WILL CALL YOU or text, email you or post you a letter.

Eligible groups

All adults over the age of 50 years.

All adults over the age of 12 in at risk groups as follows and as set out by the green book


Clinical risk groups

Chronic respiratory disease

Individuals with a severe lung condition, including those with asthma that requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission, and chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD).

Chronic heart disease and vascular disease Congenital heart disease, hypertension with cardiac complications, chronic heart failure, individuals requiring regular medication and/or follow-up for ischaemic heart disease. This includes individuals with atrial fibrillation, peripheral vascular disease or a history of venous thromboembolism.

Chronic kidney disease Chronic kidney disease at stage 3, 4 or 5, chronic kidney failure, nephrotic syndrome, kidney transplantation.

Chronic liver disease Cirrhosis, biliary atresia, chronic hepatitis. Chronic neurological disease Stroke, transient ischaemic attack (TIA).

Conditions in which respiratory function may be compromised due to neurological or neuromuscular disease (e.g. polio syndrome sufferers). This group also includes individuals with cerebral palsy, severe or profound and multiple learning disabilities (PMLD), Down’s syndrome, multiple sclerosis, epilepsy, dementia, Parkinson’s disease, motor neurone disease and related or similar conditions; or hereditary and degenerative disease of the nervous system or muscles; or severe neurological disability.

Diabetes mellitus and other endocrine disorders Any diabetes, including diet-controlled diabetes, current gestational diabetes, and Addison’s disease.


Immunosuppression due to disease or treatment, including patients undergoing chemotherapy leading to immunosuppression, patients undergoing radical radiotherapy, solid organ transplant recipients, bone marrow or stem cell transplant recipients, HIV infection at all stages, multiple myeloma or genetic disorders affecting the immune system (e.g. IRAK-4, NEMO, complement disorder, SCID).

Individuals who are receiving immunosuppressive or immunomodulating biological therapy including, but not limited to, anti-TNF, alemtuzumab, ofatumumab, rituximab, patients receiving protein kinase inhibitors or PARP inhibitors, and individuals treated with steroid sparing agents such as cyclophosphamide and mycophenolate mofetil.

Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day for adults.

Anyone with a history of haematological malignancy, including leukaemia, lymphoma, and myeloma and those with systemic lupus erythematosus and rheumatoid arthritis, and psoriasis who may require long term immunosuppressive treatments.

Most of the more severely immunosuppressed individuals in this group should already be flagged as CEV.

Individuals who are not yet on the CEV list but who are about to receive highly immunosuppressive interventions or those whose level of immunosuppression is about to increase may be therefore be offered vaccine alongside the CEV group, if therapy can be safely delayed or there is sufficient time (ideally two weeks) before therapy commences.

Some immunosuppressed patients may have a suboptimal immunological response to the vaccine (see Immunosuppression and HIV). Asplenia or dysfunction of the spleen This also includes conditions that may lead to splenic dysfunction, such as homozygous sickle cell disease, thalassemia major and coeliac syndrome.

Morbid obesity Adults with a Body Mass Index (BMI) ≥40 kg/m².

Severe mental illness Individuals with schizophrenia or bipolar disorder, or any mental illness that causes severe functional impairment.

Younger adults in long-stay nursing and residential care settings Many younger adults in residential care settings will be eligible for vaccination because they fall into one of the clinical risk groups above (for example learning disabilities). Given the likely high risk of exposure in these settings, where a high proportion of the population would be considered eligible, vaccination of the whole resident population is recommended. Younger residents in care homes for the elderly will be at high risk of exposure, and although they may be at lower risk of mortality than older residents should not be excluded from vaccination programmes (see priority 1 above). For consideration of children under 16 see below.

Other risk groups Adult household contacts of people with immunosuppression Individuals who expect to share living accommodation on most days (and therefore for whom continuing close contact is unavoidable) with individuals who are immunosuppressed (defined as above).

Adult carers Those who are eligible for a carer’s allowance, or those who are the sole or primary carer of an elderly or disabled person who is at increased risk of COVID-19 mortality and therefore clinically vulnerable.





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