Portcullis Surgery

Portcullis Surgery

Portcullis Lane, Ludlow, SY8 1GT

Current time is 13:01 - We're open

NHS

Telephone: 01584 872 939

Fax: 01584 879 031

portcullis.surgery@nhs.net

Frequently asked Questions and Answers about the Covid Vaccine

Frequently asked or possible questions.

Can I choose which vaccine I get?

Not currently, we will have to get what we are given based on the availability of supplies. As on December 8th only the Pfizer/BioN-Tech vaccine has approval for use in the UK and will be rolled out first. It is anticipated that the AstraZeneca/Oxford vaccine will be approved within a handful of weeks and will be distributed shortly after.

Who is delivering the Covid-19 vaccine in Southwest Shropshire and where will I get vaccinated?

Local GPs and GP surgeries in Southwest Shropshire have opted out of leading the vaccine program and only opted to participate in the vaccination rollout therefore all vaccine delivery and distribution of Covid vaccine will be led by the CCG (Shropshire Clinical Commissioning Group).

GPs will also be providing clinical care to their patients as usual but may reduce routine clinical care at times to accommodate for vaccine delivery. Depending on their capacity, they will be vaccinating in care homes, on home visits and helping ensure vaccination of each age group cohort is achieved in our area. Many pharmacies are also expected to deliver vaccinations.

Vaccinations will be also given at the following locations run by the CCG. It is anticipated that all will be operational before the end of January.

Vaccination Centres:

  • Telford
  • ​Shrewsbury (RSH) – currently operational

Local Vaccination Services:

  • Ludlow
  • ​Bridgnorth – currently operational
  • Whitchurch
  • ​Market Drayton
  • Oswestry (RJAH) – currently operational.

Other locations are being considered. The ambitions are to provide a vaccination site within 40 minutes travel time for everyone nationally and a shorter travel time in Shropshire. Arrangements for transport for those without a vehicle are being examined. If you are housebound or at risk from travel, a home visit will be provided.

Portcullis would have preferred the local GPs and the PCN to have been at the lead instead of the CCG. The South-East PCN covering Bridgnorth and the surrounding areas for example, is leading the campaign in their area and have already lauched their main vaccination hub in Bridgnorth which is fully operational, unfortunately we were unable to garner sufficient support for our proposal from other practices in the SW PCN so therefore any questions regarding distribution and availability of the vaccine need to be directed to Shropshire CCG and not to local practices.

Our hands are tied because we cannot be approved to provide the Pfizer vaccine as an individual practice only a group of practices can be approved, so therefore we must wait for the hub to be set up and for vaccine to be offered to our area by the CCG.

The Oxford/Astra Zeneca has now been approved which is very welcome news as this vaccine can be stored in normal fridges for upto 6months and can be managed by individual practices in a similar manner to the annual influenza vaccine. The practice will be making enquiries with the CCG, PCN and the BMA regarding the possibility of this vaccine being made available to individual practices such as Portcullis in order for us to start our vaccination programme as a practice rather than a group of practices. If we are given permission to deliver the vaccine independantly of the CCG and have any news we will post it on this forum as well as on our website immediately.
Information about Shropshire CCG and PCNs can be found following this link:

As soon as the CCG offers us confirmation of vaccine supplies we will let you all know. Please do not call the practice or email us as our hands are tied and we feel equally frustrated by the slow start in this area.

Should I have the vaccine if I’ve already had COVID?

Yes. Given a number of uncertainties such as poor performance of tests (or no access) and durability of immunity after true infection it is recommended that eligible people still have the vaccine. In the data from the trials of the two current vaccines there has been no safety issues with people who have had COVID receiving the vaccine and it hasn’t resulted in a bad reaction (i.e. from a ‘primed’ immune system).

Will the vaccine make me feel unwell?

You may experience mild side effects from the vaccines such as soreness at the injection site (usually the muscle of your upper arm like with the flu vaccination), headache, fatigue and mild fever. These happen in around half to three quarters of people and usually resolve in 2 days. Around 1 in 25 people with the Pfizer vaccine have side effects such as fatigue or headaches unpleasant enough to interfere with daily activities.

Will paracetamol effect the response?

If you do get troubling symptoms such as fever or pain it is ok to take paracetamol in the usual doses as required. Fever can be seen with the AstraZeneca vaccine but they report that paracetamol use does not affect the subsequent immune response.

I have long covid. Should I get the vaccine?

Prolonged symptoms of COVID is not a contra-indication to having the COVID vaccines, but national advice is that if people are seriously debilitated, still under active investigation, or have evidence of recent deterioration, deferral of vaccination could be considered. This is not really due to safety concerns, more that a change in those prolonged symptoms may be incorrectly attributed to the vaccine. 

I am taking steroid tablets. Is the vaccine safe and will it be as effective?

There are very few people who cannot have the vaccines. It is safe in people who may be immunosuppressed as it is not a truly live vaccine. National guidance specifically identifies immunosuppressed people as a clinical risk group who should receive the immunisation, including those on high dose steroids, disease modifying and biologic therapies such as methotrexate and rituximab, anyone with haematological malignancy, anyone undergoing chemo- or radiotherapy, transplant recipients, and more. It is possible the vaccine may not make as strong an antibody response as for people who do not have immunosuppression but it is very likely to be better than having no vaccine. It remains important to follow current advice to avoid exposure to SARS-CoV-2 even after your vaccination.

I have angina. Can I have the vaccine?

Yes. Chronic heart disease, including ischaemic heart disease which requires regular medication, is an indication you are in a higher risk clinical group which should receive the vaccine. This also includes people with severe chronic respiratory disease (including people with asthma requiring continuous or frequent use of oral steroids to control symptoms or who have history of asthma attacks requiring hospital treatment – people with well controlled asthma are not considered higher risk), chronic liver, kidney or neurological disease or diabetes, including diabetes controlled by diet.

I’m taking warfarin. Can I have the vaccine?

Yes. People with bleeding disorders or those taking anti-coagulation medication can still have the vaccine if the clinician feels it can be given safely knowing your individual bleeding risk. It is still given intra-muscularly.  If the bleeding disorder requires treatment such as clotting factor medicine for haemophilia, the vaccine should be scheduled for shortly after the treatment. People taking anti-coagulation can have the vaccine as long as they are stable. For those on warfarin as long as you are up to date with your regular testing and the last result was below the upper limit of your therapeutic range it should be safe to proceed. Use a 23 or 25g needle for the vaccination and apply firm pressure over the site for at least 2 minutes afterwards. Bruising may still occur.

Can I have other vaccines at the same time as the COVID vaccine?

This is not currently recommended. While it is likely to be safe, occasionally the immune response is less potent when some vaccinations are given together. Administering other vaccines with the COVID vaccines has not been tested so we do not know whether it would impact on the level of protection you might otherwise gain. It is therefore the preferred option that the COVID vaccine is not given within 7 days of previous vaccinations, however if you do attend it can still be considered if you are unlikely or unable to attend after the 7 days to avoid delay on your treatment.

Why has the Government changed its policy for the second dose of vaccine? What happens if I do not have the second dose on time or have it later than recommended?

The change is a pragmatic change based on the advice by the Joint Committee on Vaccination and Immunisation (JCVI) that the priority should be to immunise the maximum amount of vulnerable people quickly with at least one dose of the vaccine.

The evidence also varies between the two approved vaccines currently in use. Pfizer has said it has tested its vaccine’s efficacy only when the two vaccines were given up to 21 days apart. Regarding the Astra-Zeneca/Oxford vaccine the was variability in the interval between doses as part of the trial, some trials initially were based on only one dose of the vaccine and others were based on two. The timing of the first and second booster vaccine varied between studies.

We do not have data to give a definitive answer about the effect of a delay in your second dose. However, experience from other vaccines tells us that even with a delay, after the booster doses people will usually still develop good immunity.

Both vaccines have good results for avoiding Covid infections after only one dose Pfizer 52%, Astra Zeneca 53%. Pfizer had better results after 2 dosages 21 days apart (95%) and this was across all age groups. Astra Zeneca also had better results after 2 dosages but this was even better if the second dose was given later. 53% for less than 6 weeks and 65.4% for over 6 weeks. However no one over the age of 55 has a dose interval greater than 6 weeks. There are still ongoing trials going on to find out the best timing and intervals.

The decision to increase the intervals between doses, not only for the Oxford/AstraZeneca vaccine, but also the BioNTech/Pfizer version, is aimed at protecting more people, more quickly. With no need to keep back half the supply to give second doses to those who have already received a measure of protection, all the available doses can be used immediately.

CONCLUSION

• It takes 2 weeks to have an effective immune response after a single dose of the vaccine

• Patients can be confident that both vaccines give effective protection against covid-19 and severe disease from two weeks after a single dose, but it is not 100% so care and caution will still be needed especially for patients who are immune-suppressed

• Those who receive the Pfizer-BioNTech vaccine seem to have 90% protection two weeks after the first dose, but we don’t know how long it lasts

• Those who receive the Oxford-AZ vaccine seem to have 70% protection after the first dose, but we know that this will last for at least 12 weeks until the second dose

• The 12-week booster is crucial for more enduring protection

https://www.nbmedical.com/blog/covid-vaccination-how-effective-is-the-single-dose

What if I have a different vaccine for my second dose?

The preferred option is that people have the same vaccine for both doses. However, it is possible that due to supply constraints this may not be possible. While this has yet to be tested with the two current vaccines, the good news is that it is thought where vaccines work via a similar process you should still get good protection even with different vaccines. The Pfizer and AstraZeneca vaccines both result in a specific part of the SARS-CoV-2 virus called the spike protein becoming recognised by your immune system to develop immunity. It is therefore felt that even with a dose of each of the currently available vaccines you are still likely to produce a good immune response.

I had the my first dose but then found out I am pregnant. Should I be worried?

Specific trials in pregnant women of the two COVID vaccines have not been carried out, but broadly there is no known risk from non-live vaccines (while the AstraZeneca vaccine contains live adenovirus this is non-replicating so cannot cause infection in the mother or developing baby). Nevertheless, given the lack of safety data the advice is avoid vaccination until after your delivery and not while you are breastfeeding. If you have had the vaccine the advice is to avoid pregnancy for 2 months. If you find out you are pregnant shortly after a dose of vaccine do not be alarmed. If you still need a 2nd dose this should be postponed until after delivery. There is no known risk to the fetus but as these are new vaccines it is recommended that you are followed by the national immunisation authority. We do not recommend termination of pregnancy in the event of inadvertent immunisation as adverse effects on the baby are thought to be very unlikely.

Can my child have the vaccination?

The vaccines have yet to be tested in children <12 years old (these trials are underway) and so have not been licensed for use in this group. Given the very low risk of COVID-19 infection to children they are not currently part of the national vaccination programme, however it may be that children with specific underlying medical conditions may be considered after the initial roll-out phase.

I have food allergies, or allergies to latex, can I have the vaccine?

The latest information in the Green Book states :-

‘Following close surveillance of the initial roll-out, the MHRA has advised that individuals with a history of anaphylaxis to food, an identified drug or vaccine, or an insect sting CAN receive any COVID-19 vaccine, as long as they are not known to be allergic to any component (excipient) of the vaccine. All recipients of the Pfizer BioNTech COVID-19 vaccine should kept for observation and monitored for a minimum of 15 minutes. Facilities for management of anaphylaxis should be available at all vaccination sites.’

In the Green Book the British Society for Allergy and Clinical Immunology (BSACI) has advised that:

‘Individuals with a history of immediate onset-anaphylaxis to multiple classes of drugs or an unexplained anaphylaxis should not be vaccinated with the Pfizer BioNTech vaccine. The AstraZeneca vaccine can be used as an alternative (if not otherwise contraindicated)’

References

Green Book Chapter 14a. 2021. [online] Available at: <https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/948757/Greenbook_chapter_14a_v4.pdf>

I have had a nasty reaction to my first COVID vaccine dose.

People with possible anaphylaxis after their 1st dose should not have further COVID-19 vaccinations. If you do have any adverse reaction after your vaccination you can report this to the Medicines and Healthcare products Regulatory Agency via their Yellow Card Scheme (click here) which collects data on side effects to help us understand medicines better and advise people about them more accurately in the future.

As with anything about the current COVID pandemic, these recommendations are currently accurate but may change as our experience of the disease and with the vaccinations grows.  

(1) https://www.nejm.org/doi/full/10.1056/NEJMoa2034577?query=featured_home

(2) NB Medical

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