Summary of JCVI advice on third vaccines and boosters for the clinical community

We have put together a summary of eligibility for the third vaccine and booster programmes and how patients should be communicated with below.

Who is eligible?

Third primary dose for the immunosuppressed

  • Acute and chronic leukaemias, and clinically aggressive lymphomas (including Hodgkin’s lymphoma) who were under treatment or within 12 months of achieving cure
  • Individuals under follow up for chronic lymphoproliferative disorders including haematological malignancies such as indolent lymphoma, chronic lymphoid leukaemia, myeloma, Waldenstrom’s macroglobulinemia and other plasma cell dyscrasias (note: this list is not exhaustive) – this includes patients on active monitoring only
  • Those who had received an allogeneic (cells from a donor) or an autologous (using their own cells) stem cell transplant in the previous 24 months 
  • Those who had received a stem cell transplant more than 24 months ago but had ongoing immunosuppression or graft versus host disease (GVHD), see summary of eligibility for each programme for stem cell patients here.
  • Persistent agammaglobulinaemia (IgG < 3g/L) due to primary immunodeficiency (for example, common variable immunodeficiency) or secondary to disease/therapy 

Individuals on immunosuppressive or immunomodulating therapy at the time of vaccination including: 

  • Those who were receiving or had received in the previous 3 months targeted therapy for autoimmune disease, such as JAK inhibitors or biologic immune modulators including B-cell targeted therapies (including rituximab but in this case the recipient would be considered immunosuppressed for a 6-month period), T-cell co-stimulation modulators, monoclonal tumour necrosis factor inhibitors (TNFi), soluble TNF receptors, interleukin (IL)-6 receptor inhibitors, IL-17 inhibitors, IL 12/23 inhibitors, IL 23 inhibitors (note: this list is not exhaustive)
  • Those who were receiving or had received in the previous 6 months immunosuppressive chemotherapy or radiotherapy for any indication 

Individuals who had received immunosuppressive therapy prior to vaccination including: 

  • High-dose corticosteroids (equivalent to ≥ 20mg prednisolone per day) for more than 10 days in the previous month
  • Long-term moderate dose corticosteroids (equivalent to ≥10mg prednisolone per day for more than 4 weeks) in the previous 3 months 
  • Non-biological oral immune modulating drugs, such as methotrexate >20mg per week (oral and subcutaneous), azathioprine >3.0mg/kg/day, 6-mercaptopurine >1.5mg/kg/day, mycophenolate >1g/day in the previous 3 months
  • 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 
  • Individuals who had received high-dose steroids (equivalent to >40mg prednisolone per day for more than a week) for any reason in the month before vaccination, except for acute respiratory disease episodes (e.g. asthma)

Booster vaccination programme

  • Priority groups 1 to 6, except the immunosuppressed. 

We understand this to include all leukaemia patients, other than those eligible for a third dose.

This does not directly map to the shielded patient list. Please see the JCVI guidance below for more information.

Which vaccine should they get?

mRNA (Pfizer-BioNTech or Moderna) is preferred, according to JCVI advice. Astrazeneca should only be used in exceptional circumstances. All should be given at full dose.

mRNA is preferred, according to JCVI advice. Pfizer at full dose, Moderna at full dose at the time of writing, although half doses are expected to be given from the middle of October.

Plans for roll out

Secondary care have been asked to identify eligible patients. 

This was communicated via trusts in England, where it was asked that consultants identify patients and write to them and their GP.  This should be done by the 11th of October.

 Health Boards are being asked to identify patients in Scotland. 

We do not have further details for the roll out in Wales and Northern Ireland.

Patients can book via the usual COVID-19 vaccine booking methods (e.g. online or via 119 or other hotline) once they have been notified that they are eligible.

Please help our patients by doing the following:

  • Writing to the GP of those you consider to be eligible as soon as possible, or communicate with your colleagues and leadership to check this has been done
  • Explain to patients which they are eligible for and ask them to wait until they hear from you before booking.