COVID-19 vaccine programme next steps for leukaemia patients: from third doses to “Autumn” boosters

This article aims to explain the up to date vaccine schedule for immunocompromised people from 1st doses to the autumn booster and outlines who is eligible. On 15th July 2022 the Governments of all nations of the UK announced that eligible groups can receive another COVID-19 booster vaccine this autumn. This would be the 6th COVID-19 vaccine for many immunocompromised patients. This booster programme will start in early Autumn 2022.

Vaccine schedule for immunocompromised patients

Nb. If you are newly diagnosed the number of vaccines you need to receive might differ from those outlined in the diagram above. For example, to be eligible for the 3rd primary dose you need to have been considered severely immunosuppressed at the time of your first or second primary vaccinations. Additionally, patients who have received a stem cell transplant or CAR-T therapy should be re-vaccinated, starting with the 1st primary dose after their treatment. If you are unsure how many vaccine doses you need please contact your GP or healthcare team to enquire.

What is the autumn booster and who is eligible?

On 15th July the UK Governments announced that they had accepted the advice of the JCVI (the Joint Committee on Vaccination and Immunisation) for an autumn booster programme this year. This will see eligible people get another booster vaccine against COVID-19. 

Here is a list of everyone eligible for COVID-19 vaccination in the autumn booster campaign:

  • All adults aged 50 and over
  • Those aged 5 to 49 years in a clinical risk group, including anyone with a history of haematological malignancy such as leukaemia
  • Those aged 5 to 49 years who are household contacts of people with immunosuppression
  • Those aged 16 to 49 years who are a carer
  • Residents in a care home for older adults and staff working in care homes for older adults
  • Frontline health and social care workers  

If you are still unsure whether you are eligible for the autumn booster, you can find further information in the Green Book on page 16 here. Alternatively please contact your healthcare team and/or our advocacy team on advocacy@leukaemiacare.org.uk to enquire.

When will I get the autumn booster?

We do not have an exact start date for the autumn booster programme yet, however it has been confirmed that it will begin in the early autumn this year. This should ensure that everyone who had a previous booster receives the autumn booster approximately 3 to 6 months from their last jab.

How do I get the autumn booster?

We have not yet had the details on how to book your autumn booster but we expect that, as with previous doses, you should receive an invitation when your vaccine is due. You might also be able to book your autumn booster via the NHS website. We will update this page when we have further details. 

So household contacts of people with immunosuppression can get the autumn booster. What is the definition of household contacts?

Yes, unlike with the previous (spring) booster, household members of the immunosuppressed are now eligible for a booster vaccine in the autumn. According to the Green Book on vaccination, household contacts is currently defined as those individuals who expect to share living accommodation on most days (and therefore for whom continuing close contact is unavoidable) with individuals who meet the criteria for immunosuppression. 

Who is eligible for a flu jab this year, and can I get it at the same time as my autumn booster?

On 15th July 2022, it was also announced alongside the autumn booster programme, that a larger list of people will be eligible for a free flu jab. There were 2 phases announced, with those in the first phase expected to be offered their flu jab first. Those who are eligible for a free flu jab this year are: 

Phase 1: 

  • Everyone aged 65 years and over
  • People between the ages of 6 months and 65 years in clinical risk groups, including those with leukaemia
  • Close contacts of those who are immunocompromised, including contacts of those with leukaemia
  • all children aged 2 or 3 years on 31 August 2022
  • all primary school aged children (from reception to Year 6)
  • those in long-stay residential care homes
  • carers
  • Some frontline staff without employer-led occupational health schemes, including staff at registered residential care or nursing homes etc. 
  • Direct Payment (personal budgets) or Personal Health Budgets, such as Personal Assistants

Phase 2: 

  • All adults aged 50 to 64 years
  • Secondary school children in years 7, 8 and 9, who will be offered the vaccine in order of school year (starting with the youngest first) 

You can have your flu jab and autumn booster at the same time, as there is no evidence to suggest that doing so would have a negative impact on the efficacy of either vaccine. If you have questions or concerns about this please talk to either your healthcare team or the vaccination team. 

Should I bother with the autumn booster if I have not made antibodies to the vaccines so far?

We would encourage everyone who is eligible to take up the offer of all booster vaccinations. This includes both people who have had a good antibody response to previous vaccines and those who haven’t. After the 3rd dose of the vaccine, there was some evidence that it increased an immune response in people who had not made many or any antibodies from the previous doses. Furthermore, antibodies are only part of the immune system and the role of other parts of the immune system isn’t yet fully understood.  It is therefore possible that the boosters may yet boost your antibody production and/or your immune response further.

Evidence also shows the more recently you have been vaccinated the better protected you are. 

Is the autumn booster the same as other vaccines?

It has not yet been confirmed which vaccines will be included in the autumn booster programme, however we expect it to be very similar to the previous booster programme.

I think I am behind on my vaccines, can I still get doses I haven’t had yet?

Yes, it is still possible to get vaccinated no matter where you are on the vaccine schedule. Book an appointment via the NHS website here, attend a walk-in clinic with proof of your immunosuppressed status, or speak to a member of your healthcare team for more information.

Questions for specific groups

I am currently having chemotherapy. Should I have the vaccine?

This is a group in which the vaccines have not been specifically tested. However, since the roll out, many people will have had the vaccine close to chemotherapy treatment and we are unaware of specific problems in this group. As with other vaccines, there are specific times when they are recommended whilst you are on chemotherapy, to give the vaccines the best chance of working. If you are invited for the vaccine during a course of chemotherapy, please speak to your haematology team if you are unsure when is the most appropriate time for you to have it or to discuss any other concerns.

I have had or am currently having a transplant. Should I have the vaccine?

You can have the vaccine whilst on cancer treatment, but it is preferable that it is delivered at a time when you have an immune system working at some level.  If you have been invited to have a vaccine, please speak to your care team for advice about when to have it.

I have already had COVID-19. Should I get a vaccine?

Natural infection with COVID-19 will generate an immune response, such as producing antibodies, as this is how your body fights off the virus. However, it is not clear how long this lasts in a person’s body. Initial studies have suggested that antibodies are short-lived after infection, and there have been cases of reinfection reported, although rare. Therefore, it is recommended that you still have the vaccination, as this has been designed to give strong and lasting protection.

Are any of the vaccines currently available in the UK live vaccines?

Not currently. The Oxford-AstraZeneca vaccine contains whole virus particles, but these are not whole COVID-19 viruses. It is a different virus that has been used to deliver a part of the COVID-19 vaccine that the immune system can respond to; this type of vaccine is called a viral vector.

The virus used as the vector is called an adenovirus, and it usually causes the common cold in monkeys. It has been modified so it cannot replicate. Therefore, you are not able to become ill from either the adenovirus or COVID-19 from this vaccine.

There have been reports of a new live COVID-19 vaccine, but this is not currently available to people in the UK. We would expect this vaccine to be unsuitable for many leukaemia patients, as with other live vaccines, due to patients’ compromised immune systems. We will update this page if a live vaccine becomes available in the UK. 

Will the vaccines work for me?

There are studies which show that some people with leukaemia or similar blood cancers do not always respond as well to the vaccines as those with fully functioning immune systems. This is because some patients are unable to mount an antibody response or produce fewer antibodies which provides less protection against COVID-19. However, having a weak immune system does not necessarily mean that you will not respond to the vaccines at all; a small amount of protection is better than none, which is why you are encouraged to continue to take the vaccines when they are offered.

In addition, antibodies are not the only thing that is important. When you have a vaccine, you also make a response using your T cells; this T cell response is thought to be more important for immunity to viruses. In some studies blood cancer patients have shown a good T cell response to the COVID-19 vaccine, even if they produced a low antibody response.

It is important that you get all the doses of the vaccine that you are scheduled to receive, as this gives maximum protection.

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