This site is intended for health professionals only

Covid-19 Primary Care Resources

Third doses for immunosuppressed patients

Flu vaccination

A summary of third dose guidance and eligible groups

This information is sourced from NHSE, the JCVI and Kidney Care UK:

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

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

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)

2. 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

3. 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

4. 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

Written by Dr Poppy Freeman