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Covid-19 Primary Care Resources

Immunosuppression and the Covid vaccine

immunosuppressed third

Guidance on vaccination individual on immunosuppressive treatment

This information is sourced from :

ARMA, Versus Arthritis, Specialist Pharmacy Service (SPS), The Green Book Chapter 14a, JCVI prioritisation document , UK Chemotherapy Board

This advice applies to those CEV individuals in cohort 4 and those considered to be in an ‘at risk group’ in cohort 6 as per JCVI prioritisation :

Key points:

Medication Considerations:

  • Patients should NOT stop their immune suppressants but, if they are newly about to start immune suppression a clinical risk-benefit discussion needs to take place about having at least one vaccination prior to commencing treatment. A Decision Support Tool for patients can be used to use to aid discussion.
  • If both vaccines can be scheduled prior to commencing treatment they should be given at the shortest interval licensed by the manufacturer to ensure the least time delay
  • There are a few drugs (Rituximab, ocreluzimab, alemtuzumab and cladribine) which may affect the immune response to the vaccine
  • If a patient has not started on an immune suppressant/chemotherapy medication it may be best (depending on the severity of the disease and threat to life) to vaccinate prior to starting treatment and use the shortest interval licensed for the 2 dose Covid vaccine course
  • Special consideration in chemotherapy: delay vaccination until blood counts more normal and consider just prior to a pulse of chemotherapy (but not to be taken on the day of chemotherapy)
  • Corticosteroids IM/IV/PO and intra-articular may reduce vaccine response so may be better to delay non-urgent courses until vaccine course complete, however, if the steroid is for a flare it may be best to proceed as flares can worsen Covid prognosis in themselves

Written by Dr Carrie St John Wright

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