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Covid vaccine patients will not need lengthy observation, says NHS England


flu programme


GP sites administering Covid vaccinations will only need to observe patients for any immediate negative reactions, NHS England has said.

This comes as the draft plans for the enhanced service had suggested patients may need to be observed for 15 minutes following their vaccination.

NHS England also specified that the vaccine may cause side effects such as a headache or a fever, but the BMA told Pulse patients will not need to be advised to self-isolate if this occurs.

In a webinar for GPs yesterday, a slide presented by NHS England said: ‘Recipients of the Covid-19 vaccine should be observed for any immediate reactions during the period they are  receiving any post-immunisation information and subsequent appointment if required. There is no evidence to support the practice of keeping patients under longer observation.’

But it added that ‘as syncope can occur following vaccination, all patients should either be driven by someone else or should not drive for 15 minutes after vaccination’.

One of the two vaccines in the running to be rolled out as part of the enhanced services next month, the Pfizer vaccine, has not reported any negative effects.

However a Lancet study on interim findings from the phase I/II trials of the AstraZeneca vaccine being developed by researchers at the University of Oxford said ‘transient local and systemic reactions were common in the AZD1222 group and were comparable to previous trials and other adenoviral vector vaccines’.

These included ‘temporary injection site pain and tenderness, mild-to-moderate headache, fatigue, chills, feverishness, malaise and muscle ache’, which were all ‘lessened with the use of prophylactic paracetamol’ and less likely following the second dose of the vaccine.

NHS England notes from yesterday’s webinar said: ‘As with other vaccines there may be some local reactions at the injection site such as pain and tenderness. In addition, mild systemic events were reported such as headache, fatigue, fever, malaise and muscle ache. This information will be further clarified as the clinical data is reported and published.’

Asked whether patients needed to isolate if they developed a fever, BMA GP Committee chair Dr Richard Vautrey told Pulse: ‘No, this will be like the side-effects of some other vaccinations, we understand one of the potential vaccines may cause a brief rise in temperature that would settle with paracetamol.  

‘There would be no need to self isolate or take a test.’

Oxford researchers are yet to report phase III trial findings but interim findings from Pfizer’s phase III trial showed that their vaccine is 90% effective.

The UK Government said it has ordered 40 million doses of the Pfizer vaccine – 10 million of which will be available for use by the end of this year.

READERS' COMMENTS [4]

Patrufini Duffy 13 November, 2020 2:31 pm

IMAGINE. What will a patient say, anticipating implied consent (new GMC guidelines btw) – “Have you had it?”… “Er…not yet”. “Then why the bl**dy hell should I!!!”. And repeat that a 1000 times.

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Vinci Ho 14 November, 2020 5:08 am

After listening to the webinar hosted by Nikita Kanani on Thursday evening (12/11/2020) , here is my personal review of the whole matter up to this point :
(1) I felt slightly( only slightly) more comfortable after she and her speakers clarified the meaning of 15 minute wait after jabbing , difference between enhanced service(ES) versus direct enhanced service(DES) , and being seven day available instead of mandatory seven day opening for vaccinating . She was extra-cautious in presenting her humble words and all the time self-conscious of how we could potentially react to her . To me , I give her the benefit of doubt despite our criticism on the fiasco about the rumour of GP closures during the first wave of COVID-19 and face-to-face consultation. This is another new history chapter of our battles with the government.
(2) It is undoubtedly egregious the way BMA/GPC unilaterally released the prescriptive , apparently detailed ‘agreement with GPs’ on Monday , despite the fact that we are ,even at this point , yet to see the actual official details of the ES( not DES) and any pertinent standard operating procedure( SOP) . Taking some time for deep thinking about underlying political innuendo , I came up with the conclusion that there was clearly no agreement as such between BMA and the government . There was neither any negotiation. NHS England could potentially release the actual ES short time(e.g. 48 hours) prior to the deadline for GP/PCNs to declare engagement. NHS England’s track record of a clandestine publication of the PCN DES(service specifications) around last Christmas had set a good precedent. GPC simply passed on to the media what was thrown to its face by the government. I know some of you might think I am defending BMA and would embrace this criticism with humility . Undoubtedly, it was a flagrant violation of the truth when the health secretary and the well politically quarantined NHS England CEO declared NHS and GPs were ‘ready’.
(3) The deadline of 17/11/2020 for PCN clinical directors(unforgivably, I am still one of them) to complete a form of declaring engagement in the ES , is far too precipitous and unrealistic. Even Nikita Kanani had to confess during the webinar . PCN is required to find a ‘site’ to undergo at least , the initial phase of this massive vaccination campaign. The possible cohorts of patients to be vaccinated include age over 80 , care homes , housebound, health care workers and perhaps age 70-79 . Again , uncertainty in the absence of the actual ES.
My concern is always how to circumvent the serious disruptions to a site which is also a GP practice. Of course , most GP workload at the moment can be conducted through remote access. But I would also argue that the bigger GP practice chosen , the more is the disruption.
I also take the argument that GP practice is the clinical site most ready ready in short space of time , so as to vaccinate these cohorts in fixed period of time : ideally , we should complete the task in 6 weeks for the Pfizer vaccines since the second dose has to be administered after 21 days promptly to achieve maximum benefit. For the Astra-Zeneca one , perhaps 8 weeks with the second dose at day 28.
(4)Then the logical question is , what about non-GP sites? I can only comment from a Liverpool point of view since we are in the middle of a pilot of having multiple mass testing centres(17 in total) throughout the city . The pilot is time-limited and my question to the ‘cardigans’ (I always wear my LFC football tops anyway ) was ,’ could any of these be utilised by PCNs as an option?’
While I fully respect that some PCNs had already decided to use one of their practices, I insist that one size cannot fit all .
Realistically, as times go on , the government must set up other non-GP led sites to mop up all other cohorts for the rest of the population .
My message to CCG is : will come up with Plan A ,B and/or C . Try the best to find a designated site. If nothing still comes up after serious canvassing and analysis , I will declare ‘no suitable site can be found’ with true honesty .
(5) Ultimately, with introspection, I must say, we should be conscious that putting aside the political innuendo orchestrated by the government , this is a historic mission we are to take to be part of the equation freeing this country from the incarceration incurred by Covid 19( yes , no one should be coerced ) .
We all , as a nation , have suffered a lot . This is our ‘enhanced mission’ not a service and it is much bigger than any politician and technocrat . Money is important but perhaps not that important. NHSE/I and CCGs must , by all the means , help GPs to seek , to search ( not to yield ) and set up these appropriate sites .
Yet I would be humbled if some of you prefer to call me a ‘fool’.
History will give us (and the government) a judgement………..

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Patrufini Duffy 16 November, 2020 1:53 pm

So why say it in the first place?

David Church 16 November, 2020 3:33 pm

Hi Sofia,
I hate to pull holes in your article when the faults are not yours, but maybe it needs a revisit :
1) When GPs give flu jabs, we are supposed to observe people for 15 minutes after for ‘immediate reactions’, which usually have onset within minutes, possibly up to 15. Covid jab is brand new, si is not known to have less risk of these reactions than flu jabs.
2) “transient local and systemic reactions in AZD1222 ……comparable to previus trials in adenovirus vector vaccines”. But last wee we were told the delay in developing Covid jabs was because this was the first ever RNA virus vaccine. So there WERE NOT any previous trials of comparable jabs???
3) Any patient developing headache and fever in the first couple days after Covid jab is likely to have developed REAL Covid (especially if they received the ‘totally-side-effect-free’ Pfizer Jab), as the first couple days are asymptomatic, before fevr develops. So they are likely to be infectious. Contrary to what BMA has said, they should isolate and seek immediate qualified and suitably experienced medical advice (via 119 initially), and avoid spreading a fatal disease around in the mistaken belief that vaccination confers immediate immunity and for several days before the jab is received on top!
Best iwshes,
David
🙂

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