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Covid vaccines can be used interchangeably if necessary, says PHE

Covid vaccines can be used interchangeably if necessary, says PHE

Different types of Covid vaccines can be used interchangeably if giving two doses of the same version is not possible, Public Health England (PHE) has said.

And while coronavirus jabs should ‘ideally’ be separated from other non-Covid vaccinations by seven days, vaccination can still be ‘considered’ within a shorter time period, according to the PHE guidance published on Friday.

Pregnant women should not be routinely offered the vaccine, nor should children, it added.

The new guidance on delivering the Covid vaccine programme said it is ‘reasonable’ for healthcare professionals to offer a different second dose if the same vaccine is not available or if the patient does not know the type of vaccine they received on their first dose.

However it stressed there is ‘no evidence’ about the interchangeability of vaccine candidates so ‘every effort’ should be made to complete both doses with the same vaccine where possible.

It said: ‘For individuals who started the schedule and who attend for vaccination at a site where the same vaccine is not available, or where the first product received is unknown, it is reasonable to offer a single dose of the locally available product. 

‘This option is preferred if that individual is likely to be at immediate high risk or is considered unlikely to attend again.’

Since both vaccines are based on the spike protein of the virus, it is ‘likely’ that the second dose ‘will help to boost the response to the first dose’ even if a different vaccine candidate is used, the guidance said.

Studies are ‘underway’ to determine the interchangeability of Covid vaccines, it added.

PHE reiterated that coronavirus vaccinations should ‘ideally’ be separated from other jabs ‘by an interval of at least seven days to avoid incorrect attribution of potential adverse events’.

However, it added that patients can be vaccinated against Covid within seven days of receiving other vaccinations if there is a ‘risk of the patient not returning for a later appointment’.

The guidance said: ‘Because of the absence of data on co-administration with Covid-19 vaccines, [they] should not be routinely offered at the same time as other vaccines.  

‘[But] as both of the Covid-19 vaccines which may be authorised for use first are considered inactivated, where individuals in an eligible cohort present having received another inactivated or live vaccine, Covid-19 vaccination should still be considered. The same applies for other live and inactivated vaccines where Covid-19 vaccination has been received first.’

It added: ‘In many cases, vaccination should proceed to avoid any further delay in protection and to avoid the risk of the patient not returning for a later appointment. In such circumstances, patients should be informed about the likely timing of potential adverse events relating to each vaccine.’

It added that interference between inactivated vaccines with different antigen content is ‘likely to be limited’ although no co-administration data for Covid vaccinations currently exists.

Meanwhile, the guidance also said that the Covid vaccination should not routinely be offered to pregnant women and should be postponed until ‘completion’ of pregnancy due to lack of evidence on use in pregnant women.

However, it added that routine pregnancy testing and questioning about the last menstrual period are not required before offering the vaccine.

Healthcare professionals should tell patients that a Covid-19 vaccine may cause a mild fever, which usually goes away within 48 hours – and that isolation is not required unless Covid-19 is suspected.

PHE clarified to Pulse that patients should only be advised to take a Covid-19 test if the fever lasts longer than 48 hours.

The guidance also outlined:

  • The Covid vaccine is not for routine use in children and young people under 18 years old as vaccine trials have ‘only just begun’ in children;
  • Immunosuppressed individuals ‘may not make a full antibody response’ and should continue to follow advice to ‘avoid exposure’;
  • ‘Consideration should be given’ to vaccinating the adult household contacts of the immunosuppressed;
  • Those who have had coronavirus should still be vaccinated but ‘ideally’ not until recovery or ‘at least four weeks after onset of symptoms’.

The BMA announced earlier this month that practices should prepare for the Covid vaccination programme to start from December – as first revealed by Pulse.

GP practices are gearing up to deliver the programme from designated sites as soon as a vaccine gains approval from the MHRA.

But NHS England last week confirmed that GPs will not begin delivery of Covid vaccinations on the 1 December and can use designated sites to give patients aged 50-64 flu jabs this week to ‘test arrangements’.

It comes as the BMA’s GP Committee has been mandated to immediately renegotiate the funding GPs receive for administering the Covid vaccine by local medical committee leaders.


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Please note, only GPs are permitted to add comments to articles

GP Warwickshire 30 November, 2020 1:47 pm

I hope the software and hence the payment system will cope with a mix of vaccines. Surely if needs be the first dose could be looked up on this same software if needed.

Turn out The lights 30 November, 2020 3:02 pm

One detects yet another ‘world beating’ omni-shambles galloping over the hill like an oncoming cavalry change.

Dave Kew 30 November, 2020 4:20 pm

Not good enough PHE a D minus. Worse than Vallance’s graphs.
No evidence this will confer protection, especially if it’s Cocktail of Oxford and mRNA the theory doesn’t really stand up well to scrutiny? Like as a patient would I even tolerate this?
All that push for Evidence based medicine, pushed aside in a fit of total panic.

Keith M Laycock 30 November, 2020 5:35 pm

‘You OK with the turkey, we’ve run out the chicken soup?’.

I suppose in the face of madness there is alway insanity.

Mr Marvellous 30 November, 2020 5:42 pm

How on earth can they suggest that having different types of vaccine will be 1) effective and 2) safe?

Amit Sinha 30 November, 2020 7:56 pm

This information about :interchangeability” is utterly confusing. There is a severe lack of common sense and judgement in making such statements. It seems that the PHE is governed by non-medical staff, who would let out anything to keep us and the public guessing what’s coming next!!!

terry sullivan 30 November, 2020 10:04 pm

councils are being paid £14 a case for track and trace

Kevlar Cardie 30 November, 2020 10:05 pm

Unofficial NHS England motto :no cuff too tough.

terry sullivan 30 November, 2020 10:05 pm

cv19 does not exist?

Michael Mullineux 1 December, 2020 11:35 am

True to NHSE -form, making things up as they go along, however this time not even bothering to pretend the decision is evidential.

David Riley 1 December, 2020 12:02 pm

Sounds like Donald Trump has got a new job with PHE. What if there is a problem with mixing let alone it being ineffective. No proper trials. This needs wider publicity.

Concerned GP 1 December, 2020 12:20 pm

Can they show us the large scale peer reviewed data to support this guidance pls? This needs to be more publicly highlighted and discussed as said above. It really makes no sense.

David Church 6 December, 2020 10:50 pm

Nonsense PHE : there are NO trials of efficacy of giving courses containing doses of each of the different vaccines! therefore NO evidence to support the statement. Bad medicine.