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’.
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.