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GPs can give ‘third’ Covid vaccine dose and swap vaccines in exceptional circumstances

RSV vaccine

Patients should be given a third Covid vaccine dose in a small number of cases where the second has been given earlier than 21 days after the first ‘by accident’, GPs have been told.

The early second dose should be disregarded and treated ‘as if it wasn’t given’ and a third dose given 12 weeks after it, GPs were told in an NHS England webinar yesterday evening.

NHS England also moved to clarify what GPs should do in the small number of cases where mixed Covid vaccine schedules are necessary.

However it stressed the ‘general rule’ remains that the same vaccine should be given for both doses.

‘Exceptional circumstances’ include clinical grounds such as severe adverse reactions to the first dose, including anaphylaxis or ‘side effects that are considered reasonably severe to not warrant repeating the same vaccine’, NHS England senior clinical adviser Dr Peter Greengross told GPs.

Other exceptions include where patients ‘can’t remember’ what first dose they had, when vaccination should ‘ideally’ be delayed unless there’s a clinical reason not to and the information ‘tracked down’, potentially by ‘contacting their GP’.

Housebound or care home residents who had their first dose in hospital, instances where the correct vaccine is not available locally within four weeks or where patients received an unobtainable overseas vaccine are all grounds for mixing schedules.

Dr Greengross said GPs should give the ‘nearest similar vaccine’ – for example Pfizer and Moderna mRNA vaccines, the three whole inactivated coronavirus jabs made in China or the AstraZeneca and Institute of India Covishield vaccines.

None of the other adenovirus vaccines should be used interchangeably, he added.

The news comes as NHS England has said GP-led sites will not receive any new first-dose Covid vaccine deliveries at all over the next two weeks. They can still give first doses to patients in cohorts 1-9 with residual stock.

Meanwhile, GPs have warned of unintended consequences from the Government’s latest AstraZeneca Covid vaccine advice, including creating ‘panic’ among patients and adding to the workload of already pressured practices.


terry sullivan 12 April, 2021 4:31 pm

this breaches the emergency licencing? who pays compo?