Updated JCVI advice on Covid19 vaccines for adults aged under 30 years

by BSPGHAN | Apr 7, 2021 | News

Covid19 Vaccination update 7^th April 2021

(replaces advice on BSPGHAN website on 31^st January 2021)

Today, April 7^th, 2021, the Joint Committee on Vaccination and Immunisation (JCVI) has changed their clinical advice on Covid 19 vaccines for those aged under 30 years.  

Adults aged 18 to 29 who do not have an underlying health condition that puts them at greater risk from Covid should be offered an alternative to the Astra Zeneca vaccine if one is available.

The MHRA advised that-

• side-effects were "extremely rare" - and more work was going on to identify if the Astra Zeneca vaccine was causing blood clots.
• People who have had their first dose of the AstraZeneca vaccine should still get their second dose. 
• Only those who suffered one of these rare blood clots after the first dose should not get vaccinated.
• People with blood disorders that leave them at risk of clotting should discuss the benefits and risks of vaccination with their doctor.
• The JCVI today said that they have not made a  decision yet  (on vaccine advice) on those aged under 18 years.

The Pfizer/BioNTech vaccine is authorised for use in individuals aged 16 years and over, and the Oxford/AstraZeneca vaccine is authorised for individuals aged 18 years and over. 

Also see that here that the RCPCH updated their advice on 29^th March 2021, for paediatricians on children and young people and the COVID-19 vaccination programme https://www.rcpch.ac.uk/news-events/news/message-paediatricians-children-young-people-covid-19-vaccination-programme

This advice may be updated in light of the announcement today.

We are now in the first phase of the programme during which young people (aged 16 years and over) with specific clinical vulnerabilities will be offered vaccination^.1   ( Based on JCVI advice, individuals aged 16–65 years in at-risk groups are eligible for immunisation in Phase 1 of the programme).

The Green Book says: “Children and young people have a very low risk of COVID-19, severe disease or death due to SARS-CoV-2 compared to adults and so COVID-19 vaccines are not routinely recommended for children and young people under 16 years of age. Children under 16 year of age, even if they are CEV, are at low risk of serious morbidity and mortality, and, given the absence of safety and efficacy data on the vaccine, are not recommended for vaccination.” ²

While this is the case, vaccinations should not be offered to children and young people who fall outside the categories advised by the JCVI and the Green Book.  

The only other group identified by the Joint Committee on Vaccination and Immunisation (JCVI) and the Green Book³ that may be considered for the vaccine during phase 1 are:

• older children (aged 12 years and over) with severe neuro-disabilities and recurrent respiratory tract infections who frequently spend time in specialised residential care settings for children with complex needs.

Such vaccinations would be considered unlicensed use.⁴ Paediatricians should discuss the benefits and risks and limited safety data with children, young people and their parents/guardians. Any vaccination would need to be authorised by a prescriber (usually a doctor). We would expect that this discussion would take into account: 

• the frequency and severity of respiratory infection, and
• the history of hospital admissions, particularly the risk of or previous admissions to paediatric intensive care due to respiratory tract infections.

It is important to stress that at this time the JCVI consider that there are no data to support use of the vaccine in younger age groups or other clinical groups.

• 1. Those who are clinically extremely vulnerable will be eligible for vaccination in priority group 4 (after those aged 75 and over). Those with other clinical vulnerabilities specified by the JCVI will be eligible for the vaccine in priority group 6 (after those aged 65 and over). For further details see: www.gov.uk/government/publications/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi-30-december-2020/joint-committee-on-vaccination-and-immunisation-advice-on-priority-groups-for-covid-19-vaccination-30-december-2020
• 2. The Green Book, chapter 14a, version 7, published 12 February 2021 assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/961287/Greenbook_chapter_14a_v7_12Feb2021.pdf
• 3. The Green Book, chapter 14a, version 5 (published 21 January 2021)
• 4. The Pfizer BioNTech vaccine is authorised for 16 years and over, the AstraZeneca vaccine for 18 years and over.

Sue Protheroe
BSPGHAN President April 7^th 2021