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British Society of Paediatric Gastroenterology, Hepatology and Nutrition

Dear members

Further to advice issued on 20 January 2021 https://bspghan.org.uk/children-who-are-cev-vaccination-advice , the RCPCH has issued advice on clinical eligibility of children and young people for COVID-19 vaccines in phase 1 of the vaccination programme https://www.rcpch.ac.uk/news-events/news/message-paediatricians-children-young-people-covid-19-vaccination-programme

  • The RCPCH advises all paediatricians and others involved in vaccination to adhere to the advice provided by the JCVI and the Green Book.
  • In the first phase of the vaccination programme, only young people (aged 16 years and over) with specific clinical vulnerabilities will be offered vaccination1.
  • The only other group identified by the Joint Committee on Vaccination and Immunisation (JCVI) and the Green Book2 that should 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 require residential care. Such vaccinations would be considered unlicensed use,3 and paediatricians should discuss the benefits and risks and limited safety data with children, young people and their parents/guardians.
  • The Pfizer BioNTech vaccine is authorised for 16 years and over, the AstraZeneca vaccine for 18 years and over.
  • 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, and the RCPCH supports this view.
  • 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).

1. 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 5 (published 21 January 2021

3. The Pfizer BioNTech vaccine is authorised for 16 years and over, the AstraZeneca vaccine for 18 years and over.

Priority Groups- All ages from The Joint Committee on Vaccination and Immunisation (JCVI)

  • The groups in bold are currently being offered vaccination in the first phase:
  • Residents in a care home for older adults and their carers 
  • All those 80 years of age and over AND: 
    Frontline health and social care workers
  • All those 75 years of age and over
  • All those 70 years of age and over AND:
    Clinically extremely vulnerable (high risk) individuals over 16 years old
  • All those 65 years of age and over 
  • All individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality*
  • All those 60 years of age and over 
  • All those 55 years of age and over 
  • All those 50 years of age and over
  • Anticipated timings of vaccines
  • Bold group in the above list - first vaccine offered by mid-February.
  • Other priority groups  - first vaccine offered by April. Not in a priority group listed above, first vaccine offered by the Autumn. 
  • See link for BSPGHAN statement on children who are clinically extremely vulnerable (high risk)  https://www.rcpch.ac.uk/resources/covid-19-guidance-clinically-extremely-vulnerable-children-young-people

Children & Young People with Crohn’s and Colitis

  • Reassuringly, current data on COVID-19 shows good outcomes for people with Crohn's and Colitis, including those in the high risk group.  See https://www.crohnsandcolitis.org.uk/news/latest-coronavirus-vaccine-for-people-with-crohns-or-colitis
  • IBD patients who are 16 years or above and are not in the clinically extremely vulnerable (high risk) group (priority group 4) but take a medicine that affects the immune system, will be in vaccine priority group 6.
  • IBD patients who are aged 16 years and above and do not take an immunosuppressant medicine may not be eligible for a priority vaccine due to their Crohn's or Colitis (they may be prioritised for other reasons, such as other health conditions). This is because the risk of complications from coronavirus is very low in people under 18. However, if offered the COVID-19 vaccine, it is recommended that patients take it. 

Children and Young People on Home Parenteral Nutrition

Children, young people and adults receiving Home Parenteral Nutrition (HPN) are not formally included in the Government’s list of ‘clinically extremely vulnerable’ (CEV) groups, although adults are included in the NHS England list. The updated Government guidance now includes “other people” who have been classed as ‘clinically extremely vulnerable’ based on clinical judgement. This may include adults receiving Home Parenteral Nutrition aged over 18 years.

Young people on HPN aged over 16 years

  • Some young people aged over 16 years on HPN may be classed as CEV due to their health problems or medication and come under category 4.
    • Patients aged 12 years and over on HPN who have a severe neuro-disability and recurrent respiratory tract infections and require residential care may come under category 4
    • Young people over 16 years on HPN may come under category 6. 
    • The specialist team should advise.

https://www.bapen.org.uk/pdfs/covid-19/bapen-pinnt-statement-on-shielding-advice.pdf https://pinnt.com/News/COVID-19-Updates/COVID-19-vaccine-advice-on-priority-groups-1.aspx

Children and young people with liver disease

  1. Young people aged 16 and over with chronic liver disease without transplant or immunosuppressant treatment come under category 6.
    1. Young people aged 16 and over deemed clinically extremely vulnerable (as per advice from speciality team) would come under category 4.

https://childliverdisease.org.uk/covid-19-vaccine

https://www.bsg.org.uk/covid-19-advice/a-joint-statement-on-vaccination-for-sars-cov2-in-patients-with-liver-disease/

This advice on vaccination above does not include pregnant women or those under the age of 16 years,  UNLESS the patient is aged 12 years and over and has a severe neuro-disability and recurrent respiratory tract infections and requires residential care. There are currently no plans to prioritise vaccinating people who live with someone who is in a higher risk group. Advice may be updated.

Sue Protheroe.       President of BSPGHAN 31/01/21

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