Covid19 Vaccination update 7th April 2021
(replaces advice on BSPGHAN website on 31st January 2021)
Today, April 7th, 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 29th 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.
BSPGHAN President April 7th 2021
I hope this email finds you all well.
I trust that you are looking forward to our BSPGHAN Annual Meeting 27-29th April. If you already registered for January, there’s no need to re-register for April. A reminder that accepted abstracts will be published in Frontline Gastroenterology.
I hope that you are making regular use of your access to the journal and enjoying the brilliant educational material that is accessed via our members login page?
Please see Highlights for Members – Publishing Papers to Impact on Practice for March 2021 sent from the Editor in Chief, Professor Mark Beattie.
Sue BSPGHAN President.
I wanted to highlight some of our recent published content that I thought would be of interest
The gut microbiome: what every gastroenterologist needs to know
Getting to grips with sarcopenia: recent advances and practical management for the gastroenterologist
Diagnostic ileocolonoscopy: getting the basics right
Refeeding syndrome : physiological background and practical management
British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding
Also online first
How to manage a high-output stoma
Short bowel syndrome in infancy: recent advances and practical management
Gut-focused hypnotherapy for children and adolescents with irritable bowel syndrome
Exit strategies from the COVID-19 lockdown for children and young people receiving home parenteral nutrition (HPN): lessons from the BSPGHAN Intestinal Failure Working Group experience
Eosinophilic oesophagitis: recent advances and practical management
Check out the journal – lots of other excellent content across gastroenterology, endoscopy, hepatology and nutrition
Follow us on twitter https://twitter.com/FrontGastro_BMJ
Check out the blog https://blogs.bmj.com/fg/
Listen to our regular podcasts https://soundcloud.com/bmjpodcasts/sets/frontline-gastroenterology
Check out the instructions for authors – send us your best work – pre submission enquiries welcome https://fg.bmj.com/pages/authors/
Professor RM Beattie
Consultant Paediatric Gastroenterologist
Honorary Professor of Paediatric Gastroenterology and Nutrition
Editor in Chief Frontline Gastroenterology
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).
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.
Children and young people with liver disease
- Young people aged 16 and over with chronic liver disease without transplant or immunosuppressant treatment come under category 6.
- Young people aged 16 and over deemed clinically extremely vulnerable (as per advice from speciality team) would come under category 4.
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
Children who are CEV & vaccination advice
Following our involvement in the development of the College’s advice on children and young people who are clinically extremely vulnerable, I would like to highlight the College’s recent statement on the COVID-19 vaccination programme.
As you will be aware, the Joint Committee on Vaccination and Immunisation (JCVI) has advised that those who are clinically extremely vulnerable (CEV) and aged 16+ should be vaccinated as part of priority group 4, alongside those aged 70-74. JCVI’s advice is available here. The College supports JCVI’s approach on vaccine prioritisation, and we’d encourage you to follow that. It is essential that the programme is guided by evidence and we expect to see more safety and efficacy data gathered in the next few months that will inform vaccination strategies for groups not covered by this first phase (such as children and young people under 16 who are CEV).
The RCPCH also wanted to flag with you that it has recently come to our attention that, following the introduction of lockdown in England on 4 Jan, all those who are CEV and on the NHS Digital shielded patient list in England (adults, children and young people) have been sent a letter from the DHSC advising them to shield. This letter also refers to the vaccination programme but does not make it clear that those aged under 16 are not in the priority groups in the first phase. Contrary to what is said in the letter, it is not expected that children and young people under 16 who are CEV will be invited for vaccination by mid-February 2021. The RCPCH have raised this unfortunate miscommunication issue with DHSC and NHS England and asked them to look into it.
BSPGHAN Council are delighted to announce that we have consolidated an affiliation with Frontline Gastroenterology. FG is an official publication of the British Society of Gastroenterology and is a companion journal to Gut and BMJ Open Gastroenterology. Frontline Gastroenterology publishes articles that accelerate adoption of innovative and best practice in the fields of gastroenterology, hepatology and clinical nutrition. Frontline Gastroenterology is especially interested in articles on multidisciplinary research and care, focusing on both retrospective assessments of novel models of care as well as putative future directions of best practice. The journal also publishes articles in the domains of clinical quality, patient experience, service provision and medical education.
This arrangement offers an exciting opportunity for BSPGHAN members to receive Free access to the online publication as a benefit of membership.
Access is via the secure member area on the BSPGHAN website- after logging in, click on the Frontline Gastroenterology link to access the journal. If you have any problems accessing this, please email us at firstname.lastname@example.org.
Please accept our very best wishes for 2021 to you all from all on BSPGHAN council.
As we enter the third national lockdown, with surges of cases of the new variant of Covid19 and rates of transmission high nationally, government has issued guidance on shielding for adults. https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19
Importantly, since the first wave, our knowledge of COVID-19 has grown. We now know that very few children and young people are at highest risk of severe illness due to the virus. This means that the National Guidance for children and young people issued December 21 is current at the time of writing and I hope that it is useful for you to review it here- https://www.rcpch.ac.uk/resources/covid-19-guidance-clinically-extremely-vulnerable-children-young-people
The RCPCH guidance sets out that the evidence gathered since the start of the pandemic indicates that the risk of severe disease caused by SARS-CoV-2 or Covid19 infection in children is extremely low and although no one group of conditions has been identified as being at particular risk, specialists have identified those conditions which may make the child or young person CEV as set out in group A list (see the list on the link).
These children are usually CEV under normal (non-pandemic) circumstances, and at risk of severe disease due to a variety of infections which would result in mild disease in the majority of the population.
Lists conditions that require discussion between the clinician and the child and their family/carer to establish whether they are clinically extremely vulnerable (CEV) on a case by case basis. This decision will depend on the severity of the condition and knowledge that the secondary and tertiary care clinical teams have of the particular circumstances of the child. Of note, the majority of children with conditions listed in Group B will not be CEV.
Group B Paediatric gastroenterology, hepatology and nutrition
Paediatric inflammatory bowel disease (IBD) patients who meet one or more of the following criteria:
- Commencement of biologic therapy plus immunomodulatory or systemic steroids within previous six weeks
- Moderate to severely active disease not controlled by moderate risk treatments who may require an increase in treatment
Intestinal failure patients requiring Home Parenteral Nutrition (HPN) who meet one or more of the following criteria:
- Primary immunodeficiency or immunodeficiency induced by drugs as part of their therapy.
- Other significant conditions or other organ involvement (renal, haematology, cardiac, GI, respiratory, diabetes mellitus)
Liver disease who meet one of more of the following criteria:
- Decompensated liver disease
Receiving post-transplant immunosuppression or on Liver/small bowel/multivisceral transplant waiting list
- Liver disease and other significant conditions or other organ involvement (renal, haematology, cardiac, GI, respiratory, diabetes mellitus)
- Active or frequently relapsing autoimmune liver disease where they are likely to need increase in treatment.
As far as I am aware, the guidance shared here for children has not been updated but of course it may be updated at any time. We understand that when a considerable proportion of the most vulnerable groups have been vaccinated, there is the prospect of relaxing some of the lockdown measures, but the vaccine time table according to Prof Chris Whitty reamins “realistic but not easy”.
Please get in touch if you hear further updates and we can share with members.
President BSPGHAN 5th January 2021