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Third vaccine dose for children with severely weakened immune systems

CLDF welcomes the advice from the Joint Committee on Vaccination and Immunisation (JCVI) that a third vaccine dose will be offered to people aged 12 and over with severely weakened immune systems as part of their primary schedule, following data from trials of those who are immunosuppressed. 

This is because people with specific conditions that make them particularly vulnerable to COVID-19 may have received less protection against the virus from two vaccine doses and a third dose will help deliver that. 

Studies are ongoing to see how effective a third dose is for immunosuppressed people, but it is very unlikely to cause any harm. Therefore, on balance, the JCVI’s view is that a third dose can be safely offered as it may increase their protection. 

 For those people who are offered a third dose, the Health Secretary has stressed that this is part of their primary schedule and not the start of the booster programme. The potential booster programme is an additional offer and may include these groups of individuals again as well as several other vulnerable groups later in the year. Details of whether and when the booster programme will take place is yet to be announced.   

This third primary dose is likely to affect a number of our children and young people. It will be offered to those with severe immunosuppression, at a bespoke interval (advised by their specialist) and guided by the UK’s immunisation handbook, the Green Book. Below is a list of very specific groups:  

  1. Individuals with primary or acquired immunodeficiency states at the time of vaccination due to conditions including: 
  • acute and chronic leukaemias, and clinically aggressive lymphomas (including Hodgkin’s lymphoma) who were under treatment or within 12 months of achieving cure 
  • individuals under follow up for a chronic lymphoproliferative disorders including haematological malignancies such as indolent lymphoma, chronic lymphoid leukaemia, myeloma, Waldenstrom’s macroglobulinemia and other plasma cell dyscrasias (Note: this list is not exhaustive) 
  • immunosuppression due to HIV/AIDS with a current CD4 count of <200 cells/µl for adults Primary or acquired cellular and combined immune deficiencies – those with lymphopaenia (<1,000 lymphocytes/ul) or with a functional lymphocyte disorder. 
  • those who had received an allogeneic (cells from a donor) or an autologous (using their own cells) stem cell transplant in the previous 24 months 
  • those who had received a stem cell transplant more than 24 months ago but had ongoing immunosuppression or graft versus host disease (GVHD) 
  • persistent agammaglobulinaemia (IgG < 3g/L) due to primary immunodeficiency (e.g. common variable immunodeficiency) or secondary to disease / therapy 
2. Individuals on immunosuppressive or immunomodulating therapy at the time of vaccination including: 
  • those who were receiving or had received immunosuppressive therapy for a solid organ transplant in the previous 6 months. 
  • those who were receiving or had received in the previous 3 months targeted therapy for autoimmune disease, such as JAK inhibitors or biologic immune modulators including B-cell targeted therapies (including rituximab but in this case the recipient would be considered immunosuppressed for a 6 month period), T-cell co-stimulation modulators, monoclonal tumour necrosis factor inhibitors (TNFi), soluble TNF receptors, interleukin (IL)-6 receptor inhibitors., IL-17 inhibitors, IL 12/23 inhibitors, IL 23 inhibitors. (N.B: this list is not exhaustive) 
  • those who were receiving or had received in the previous 6 months immunosuppressive chemotherapy or radiotherapy for any indication. 
3. Individuals with chronic immune-mediated inflammatory disease who were receiving or had received immunosuppressive therapy prior to vaccination including: 
  • high dose corticosteroids (equivalent ≥ 20mg prednisolone per day) for more than 10 days in the previous month 
  • long term moderate dose corticosteroids (equivalent to ≥10mg prednisolone per day for more than 4 weeks) in the previous 3 months 
  • non-biological oral immune modulating drugs e.g. methotrexate >20mg per week (oral and subcutaneous), azathioprine >3.0mg/kg/day; 6-mercaptopurine >1.5mg/kg/day, mycophenolate >1g/day) in the previous 3 months 
  • certain combination therapies at individual doses lower than above, including those on ≥5mg prednisolone per day in combination with other immunosuppressants (other than hydroxychloroquine or sulfasalazine) and those receiving methotrexate (any dose) with leflunomide in the previous 3 months 
4. Individuals who had received high dose steroids (equivalent to >40mg prednisolone per day for more than a week) for any reason in the month before vaccination 

The NHS will contact people as soon as possible to discuss their needs and arrange an appointment for a third dose where clinically appropriate.  With how quickly advice is changing and being extended please do bear with NHS professionals while they set up the platforms and processes needed to implement these next steps. 

Those with less serious immunosuppression are not included in this advice but may become eligible for another dose as part of a potential booster programme, pending further advice from the JCVI. 

The full Government statement on the JCVI advice is available here

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