Updated BSPGHAN shielding guidance (Published 07 July 2020)

We have been informed that BSPGHAN shielding guidance has been updated due to further evidence and review of the risk and impact on those children with a liver condition. Professionals are aware they have been quite strict with their patients so far. This review has been undertaken to allow more relaxation due to the additional evidence gained specifically about children with liver conditions as mentioned in the link to the guidance below. It focuses on allowing more paediatric liver patients to come out of shielding.

What are the changes?

There are now only two groups (A – need to continue shielding, B – all groups that can come out of shielding, including those previously in group C)
Those more than six months post liver transplant with stable immunosuppression levels can now come out of shielding. This has changed from one year post liver transplant.
Liver disease with other significant co-morbidities (Group A) must remain shielding if also advised to do so by the other speciality.
Minor change to definition of chronic but stable liver disease (in Group B – do not need to shield).

What is the breakdown for each group?

Group A – shielding group

1. Decompensated liver disease (ascites, portal hypertension)

2. Receiving post-transplant immunosuppression (<6 months from LT) or on liver/small bowel/multivisceral transplant waiting list

3. Liver disease with other significant co-morbidities (immunodeficiency, post other organ transplantation, respiratory conditions) for which they have also been advised to continue shielding by the respective subspecialty.

4. Active or frequently relapsing autoimmune liver disease where they are had a recent (<3 months) increase in treatment

5. Intravenous or oral steroids ≥20mg/day prednisolone (or >0.5mg/kg) or equivalent per day (only while on this dose)

6. Commencement of biologic therapy plus immunomodulatory or systemic steroids with previous six weeks

7. Requirement for parenteral nutrition

Group B – do not need to shield

1. Chronic but stable liver disease (on routine follow up appointments)
2. Portal vein thrombosis/portal cavernoma
3. More than 6 months post liver transplant with stable immunosuppression levels
4. Autoimmune liver disease more than 3 months on maintenance treatment

Please do contact your/your child’s clinical team if you are unsure if you come under Category B to ‘unshield’.

You can read the full updated BSPGHAN guidance here.

When these groups apply and local lockdowns

These will apply to all those shielding in England until 1 August, Northern Ireland until 31 July, Wales until 16 August (subject to review) and Scotland until 31 July (subject to review). Please remember to keep an eye on announcements in your countries regarding changes to these dates as it depends on the rate of infection at the time. The guidance will also apply if shielding comes back into place later in the year in each country.

Where there are local lockdowns (e.g. currently Leicester) these shielding categories will apply. If shielding has ended in your country when a local lockdown takes place, those in Group A may be advised to resume shielding until local restrictions ease again. These groups also apply if a second peak arises and shielding comes back into place. If you have any concerns about this, please contact your medical team.

* These groups apply to children and young people under 18. Those over 18 and/or in adult services it would be best to check with your clinical team as guidance may be different.

Reviews

There will be several reviews of this guidance taking place over the next few months, including in September when most children will be returning to school. This is so that families can make more educated decisions according to the most up-to-date evidence and ensure schools are aware of the needs of their children when they return. We will update you as and when these updates come through.

Generic NHS and Government letters

This is the guidance that your clinicians will be following as it is a detailed breakdown of paediatric liver conditions developed in collaboration with specialist paediatric liver centres and will be reviewed regularly. Always follow advice provided to you by your clinician rather than generic NHS/Chief Medical Officer letters that you may receive as your clinician will provide individualised recommendations.