Identifying and inviting or signposting people who are immunosuppressed for the COVID-19 spring booster

Classification: Official

Publication approval reference: C1661

To:

  • All ICB Chief Executive Designates
  •  All NHS Trust and Foundation Trust:
    – Chief Executives
    – Medical Directors
    – Chief Nurses
    – Chief Pharmacists
  • CCG accountable officers
  • Primary Care Networks
  • All GP practices

cc:

  • All local authority chief executives
  • National Clinical Directors
  • CCG Chief Pharmacists
  • NHS Regional Directors
  • NHS Regional Directors of Commissioning

Dear colleagues

Identifying and inviting or signposting people who are immunosuppressed for the COVID-19 spring booster

The Joint Committee on Vaccination and Immunisation (JCVI) recommended that people who are aged 12 years and over who are immunosuppressed as set out in the Green Book (Annex A) should be offered a booster dose during the Spring Campaign.

“Immunosuppressed individuals who have received an additional primary dose may have received the booster (fourth) dose more recently. These latter individuals and other eligible people who received their last vaccine more recently should also be offered the booster during the spring campaign providing there is at least three months from the previous dose. This will ensure they have additional protection against a potential summer wave and will align with their peers to facilitate an autumn programme.”

Thank you to you and your teams for your support in vaccinating people who you know to be immunosuppressed. We are writing to set out additional urgent steps to ensure that all remaining eligible immunosuppressed individuals receive a booster during the Spring Campaign.

We know that many people in this group rely on the advice and guidance of their GP or treating clinician in secondary care, and to support improved uptake it is important to embed discussions about vaccination and signposting to vaccination services into the routine clinical care of patients.

UKHSA has developed a search in PRIMIS to identify the immunosuppressed cohort that should now be run by GP practices. We are unable to run a national search for these individuals and need to ask for the help of GP practices to run this query and invite eligible immunosuppressed individuals who have not yet received a spring booster to book an appointment via the National Booking Service (NBS) or attend a walk in service.

Actions now required by PCNs

  • Practices should access the PRIMIS search function held within GP IT systems which has now been updated and undertake local searches and identification of immunosuppressed individuals eligible for spring boosters. This is a non-exhaustive list and due to coding and challenges of identifying a complex cohort of patients there may be additional eligible individuals not listed identified by the practice. Relevant Green Book extracts to identify these individuals are included at Annex A.
  • Where they have not already done so, practices should contact individuals identified via the PRIMIS search function or local searches of their registered list, to make an offer of a spring booster by 27 June using the template letter at Annex B. As per JCVI advice, the spring booster dose should be offered provided there is at least 3 months from the previous dose.
  • Practices that are not delivering the COVID-19 vaccination enhanced service should share a list of eligible patients, based on those identified via the GP PRIMIS and local searches, with their local commissioner (CCG) by 23 June so alternative provision can be made. This request is necessary for the reasons of public interest.
  • Additionally, the current immunosuppressed cohort list held in the COVID-19 GP Dashboard is scheduled to be refreshed by 17 June and will include an updated cohort list for adult (aged 12+) spring booster immunosuppressed.
  • CCGs will be asked to provide assurance that their PCNs have completed these actions.

Actions for secondary care clinicians

  • Contact any immunosuppressed individuals (as defined by the Green Book in Annex A below) identified through locally held lists and those patients who you have regular contact with, to inform them of their eligibility for a spring booster vaccination.
  • A template letter is provided in Annex B that should be used to notify and act as proof for individuals who are immunosuppressed of their eligibility for COVID-19 vaccination. Please ensure that this is sent to all individuals identified as immunosuppressed eligible for a spring booster.
  • Ensure that all routine contacts with immunosuppressed people in outpatients, day treatment units etc include a discussion about eligibility for a spring booster vaccination and advise that if they have not already done so eligible individuals should book an appointment via the National Booking Service or attend a local walk-in clinic.

We appreciate your support to continue to ensure we maximise the opportunity for vulnerable patients to access a booster during the Spring Campaign.

Yours sincerely

Steve Russell

National Director for Vaccinations and Screening

NHS England and NHS Improvement

 Dr Nikita Kanani MBE

Medical Director for Primary Care

NHS England and NHS Improvement

 Professor Stephen Powis
National Medical Director
NHS England and NHS Improvement

 

 

Annex A: Relevant Green Book extracts for eligible immunosuppressed patients

Table 3: Clinical and other risk groups for individuals aged 16 years and over eligible for COVID-19 immunisation.

Immunosuppression Immunosuppression due to disease or treatment, including patients undergoing chemotherapy leading to immunosuppression, patients undergoing radical radiotherapy, solid organ transplant recipients, bone marrow or stem cell transplant recipients, HIV infection at all stages, multiple myeloma or genetic disorders affecting the immune system (e.g. IRAK-4, NEMO, complement disorder, SCID).

Individuals who are receiving immunosuppressive or immunomodulating biological therapy including, but not limited to, anti-TNF, alemtuzumab, ofatumumab, rituximab, patients receiving protein kinase inhibitors or PARP inhibitors, and individuals treated with steroid sparing agents such as cyclophosphamide and mycophenolate mofetil.

Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day for adults.

Anyone with a history of haematological malignancy, including leukaemia, lymphoma, and myeloma.

Those who require long term immunosuppressive treatment for conditions including, but not limited to, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, scleroderma and psoriasis.

Some immunosuppressed patients may have a suboptimal immunological response to the vaccine.

Table 4: Clinical and other risk groups for children and young people aged 5-15 years

Immunosuppression Immunosuppression due to disease or treatment, including:

  • those undergoing chemotherapy or radiotherapy, solid organ transplant recipients, bone marrow or stem cell transplant recipients
  • genetic disorders affecting the immune system (e.g. deficiencies of IRAK-4 or NEMO, complement disorder, SCID)
  • those with haematological malignancy, including leukaemia and lymphoma
  • those receiving immunosuppressive or immunomodulating biological therapy
  • those treated with or likely to be treated with high or moderate dose corticosteroids
  • those receiving any dose of non-biological oral immune modulating drugs e.g. methotrexate, azathioprine, 6-mercaptopurine or mycophenolate
  • those with auto-immune diseases who may require long term immunosuppressive treatments

Children who are about to receive planned immunosuppressive therapy should
be considered for vaccination prior to commencing therapy.

Annex B: Template referral letter inviting individuals aged 12 years and over who are immunosuppressed

Dear [name]

 

You are eligible for a Spring Booster dose of the COVID-19 vaccine

 

We are writing to let you know that you are now eligible for a Spring booster dose of the COVID-19 vaccine, following advice from the Joint Committee on Vaccination and Immunisation (JCVI) on 21 February.

The advice recommends that individuals aged 12 and over who are immunosuppressed should be given a spring booster dose from around 6 months after their last COVID-19 vaccination dose. As a minimum three months should have elapsed since your previous COVID-19 vaccination dose. This is being advised as a precautionary measure to increase immunity levels and provide a better vaccine response, based on studies and experience with other vaccines.

You are eligible for a Spring Booster given your [diagnosis and/or treatment, delete as appropriate] on [date].

 

Please take this letter with you to your COVID-19 vaccine appointment to demonstrate your eligibility. You can get your vaccine by:

  • booking an appointment via the National Booking System and selecting to book “a booster for people with a weakened immune system aged 12 to 74 years old”
  • or attending any walk-in clinic offered by your local vaccination centre, community pharmacy or hospital hub. You can search for walk-in clinics in your local area on the NHS site finder.

 

Yours sincerely

[Signatory on behalf of NHS trust]