Vaccination of permanent adult household contacts of severely immunosuppressed individuals alongside JCVI priority cohort 6
- Definition of severely immunosuppressed individuals
- Definition of adult household contacts
- Next steps
- Annex A
Publications Approval Reference: C1236
To: Medical Directors of Acute Trusts
- All ICS and STP leads
- NHS Regional Directors
- NHS Regional Directors of Commissioning
31 March 2021
Dear secondary care colleagues
We are writing to let you know that the JCVI has recently advised that adult household contacts of severe immunosuppressed adults (aged 16 years and over) are offered COVID-19 vaccination alongside priority group 6.
This is in response to regular monitoring of data on vaccine effectiveness and impact, which indicates lower protection in vaccinated adults who are immunosuppressed. Those with severe immunosuppression are therefore more likely to suffer poor outcomes following infection and are less likely to benefit from the vaccines offered. The JCVI’s recommendation to vaccinate adult household contacts aims therefore to reduce the risk of infection in the immunosuppressed who may not be able to fully benefit from vaccination.
Definition of severely immunosuppressed individuals
The JCVI definition of severely immunosuppressed individuals is those currently included in either priority group 4 and 6 using the definition set out in the Immunosuppression section of Table 3 ‘Clinical risk groups 16 years of age and over who should receive COVID-19 immunisation’ in the Greenbook Chapter 14A. This section covers immunosuppression due to disease or treatment. This includes but is not limited to:
- individuals who are receiving immunosuppressive or immunomodulating biological therapy and individuals treated with steroid sparing agents
- 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, and those who may require long term immunosuppressive treatments.
Immunosuppressed children are not included in the definition, in that their adult household contacts are not being advised for vaccination as part of the JCVI guidance.
Definition of adult household contacts
We are using the same principles to define household contacts in this context as those used in the Greenbook Chapter 19: Influenza “individuals who expect to share living accommodation on most days…. and therefore, for whom continuing close contact is unavoidable.”
The JCVI advice covers individuals aged 16 years or over only. Those household contacts aged 16-17 years old will need to receive the Pfizer/BioNTech vaccine.
Children are excluded. Given that there is still no data on the safety, reactogenicity or efficacy of COVID-19 vaccines in children and that children are much less likely to have poor outcomes from COVID-19, the JCVI is not currently advising vaccination of household contacts of immunosuppressed children, or household contacts of immunosuppressed adults who are themselves children.
Members of ‘bubbles’ that do not live with the immunosuppressed individual for the majority of the week (frequent visitors and other non-carers who might visit the house often but not for the majority of the week, including overnight stays) are excluded from the definition.
Those living in long-stay residential care homes or other long-stay care facilities will already be eligible for a vaccine in priority cohorts 1 and 6, in line with JCVI recommendation. As with the influenza vaccine, this does not include prisons, young offender institutions, university halls of residence etc.
Whilst SNOMED codes will capture a proportion of this group within primary care, some individuals will need to be added via NHS trusts.
Please cascade this information to the relevant departments within your trust, asking specialists to inform the immunosuppressed patient’s GP that their adult household contacts are eligible for the COVID-19 vaccination, and advise your eligible patients to contact their registered GP.
We are writing to all GP practices separately asking them to identify and write to individuals on their registered patient lists who fall into the above definition of severely immunosuppressed.
Eligible household contacts are being advised to call their registered GP practice to book a vaccination appointment and they will then be invited to attend the PCN-led Local Vaccination Services (LVS) site. Household contacts will need to use the letter sent from the GP practice (template example in Annex A) to the immunosuppressed individual, together with their own valid proof of address which must match that of the immunosuppressed individual, in order to provide evidence of eligibility for vaccination. This will be requested upon arrival for their vaccination appointment.
Thank you in advance for helping to inform this vulnerable population of their permanent adult household contacts’ eligibility for COVID-19 vaccination.
Dr Nikita Kanani | Medical Director for Primary Care | NHS England and NHS Improvement
Ed Waller | Director of Primary Care | NHS England and NHS Improvement
Template letter to severely immunosuppressed individuals for GP practices to adapt
Your permanent, adult household contacts are now eligible to receive the COVID-19 vaccination
We are writing to let you know that your adult household contacts are now eligible to receive the COVID-19 vaccination.
This is because the Joint Committee on Vaccination and Immunisation (JCVI) has recently advised that adult (over 16 years of age) household contacts of those individuals who have a disease or illness, are receiving treatment / medication which means that their immune system is suppressed should be offered COVID-19 vaccination. This aims to reduce the risk of infection to you, as even though you may have received your COVID-19 vaccination, you may have lower protection from the vaccine due to suppression of your immune system.
The JCVI advice applies to adult household contacts who are 16 years and above with whom you “expect to share living accommodation on most days…. and therefore, for whom continuing close contact is unavoidable.” Children are excluded.
Members of ‘bubbles’ that do not live with you for the majority of the week (frequent visitors and other non-carers who might visit the house often but not for the majority of the week, including overnight stays) are excluded from the definition.
Please let your adult household contacts know that they can now book a vaccination appointment via their registered GP practice, who will then invite them to attend their GP-led Local Vaccination Service.
Your household contacts will need to use this letter, together with their own valid proof of address which should match your address, in order to provide evidence of eligibility for vaccination. This should happen upon arrival for their vaccination appointment. If an adult is supporting you through a period of treatment e.g. chemotherapy and they are unable to provide a valid proof of address, they should contact their registered GP who will be able to advise them.
This link on the government website outlines what is a valid proof of address: Proof of identity checklist – GOV.UK (www.gov.uk) and includes the following:-
- Utility bill (gas, electric, satellite television, landline phone bill) issued within the last three months
- Local authority council tax bill for the current council tax year
- Current UK driving licence (but only if not used for the name evidence)
- Bank, Building Society or Credit Union statement or passbook dated within the last three months
- Original mortgage statement from a recognised lender issued for the last full year
- Solicitors letter within the last three months confirming recent house purchase or land registry confirmation of address
- Council or housing association rent card or tenancy agreement for the current year
- Benefit book or original notification letter from Benefits Agency (but not if used as proof of name)
- HMRC self-assessment letters or tax demand dated within the current financial year
- Electoral Register entry or NHS Medical card or letter of confirmation from GP’s practice of registration with the surgery
Note that any household contacts aged 16-17 years old will need to receive the Pfizer/BioNTech vaccine as the Oxford/AstraZeneca vaccine has only been authorised for use in people aged 18 years and over.
For more information about the coronavirus vaccine, read the leaflet that came with this letter, or visit www.nhs.uk/covid-vaccination