COVID-19 vaccines and immunodeficiency

On this webpage you will find information and FAQs about COVID-19 vaccines.

Spring 2024 COVID-19 vaccination programme (posted 26th March 2024)

The Joint Committee on Vaccination and Immunisation (JCVI) has published the eligibility criteria for the Spring COVID-19 vaccination programme.

We encourage you to take up the offer of the Spring booster as it will help reduce the chances of you developing severe COVID-19 disease.

Eligibility

The JCVI has advised that a booster dose of the COVID-19 vaccine should be offered to:

  • Adults aged 75 years and over
  • Residents in a care home for older adults
  • Individuals aged 6 months and over who are immunosuppressed (as defined in tables 3 or 4 (pages 23-26) in the COVID-19 chapter of the Green Book) and includes people affected by primary and secondary immunodeficiency.

Please note that people under 75 years old living in the household of an immunosuppressed person will not be offered a free vaccination.

Dates:

Private vaccines will be available for the first time from April 2024 Local private Covid vaccination service – Pharmadoctor.

For the latest on access to lateral tests and access to COVID-19 treatments visit our website at Access to COVID-19 treatments – Immunodeficiency UK.

How many doses of the COVID-19 vaccine have people with weakened immune systems been offered?

The COVID-19 vaccine schedule for eligible groups has been:

  • 1st primary dose, from around Jan 2021
  • 2nd primary dose, from around April 2021
  • 3rd primary dose, from around September 2021
  • 4th dose (1st booster), from around January 2022
  • 5th dose (Spring 2022 booster), from around April 2022
  • 6th dose (Autumn 2022 booster), from around September 2022
  • 7th dose (Spring 2023 booster), from around April 2023
  • 8th dose (Autumn 2023 booster), from around September 2023

Frequently asked questions

In these circumstances it would be difficult to know which of the treatments has given a reaction if these are given in the same day.  Speak to your health team for advice that covers your specific medical circumstances.

The vaccine you will be offered will be dependent largely on the supplies available from the manufacturers and the logistics of the roll out of the COVID vaccine programme.

If you are taking medication, please bring a list of these with you to the vaccination centre. Do not bring the medicines themselves. If you are taking a blood thinner called ‘warfarin’ you will also be going for regular blood tests to monitor the thickness of your blood using a test called INR. The INR test result is a number (for example 2.5). Please make sure you know your latest INR reading and when that was last checked.  If you don’t know this, you can get it from your GP surgery.

Like all medicines, vaccines can cause side effects. Most of these are mild and short-term, lasting no longer than a week, and not everyone gets them. These may include: a sore arm where the needle went in; feeling tired; a headache; feeling achy; feeling or being sick.

You can take painkillers, such as paracetamol, if you need to. If you have a high temperature, you may have coronavirus or another infection. If your symptoms get worse or you are worried, call 111.

Read about the coronavirus vaccines at https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/coronavirus-vaccine/

You can report side effects at Yellow Card Scheme – MHRA.

For the Autumn 2023 booster programme there is an extension of the vaccination programme to household members.

If you are participating in a research study you may in time get to know this, but, at the moment, there is unlikely to be mass testing to determine benefit.

Patients should always seek personalised medical advice from their healthcare professionals and clearly inform the vaccine centre about their COVID-19 infection and any treatment that was given to treat the infection. For adults no specific period is mandated, however in general terms a minimum of clinical recovery to up to 4 weeks after a positive test is advised. This advice does not replace the need to obtain specific guidance from a healthcare professional with access to your full patient history. The guidance for children is different to adults and longer periods are advised between infection and vaccination (8-12 weeks).

All vaccines undergo extensive safety testing and must meet exacting standards to progress through the different stages of clinical trials. Their use must be approved and licensed before their use through expert review of all trial data through the Medicines and Healthcare products Regulatory Agency (MHRA). They check that the trial meets the necessary efficacy and safety levels. You can find out more about this process at http://vk.ovg.ox.ac.uk/vaccine-development

The safety of the vaccines will be monitored on an ongoing basis, as with all licensed drugs. This is undertaken by the Medicines and Healthcare products Regulatory Agency (MHRA) through the Yellow Card Scheme. Reports of suspected side effects are sent to the MHRA by drug companies (who are obliged to pass on any reports of suspected side effects that are defined as serious), health professionals, and patients themselves.

The data are evaluated each week, and the reported side effects are compared against the expected side effects as detailed in the information sheet for the vaccine. If a previously unidentified reaction emerges, or the frequency of reactions is not in line with what is expected, then the MHRA will investigate carefully. What happens next depends on the kind of side effect identified, but options include insisting that details of the new side effect are given in the product information leaflet or giving out warnings identifying groups of patients who should not be given the vaccine. In rare circumstances, the vaccine may be withdrawn from use.

You cannot catch COVID from the vaccines. But it is possible to have caught COVID and not realise you have the symptoms until after your vaccination appointment. If you have any of the symptoms of COVID, stay at home and arrange to have a test.  If you need more information on symptoms visit: www.nhs.uk/conditions/coronavirus-COVID-19/symptoms/

There are very few individuals who cannot receive the COVID-19 vaccines approved in the UK. Where there is doubt, rather than withholding vaccination, appropriate advice should be sought from the relevant specialist e.g. an allergist or immunologist, or from the local immunisation or health protection team.

To get the vaccine, you will need to be registered with a GP surgery. If you aren’t you will have to get registered or wait until the vaccine is offered more widely at other locations.

At the moment COVID vaccines are only available through the NHS.

The Department of Health (DOH) green book (the DOH vaccine reference book) gives the following statement:

‘Anaphylaxis
Anaphylactic [severe allergic] reactions to vaccines are extremely rare but have the potential to be fatal. Between 1997 and 2003, there were 130 reports to the Medicines and Healthcare products Regulatory Agency (MHRA) of anaphylaxis or anaphylactic-type reactions following immunisation (excluding the meningitis C campaign), although no deaths as a result of the reaction were reported. In that time, around 117 million doses of all vaccines were supplied to hospitals and GPs. This rate (approximately one per million vaccine doses) is similar to that reported from other countries (Bohlke et al., 2003; Canadian Medical Association, 2002).’

Other reactions are non-anaphylactic vaccine events and they are more common, but can usually be managed with antihistamines or will go of their own accord.

If you have concerns discuss the issue with your health team.

The Joint Committee on Vaccination and Immunisation (JCVI) provides advice to the Government about this. They examine data on who suffers the worst outcomes from coronavirus and who is at highest risk of death.

These websites may be helpful:

We do not know precisely the mix of people who have taken part in the clinical trials but patients who are immunocompromised would not be eligible to take part in a vaccine trial in the way that they are conventionally set up.

RNA is an abbreviation for ribonucleic acid. mRNA acts as a messenger carrying instructions from DNA to make proteins.

Traditional virus vaccines use actual viruses that are weakened so they do not harm people and have to be grown in chicken eggs; a process that can take many months. By contrast, the COVID-19 RNA vaccines delivers part of the virus genetic coding for the ‘spike’ protein. This RNA is then coated in a lipid so it can enter the body’s cells and this is injected into the patient. The RNA vaccine then enters the cells and instructs them to produce the COVID spike protein. This prompts the immune system to produce antibodies and activate T cells to destroy infected cells.

RNA-based vaccines are easier and faster to develop, once scientists have the genetic sequence of the protein they want to create. Protein-based vaccines are harder to manufacture but many successful vaccines have been produced in this way, e.g. Hepatitis B and some flu vaccines use this method.

The currently available vaccines produce a protective IgG response against COVID-19, so IgAD should not affect protection. As yet we do not know if vaccine induced IgA responses provide additional protection in COVID but we hope that data will follow from the COV-AD study (see ‘Study starts to look at COVID vaccine responses in patients affected by primary and secondary antibody deficiency’), which measures responses to IgG/A/M in patients with immune deficiency of all types receiving vaccination. We do know that males with the primary immunodeficiency XLA, who never make any IgA or IgM, and who are on lifelong IgG replacement only, are very well served by IgG protection only, suggesting that IgA is redundant in the immune system for most people.

Taking the flu as an example, unfortunately, we don’t have routine antibody tests or T-cell function tests to see if patients have responded to vaccination given in the clinic and we suspect that many will not.  We do know that licenced vaccines are safe. We also know that those with poorer immunity such as the elderly can make a useful response. If patients might derive even a tiny amount of protection from a safe vaccine, many doctors think that is a worthwhile balance, given that influenza-like COVID can result in deaths. The exception to this is we do not recommend live vaccines in many children with more significant PID.

The community can do its bit to encourage friends and family to have an approved COVID vaccination. This will help protect those who don’t have immunity to COVID-19 infection.

This remains unclear and until we know most doctors are likely to give the same advice as flu-vaccine, if it gives even a tiny benefit from T-cell responses to reduce either the risk of infection or to make the illness less severe then as long as it has been licenced and is safe, then antibody deficient patients should consider having it.  We should also acknowledge that some people with e.g. specific antibody deficiency may make a good response to COVID vaccines, just as they might to tetanus but not to e.g. pneumococcus.

Updated March 2023