This document relates to patients who do not have COVID-19 or are not suspected of having COVID-19.
Rollout out of Covid-19 vaccines that have been approved by the European Medicines Agency (EMA) is underway in our health service. Other Covid-19 vaccines are in the process of being reviewed by the EMA and will be made available once the EMA is satisfied that they are safe and effective.
Yes. Patients with cancer have an increased risk of severe illness from Covid-19. Clinicians should advise patients with cancer and cancer survivors to avail of the Covid-19 vaccine, unless there is a clinical contraindication.
Patients may receive the Covid-19 vaccine at mass vaccination clinics, nursing homes, GP surgeries, hospitals or community pharmacies. The vaccine will be administered by qualified and trained healthcare workers including hospital doctors, community medical officers, nurses, GPs, pharmacists, paramedical staff and physiotherapists. Further information will be made available as the rollout progresses.
The COVID-19 Vaccine Allocation Strategy sets out a priority list of groups for vaccination once a safe and effective vaccine(s) has received authorisation from the European Medicines Agency (EMA). https://www.gov.ie/en/publication/39038-provisional-vaccine-allocation-groups/#your-quick-guide-to-the-provisional-vaccine-allocation-groups
The Strategy was developed by the National Immunisation Advisory Committee (NIAC) and Department of Health, endorsed by the National Public Health Emergency Team (NPHET), and approved by Government on 8 December 2020.
The Strategy is a further component to the State’s response to the COVID-19 pandemic, and will evolve and adapt with more detailed information on the vaccines and their effectiveness.
The following are the first seven of the fifteen priority list of groups:
Patients with cancer and cancer survivors will be represented in all of these groups. Patients with cancer have an increased risk of severe illness from Covid-19 and should be advised to avail of the Covid-19 vaccine as soon as it is offered to them. Cancer is included in the medical conditions associated with groups 5 and 7.
The Covid-19 vaccine is given as an intramuscular injection into the upper arm (deltoid muscle). Two doses are required and they should be given at the recommended interval as per the vaccine Summary of Product Characteristics (SmPC).
No. It may take approximately 7 days after the second dose (booster dose) for the body to be protected from Covid-19. The level of immunity generated by the vaccine in patients with cancer may be affected by a range of factors, including the type of cancer, the type of anticancer treatment, the timing of administration of the vaccine, pre-existing immune dysfunction and general level of fitness. The efficacy of the vaccine may be lower in those who are immunosuppressed.
Additionally, we do not yet know whether the vaccine will stop people from spreading Covid-19 to others, so even if you have been vaccinated you should still continue observing public health measures to reduce the spread of Covid-19, including physical distancing, cough etiquette, wearing face coverings and regular hand washing.
We do not yet know how long the vaccine will provide immunity from Covid-19. It is important to note that older and immunosuppressed patients may not mount an adequate immune response to the vaccine.
Yes - when a person has received both doses of the Covid-19 vaccine they should still continue observing public health measures to reduce the spread of Covid-19, including physical distancing, cough etiquette, wearing face coverings and regular hand washing.
There are two main reasons for this:
Most of the known side effects of the Covid-19 vaccine are mild to moderate and should not last any longer than a week.
The most frequent reported side effects are:
Analgesics may be used to alleviate these side effects if appropriate and in consultation with the treating consultant. If a cancer patient reports a high temperature following Covid-19 vaccination, it may be related to infection and should be investigated as appropriate.
Lymphadenopathy has been observed in some patients post Covid-19 vaccination and is listed as an uncommon adverse effect in more than one of the vaccine SmPCs.
The Covid-19 vaccine is a new vaccine and its safety and efficacy will continue to be monitored on an ongoing basis. No long-term complications from Covid-19 vaccination have been reported to date.
Yes. Patients with a history of serious allergic reaction (anaphylaxis) to a Covid-19 vaccine or any of its constituents should not receive the Covid-19 vaccine. If a patient has a reaction to the vaccine it usually occurs within minutes of administration. Staff administering vaccines should be trained to manage allergic reactions/anaphylaxis.
The mRNA* Covid-19 vaccines (i.e. Pfizer/BioNTech and Moderna) contain a substance called polyethylene glycol (PEG), which forms a protective coating around the mRNA, facilitating delivery of mRNA to the cells. Severe allergic reactions to PEG are rare, and persons with a history of PEG allergy may not be eligible to receive mRNA vaccines. Appropriate advice should be sought from relevant specialists and/or affected patients should consider waiting for the approval of other Covid-19 vaccines that do not use PEG in the manufacture of the vaccine.
The Pfizer/BioNTech and Moderna vaccines do not contain latex.
The Pfizer/BioNTech and Moderna vaccines do not contain any egg proteins and are not contraindicated in egg allergy.
* mRNA = messenger ribonucleic acid. A molecule in cells that carries genetic code from the DNA in the nucleus of the cell to ribosomes for protein synthesis.
Yes. Patients with a history of serious allergic reaction (anaphylaxis) to a Covid-19 vaccine or any of its constituents should not receive the Covid-19 vaccine. See the product SmPC for further information on the vaccine ingredients.
Vaccination of patients with acute severe febrile illness or acute infection should be deferred until recovery. A minor infection and/or low grade fever should not delay vaccination.
Patients who are receiving anticoagulant therapy or those with thrombocytopenia or any coagulation disorder should be given the vaccine with caution – the usual precautions for intramuscular injection should be taken when administering the Covid-19 vaccine.
Any decision to defer or delay the start of treatment while awaiting a vaccination should be discussed with the patient. This includes chemotherapy, radiotherapy or surgery.
Clinicians should advise patients who are due to start cancer treatment (chemotherapy/radiotherapy) or due to undergo cancer surgery to avail of the vaccine as soon as it is offered to them unless clinically contraindicated.
Patients with immunosuppression may not mount a sufficient immune response to vaccination. Patients who have undergone B cell depletion in the past 6 months may have a reduced immune response to vaccination.
As the currently available Covid-19 vaccines are not live vaccines, it is unlikely that they would pose an additional safety risk to patients receiving SACT. In the absence of definitive evidence regarding the immunogenicity of the Covid-19 vaccine in immunosuppressed patients, the following recommendations have been made based on current knowledge of the Covid-19 vaccine and the evidence available in relation to other vaccines.
Ideally patients should receive the Covid-19 vaccine as soon as possible before they start treatment, or if already on treatment they should receive the vaccine between treatment cycles (See Appendix 1).
As the currently available Covid-19 vaccines are not live vaccines, it is unlikely that they would pose an additional safety risk to bone marrow transplantation patients. However, patients who have undergone B cell depletion in the past 6 months may have a reduced immune response to vaccination.
The timing of vaccination after allogeneic stem cell transplantation should follow general recommendations – in the absence of graft-versus-host disease (GVHD), the vaccine can typically be administered 6 months post stem cell transplantation. If the transmission rate in the local area is high, the vaccine could be administered 3 months after stem cell transplantation and should take precedence over regular vaccinations – wait approximately 6-8 weeks post Covid-19 vaccination before administering other vaccines. GVHD patients should not be excluded from Covid-19 vaccination unless their GVHD is severe, uncontrolled grades 3-4.
Clinicians should advise patients due to start radiotherapy to avail of the Covid-19 vaccine as soon as it is offered to them unless clinically contraindicated. Clinicians should discuss the timing of the vaccination with patients who are undergoing radiotherapy treatment when they are offered the vaccine in their allocation group.
Clinicians should advise patients awaiting cancer surgery to avail of the vaccine as soon as it is offered to them unless clinically contraindicated. Vaccines should be administered at least 7 days before surgery to ensure side effects of the vaccine are not confused with perioperative surgical symptoms. Decisions regarding vaccination of patients awaiting cancer surgery should be made in close consultation with the treating clinician/team. If there is insufficient time to administer both doses of the vaccine pre-operatively, the second dose can be administered post-operatively.
Yes, but avoid administering the vaccine in the affected limb.
Currently no data exists around the co-administration of the Covid-19 vaccine with other vaccines. Until further information becomes available, it is prudent to leave at least 14 days between administering the Covid-19 vaccine and administering another vaccine.
No. It is recommended that patients with cancer receive the standard dosing strategy. There is no current guidance on the administration of a third dose for cancer/immunocompromised patients.
No, the vaccines are not interchangeable. The same vaccine and brand should be used for both doses in an individual patient.
Yes, patients who were previously exposed to Covid-19 should receive the vaccine. Re-infection with Covid-19 is possible so it is important to be vaccinated to reduce the risk. Patients should wait until they have fully recovered from Covid-19 before getting vaccinated. Vaccination should be deferred until clinical recovery from Covid-19 and at least four weeks after diagnosis or onset of symptoms, or four weeks from the first PCR positive specimen in those who are asymptomatic.
Clinicians should advise patients to avail of the Covid-19 vaccine as soon as it is offered to them and advise on the timing of vaccination in relation to the clinical trial.
Covid-19 vaccines are not routinely recommended for children and young people under 16 years of age. The current scientific evidence suggests that children are not at risk of severe illness from Covid-19, even if they have underlying medical conditions.
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