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Covid-19 HSE Clinical Guidance and Evidence

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Immunisation Navigation

FAQs for Healthcare Professionals - Covid-19 Vaccination for Adult Patients with Cancer Version

FAQs for Healthcare Professionals - Covid-19 Vaccination for Adult Patients with Cancer (VCD19-003/18.01.21)


This document relates to patients who do not have COVID-19 or are not suspected of having COVID-19.

FAQ
  1. When will the vaccine be available?

  2. Should patients with cancer and cancer survivors be vaccinated against Covid-19?

  3. Where will patients with cancer receive the Covid-19 vaccine?

  4. When will patients with cancer receive the Covid-19 vaccine?

  5. How is the Covid-19 vaccine given?

  6. Will the vaccine provide protection against Covid-19 immediately?

  7. How long does the protection last?

  8. Do people who are vaccinated need to continue following general public health advice to prevent the spread of Covid-19?

  9. What are the side effects of the Covid-19 vaccine?

  10. Can the Covid-19 vaccine cause an allergic reaction?

  11. Are there any contraindications with the Covid-19 vaccine?

  12. What other considerations are advised with the Covid-19 vaccine?

  13. Should patients defer/delay their treatment while waiting for a vaccination?

  14. When should patients on systemic anticancer therapy (SACT) (e.g. chemotherapy and immunotherapy) receive the Covid-19 vaccine?

  15. When should bone marrow transplantation patients receive the Covid-19 vaccine?

  16. Can a patient on radiotherapy treatment receive the Covid-19 vaccine?

  17. Can a patient awaiting cancer surgery receive the Covid-19 vaccine?

  18. Can patients with lymphoedema, or those who are at risk of lymphoedema, receive the Covid-19 vaccine?

  19. Can other vaccines be given at the same time as the Covid-19 vaccine?

  20. Will patients with cancer require a third dose of the vaccine because of possible reduced effectiveness?

  21. Are vaccines interchangeable i.e. can one vaccine be used for the first dose and can another brand be used for the second dose?

  22. Can a patient who had previous exposure/infection with Covid-19 receive the vaccine?

  23. Can patients with cancer on clinical trials receive the Covid-19 vaccine?

  24. Should children undergoing treatment receive the Covid-19 vaccine?

1. When will the vaccine be available?

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. 

2. Should patients with cancer and cancer survivors be vaccinated against Covid-19?

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.

3. Where will patients with cancer receive the Covid-19 vaccine?

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.

4. When will patients with cancer receive the Covid-19 vaccine?

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:

  1. Adults older than 65 years who are residents of long-term care facilities and staff members on site
  2. Frontline healthcare workers (HCWs) in direct patient contact roles or who are at risk of exposure to bodily fluids or aerosols
  3. Persons aged 70 years and older
  4. Other HCWs not in direct patient contact
  5. Persons aged 65-69 years – those with medical conditions, including cancer, will be prioritised first
  6. Key workers (Vaccination programmes)
  7. Persons aged 18-64 years with medical conditions, including cancer

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.

5. How is the Covid-19 vaccine given?

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).

6. Will the vaccine provide protection against Covid-19 immediately?

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.

7. How long does the protection last?

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.

8. Do people who are vaccinated need to continue following general public health advice to prevent the spread of Covid-19?

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:

  1. We do not yet know whether the vaccine will stop people from spreading Covid-19 to others
  2. Not all people will mount an adequate immune response to the Covid-19 vaccine, e.g. older and immunosuppressed patients.

9. What are the side effects of the Covid-19 vaccine?

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:

  • pain at injection site
  • feeling tired
  • headache
  • feeling achy
  • low grade fever or chills

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.

10. Can the Covid-19 vaccine cause an allergic reaction?

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.

11. Are there any contraindications with the Covid-19 vaccine?

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.

12. What other considerations are advised with the Covid-19 vaccine?

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.

13. Should patients defer/delay their treatment while waiting for a vaccination?

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.

14. When should patients on systemic anticancer therapy (SACT) (e.g. chemotherapy and immunotherapy) receive the Covid-19 vaccine?

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).

15. When should bone marrow transplantation patients receive the Covid-19 vaccine?

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.

16. Can a patient on radiotherapy treatment receive the Covid-19 vaccine?

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. 

17. Can a patient awaiting cancer surgery receive the Covid-19 vaccine?

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.

18. Can patients with lymphoedema, or those who are at risk of lymphoedema, receive the Covid-19 vaccine?

Yes, but avoid administering the vaccine in the affected limb.

19. Can other vaccines be given at the same time as the Covid-19 vaccine?

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.

20. Will patients with cancer require a third dose of the vaccine because of possible reduced effectiveness?

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.

21. Are vaccines interchangeable i.e. can one vaccine be used for the first dose and can another brand be used for the second dose?

No, the vaccines are not interchangeable. The same vaccine and brand should be used for both doses in an individual patient. 

22. Can a patient who had previous exposure/infection with Covid-19 receive the vaccine?

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.

23. Can patients with cancer on clinical trials receive the Covid-19 vaccine?

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.

24. Should children undergoing treatment receive the Covid-19 vaccine?

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.

 

Where can I find more information?

 

Bibliography
  1. National COVID-19 Vaccination Programme:Strategy https://www.gov.ie/en/publication/bf337-covid-19-vaccination-strategy-and-implementation-plan/#:~:text=Minister%20for%20Health%2C%20Stephen%20Donnelly,health%20and%20social%20care%20services
  2. Allergy UK https://www.allergyuk.org/about/latest-news/1374-allergy-and-the-coronavirus-covid19-vaccine 
  3. Arthritis UK https://www.arthritis.org/health-wellness/about-arthritis/related-conditions/other-diseases/covid-19-faqs-medication-treatment-and-vaccines
  4. American Society of Haematology (ASH) https://www.hematology.org/covid-19/ash-astct-covid-19-and-vaccines
  5. American Society of Clinical Oncology (ASCO) https://www.asco.org/asco-coronavirus-resources/covid-19-patient-care-information/covid-19-vaccine-patients-cancer
  6. British Transplantation Society (BTS) https://bts.org.uk/wp-content/uploads/2020/12/December-2020-BTS-position-statement-vaccination-in-solid-organ-transplant-recipients-FINAL-002.pdf
  7. COVID-19 Real-Time Learning Network (in association with CDC and IDSA) https://www.idsociety.org/covid-19-real-time-learning-network/vaccines/vaccines-information--faq/#concurrent
  8. European Society for Blood and Marrow Transplantation (EBMT) https://www.ebmt.org/sites/default/files/2020-12/COVID%20vaccines%20version%202.03%20with%20table.pdf
  9. European Society Medical Oncology (ESMO) https://www.esmo.org/covid-19-and-cancer/covid-19-vaccination
  10. ESMO Ten Statements https://perspectives.esmo.org/news/covid-19-vaccination-in-patients-with-cancer-esmo-releases-ten-statements
  11. Guys and St Thomas’ NHS Foundation Trust Clinician Frequently Asked Questions (FAQs) and guidance on Covid-19 vaccine for patients receiving Systemic Anti-cancer Therapy (SACT) v1.0 https://www.ukchemotherapyboard.org/publications
  12. Health Products Regulatory Authority (HPRA) http://www.hpra.ie/homepage/medicines/covid-19-updates/approval-of-covid-19-vaccines-frequently-asked-questions
  13. HSE National Immunisation Guidelines Chapter 3. Immunocompromised Patients https://www.hse.ie/eng/health/immunisation/hcpinfo/guidelines/chapter3.pdf
  14. HSE Clinical Guidance for Covid-19 Vaccination V2.0 https://www.hse.ie/eng/health/immunisation/hcpinfo/covid19vaccineinfo4hps/clinicalguidance.pdf
  15. HSE Clinical Guidance and Evidence https://hse-ie.libguides.com/c.php?g=679077&p=4922165
  16. NHS Specialist Pharmacy Service (SPS) https://www.sps.nhs.uk/home/covid-19-vaccines/
  17. Public Health England Covid-19 vaccination programme Information for healthcare practitioners V3.1 https://www.gov.uk/government/publications/covid-19-vaccination-programme-guidance-for-healthcare-practitioners
  18. US CDC https://www.cdc.gov/vaccines/covid-19/index.html

 

Appendix 1: Suggested timings for Covid-19 vaccination for patients on systemic anticancer therapy (SACT) treatment
  • (Adapted from Guys and St Thomas’s NHS Foundation Trust Clinicians FAQs v1.0)

SACT table 2

National Health Library & Knowledge Service. Health Service Executive. Dr. Steevens' Hospital, Dublin 8. Tel: 01-6352555/8. Email: hselibrary@hse.ie

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