Updated: COVID-19: the green book, chapter 14aCoronavirus (COVID-19) vaccination information for public health professionals.

[Moomin8]

This was updated today.

Published 27 November 2020

Last updated 26 January 2021

Updated clarification around allergies.

gov.uk/government/publicati...

[Lolabridge]

Also some interesting information for those on immune suppressing biologic therapy such as anti-TNF, rituximab etc about the timing of vaccinations. See last paragraph at the bottom of page 14 of the Green Book.Thanks for posting Moomin.

[Eiram50 in reply to Lolabridge]

I think the difficulty is that the roll out is guided by the recommendations in terms of the priority groups, but that the overall direction and distribution ( ie immunising as many as possible with first dose) is ultimately a political decision. Therefore, I’m not sure that anything else will make any difference at the minute?

[Lolabridge in reply to Eiram50]

Yes I think you’re right.

[Eiram50 in reply to Lolabridge]

We may be slightly luckier in Scotland, but when then, there are elements that are dictated by Westminster in as far as supply etc

[Eiram50 in reply to Eiram50]

But “then” not when then

[bubblyalex]

Thank you Moomin. This is very interesting indeed ... “... Where possible, it would also be preferable for the 2-dose schedule to be completed prior to commencing immunosuppression. This would entail offering the second dose at the recommended minimum for that vaccine (three or four weeks from the first dose) to provide maximum benefit that may not be received if the second dose was given during the period of immunosuppression....” Surely this means that some of us can and should have the second dose sooner.

[Moomin8 in reply to bubblyalex]

🤞Maybe someone is able to ask their rheumatologist about thus? I don't have email access to mine unfortunately.

[bubblyalex in reply to Moomin8]

I have sent an email to my gp who is organising mine 🤞🏻🤞🏻🤞🏻🤞🏻🤞🏻

[Lolabridge in reply to bubblyalex]

I wrote a letter to my GP asking for the 2 vaccinations fairly swiftly please if at all possible so then I could have my next Rtx infusion cycle after a four week gap because I know I will need it soon. I was not happy with with her reply, which was obviously a standard response."...Unfortunately you are only guaranteed the first vaccine as it is a government decision to delay the second dose over which I have no jurisdiction but I understand they are promising the second dose within 12 weeks. Let’s hope so. "

I left a message on my hospital's patient advice and information line to ask for a call to discuss and received a call back almost immediately. The nurse said to have the first dose of the vaccine, wait 4 weeks, have first rtx infusion, then wait 2 weeks and have next rtx infusion and wait at least another 4 weeks before having the next dose of vaccine "so that will work within the 12 weeks." !!

I pointed out that is not what is advised in The Green Book dated 25 January which says both doses of the vaccine before rtx infusion, but she said the above is what she had been told to tell me by the lead consultant at the hospital. FGS!!! 🤦‍♀️

[bubblyalex in reply to Lolabridge]

I hope this latest green book adjustment will hopefully mean the gp’s response is out of date 🤞🏻🤞🏻 my gp is not in this week so I must wait for a reply. I am though surprised by your hosp ... doesn’t that ignore the key problem with the Covid vaccine and the rxt B cell issue? by having the any part of the rxt infusion we automatically drop our B cells straight away and so the immune response to the vaccine isn’t as we would like it. 🤷🏻‍♀️how complicated.

[Lolabridge in reply to bubblyalex]

Yes it does, as I pointed out to the nurse and ask her to mention The Green Book update to the lead consultant. I'm hoping for a modified response soon but I'm not going to hold my breath!

[bubblyalex in reply to Lolabridge]

My fingers are crossed ... hopefully by prodding they will review because it clearly gives the ability to change things on face value ... they may not have seen the update... maybe 🤔

[Moomin8 in reply to Lolabridge]

🤞

[Hidden in reply to bubblyalex]

The way I read what you quoted, it's saying people should have both doses of vaccine before they first start on immunosuppressants. As most people here are already getting immunosuppressants, the advice makes no difference. It's like being told to have your flu jab before starting immunosuppressants. It only applies right at the start of the journey.

[Lolabridge in reply to Hidden]

Yes but it would seem to make sense to also apply that to patients about to have maintenance doses of immunosuppressive therapy too. Rituximab patients whose B cells will be repopulating after 6+ months and before their next cycle will be at in their least immune suppressed state at that time.

[Hidden in reply to Lolabridge]

Ah, I'm not familiar with how Rituximab is delivered. I see what you mean.

[KellyInTexas]

Kiitos.

[bubblyalex in reply to KellyInTexas]

? Not sure what this means 😁