NHS England spells out next steps as GPs told to cancel AZ jabs booked for under-30s

GP-led vaccination sites should offer under-30s due to receive a first dose of AstraZeneca COVID-19 vaccine from 9 April a chance to rebook at a site offering alternative vaccines, NHS England has said.

The chance to switch to sites offering one of the other COVID-19 vaccines approved for use in the UK - the Pfizer/BioNTech or Moderna vaccines - should also be offered to patients with 'contraindications or conditions that require special precautions' highlighted in updated MHRA advice.

BMA leaders warned NHS England must do 'everything it can' to make access to vaccines as easy as possible, after a warning from the deputy chief medical officer that some patients will face longer waits or need to travel further for jabs at sites offering alternatives to the AstraZeneca vaccine.

NHS England wrote to local vaccination sites and GPs late on 7 April after regulators set out updated advice on use of the AstraZeneca vaccine.

COVID-19 vaccine

Both UK and EU regulators confirmed the benefits of the vaccine outweigh the risks for the vast majority of people. However, in the UK, people under 30 years of age will now be offered alternative vaccines as a first choice.

Meanwhile, the MHRA has said that use of the AstraZeneca vaccine in patients with 'a history of cerebral venous sinus thrombosis, acquired or hereditary thrombophilia, heparin-induced thrombocytopenia or antiphospholipid syndrome should be only be considered when the potential benefit outweighs any potential risks'.

The NHS England letter highlighted advice from the Joint Committee on Vaccination and Immunisation (JCVI) that ‘all those who have received a first dose of the AstraZeneca COVID-19 vaccine should continue to be offered a second dose of AstraZeneca COVID-19 vaccine, irrespective of age’.

However, it also flags MHRA advice that patients who have 'experienced major venous and arterial thrombosis occurring with thrombocytopenia following vaccination with any COVID-19 vaccine should not receive a second dose of COVID-19 Vaccine AstraZeneca'.

Booking appointments

The NHS England letter says appointments for patients in cohorts 1-9 aged under 30 due to receive a dose of AstraZeneca vaccine at a mass vaccination site or a community pharmacy, booked through the national booking service, will be 'cancelled centrally'.

Appointments for patients in this category booked locally to receive a jab 'must be cancelled locally'. Patients will be 'asked to contact their GP team to discuss the benefit and risks to them of receiving the AstraZeneca or another vaccine', the letter confirms.

If patients choose to go ahead with receiving a dose of AstraZeneca vaccine after talking to a clinician, 'all vaccination sites should make this option available'.

Where patients choose to have an alternative vaccine, PCN vaccination sites 'should rebook this individual in a clinic offering the Pfizer/BioNTech vaccine over the coming four weeks'.

Key symptoms

The MHRA has also urged health professionals to be alert to 'signs and symptoms of thromboembolism and/or thrombocytopenia'.

Patients receiving COVID-19 vaccinations should be 'instructed to seek immediate medical attention if they develop new symptoms such as shortness of breath, chest pain, leg swelling, persistent abdominal pain, any neurological symptoms or signs (such as blurred vision, confusion or seizures) or unusual skin bruising and/or petechiae after vaccination', according to updated MHRA advice.

The guidance adds: 'Vaccinated individuals should also seek immediate medical attention if they develop new onset or worsening persistent headaches which do not respond to simple painkillers four or more days after vaccination.

'Patients with thromboembolic events and concurrent thrombocytopenia should be urgently referred to a secondary healthcare centre and to a specialist in haematology for advice on further management.'

Benefits outweigh risks

Commenting on the updated advice, BMA chair Dr Chaand Nagpaul said: 'We acknowledge the fact that the risk of blood clots remains an extremely rare event and the benefits of being vaccinated with the Oxford/AstraZeneca vaccine against COVID-19 still outweigh the risks for the majority of the population.

'It is absolutely right that the JCVI is being honest about the change of direction in advising those who are under 30 to be vaccinated with either the Moderna or Pfizer vaccine - we are fortunate that there are alternative vaccinations that can be offered to those under 30.

'It’s important that NHS England does everything it can to make this process as easy as possible so that patients will get their first and second doses so that the public can continue to have confidence in the programme.'

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