All posts by Vicky Hoskins

COVID 19 Vaccination 2nd dose FAQ’s

Publication approval reference: C1200
COVID-19 vaccination programme: FAQs on second doses
Version 1 – 19 March 2021
LOCATION OF SECOND DOSE
Does second dose vaccination need to happen at the same place as the first
dose?
• People using the National Booking Service (booking into a vaccination centre or
designated community pharmacy) are given their closest available appointment
locations. While we expect most people will book both appointments at the same
location, there is an option for the second dose appointment to be booked at a
different location. This applies to the COVID-19 AstraZeneca vaccine only.
• People who had their first dose through a GP service should be invited for their
second dose through the same GP service.
• People who had their first dose at a Hospital Hub site should be invited or be able
to book their second dose at the same location.
• There are other circumstances in which it may be appropriate for a patient to
receive their second dose in a different location to their first dose, for example,
discharged outpatients, students, doctors in training on rotation to hospitals, people
who have become housebound or moved into a care home since their first dose, or
patients who have moved to a new house to somewhere a long way away from
where they had their first dose.
• Local systems should take a common-sense approach to these cases, eg trying to
reduce extensive travel for elderly patients where possible.
SECOND DOSE INTERVAL PERIOD
What is the second dose interval period?
• The agreed dose interval period is set at 77-84 days as outlined in the Chief
Medical Officer’s letter. Vaccine will be supplied for second dose clinics to take
place 11 weeks post first dose clinics, so that the 12-week time period between
doses is achieved.
Can clinics be scheduled early to vaccinate outside of the interval period?
• Clinics should not schedule second dose appointments earlier than 77 days post
the first dose, unless there are exceptional circumstances, as this is not in line with
the agreed dose interval.
Are there any circumstances when individual patients can receive their second
dose outside of the standard interval period?
• The Green Book states that second dose should in almost all cases be given
between 77 and 84 days after the first dose. However, there are a small number of
2
circumstances when the second dose can be given at a different time interval, for
example:
Some patients with planned immunosuppressive therapy
• There are a small number of patients who are about to receive planned
immunosuppressive therapy and, where clinically appropriate, should be
considered for vaccination prior to commencing therapy (ideally at least two
weeks before), when their immune system is better able to make a response.
• Where possible, it would also be preferable for the two-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.
Homeless people and rough sleepers
• Given the vulnerabilities of homeless people and rough sleepers, local teams
should exercise operational judgement and consider a universal offer, where
those experiencing homelessness or rough sleeping are vaccinated alongside
priority group 6 (as far as local teams consider appropriate).
• To maximise coverage in this group, JCVI also advise a first vaccine dose
should be given, even if follow up for a second dose is likely to be uncertain,
and that the dosing schedule can be compressed if that makes delivery of a
second dose more certain.
• If an interval longer than the recommended interval is left between doses, the
second dose should still be given. The course does not need to be restarted.
Can patients be vaccinated sooner than 77-84 days if it is operationally
convenient?
• Second doses should be offered within 77-84 days. The clinical evidence for the
COVID-19 AstraZeneca vaccine shows better efficacy following a 12-week gap,
which is the basis of the JCVI recommendation.
• However local areas should agree a pragmatic approach to giving doses earlier
than this following a clinical assessment and weighing up risks and benefits.
SCHEDULING AND ADMINISTERING SECOND DOSES
Can different vaccines be used for first and second doses?
• The Green Book states that the same vaccine used for the first dose must be
used for the second, except in very exceptional circumstances. These
exceptional circumstances are:
o If the first product received is unknown or if they received a brand that is
not available in the UK. In these circumstances every effort should be
made to determine which vaccine the individual received for their first
dose and to complete the two-dose course with the same vaccine.
3
o If the patient initially had the Pfizer Vaccine in an LVC or HH clinic and
has since become housebound. In these circumstances as the COVID-
19 vaccine AstraZeneca can be transported, a second dose with this
vaccine can be given.
• Those who experienced anaphylaxis reactions with the first dose of one brand
of vaccine may be offered another vaccine if advised by an allergy specialist.
CONSENT
Does consent need to be obtained for the second dose, in particular in the case
of care home residents?
• The Standard Operating Procedure for Covid vaccination in community settings
states that “the giving and obtaining of consent is viewed as a process, not a
one-off event. Consent should still be sought on the occasion of each
immunisation visit. Consent must be given voluntarily and freely”. It is not
necessary for care home staff to obtain a second consent form. The original
consent forms include the second dose, as they describe consent for the full
course. However, patients should have the opportunity to refuse the second
dose – this may occur in the rare case of a side effect. Further details are
available on NHS Futures web platform issued by the clinical workstream.
• If care home residents do not have capacity and the decision to vaccinate has
been made on best interests or through an attorney, this would have been for
the full course, so would not necessarily require a second process. However, at
the time of the vaccination, there should be the opportunity for an individual or
advocate to refuse consent. We expect this to be unlikely in most cases.
DATA AND RECORDING
How are first and second dose vaccination events recorded?
• First and second dose vaccinations are to be recorded in the points of care system
in an accurate and timely manner in order to start the allocation calculations. This is
important for Pfizer in particular, as its supply is finite.
• Outcomes4Health differentiates between first and second doses.
• Once a first dose event has been recorded on the system this will trigger a second
dose allocation requirement 11 weeks later.
• It is important that doses are recorded onto the points of care system at the point of
vaccination to ensure clinical safety, eg ensuring that a patient receives the correct
second dose.
VACCINE ALLOCATIONS AND SUPPLY
How do we manage any surplus doses?
• Where there is surplus vaccine following second dose clinics, this should be
used for first doses in the prevailing priority cohorts, for those patients who have
been vaccinated prior to starting immunosuppression and who need a shorter
interval between doses.
• For LVS in particular, every effort is being made to right-size Pfizer supply with
the use of pack down in order to minimise surplus.
4
How will we separate first and second dose vaccines on site?
• Vaccine deliveries will not be separated into first and second doses. This will
need to be done on site on arrival, informed by the allocation planning process.
Sites will receive their regular weekly allocation information which will include
first and second dose summaries in order to do this.
• Care must be taken to ensure that volume allocated for second dose activity is
appropriately identified and directed to second dose clinics.
• HHs’ and VCs’ Immform accounts will show total allocation per site – there is no
differentiation between first and second dose on Immform.
When will second dose allocations be available?
We are trying to provide visibility of four weeks’ worth of allocations ahead of time, to
be finalised about two weeks in advance of delivery to Local Vaccination Services, or
availability to order in the case of Vaccination Centres or Hospital Hubs. Exact
timelines will be communicated shortly through the usual cascade routes. For Local
Vaccination Services and Pfizer vaccine we are making efforts to extend to more than
four weeks’ worth of allocations ahead of time.
What if we don’t have sufficient supplies to cover patients who didn’t have their
first dose at that site?
In the unlikely event that supply is insufficient please urgently escalate through the
normal routes.
Who do I contact if I have a query around final second dose allocations?
• If your query is related to final dose allocation, it should follow the standard comms
route, ie from SVOC, to RVOC, to NVOC which is then shared with the central
team.
• Please do not bypass this process, to ensure your queries and requests are
actioned as soon as possible.
• The role of Customer Services remains unchanged, same routes apply for second
dose as those for first dose.

Patient Participation Group Meeting 11/01/2021

Minutes of Pathfields Patient Group Zoom Meeting 11 January 2021

 

Present   Phil Hart, Bernice Lewin, Helen Baker, Anne and Jeff Morgan, Christine Lewis, Natalie Harrison.

Apologies   Dr Dave Attwood, Len Gaynor, Caroline Sozer, Annie Jenkin, Ursula Brown, Paul Russell. Jenny Thornton

 

Dr Attwood was unable to attend as he is busy vaccinating patients at our local Care Homes.

We are grateful to Helen who updates us on the Covid Vaccination progress in Pathfields.

 

At present Pathfields patients over 80 are invited to attend the Pavillions , Millbay Road for their vaccinations.  17 practices across the city ( not Beacon or Plymstock practices who have their own arrangements )  are working together to coordinate the rollout. The Pfizer vaccine is being used there and requires complicated mixing and drawing up into vials.  The staff working in shifts 8am-8pm are all vaccinated and parking is free. There is a requirement to stay for 15 minutes after vaccination.  When regular deliveries are received the centre will hopefully be open 7 days a week.

Patients in the relevant cohorts, at present over 80s, are invited by phone call from the practice. Helen reports that take up has been very high so far.  Further cohorts will be invited by phone call or possibly by text in due course. Currently phone calls are being made from Beaumont Villa to arrange appointments for vaccination.  Members of the group expressed concerns regarding contacting patients who are unwilling to answer telephone calls from private numbers and who may miss the chance to get their appointment.  Members asked Helen to confirm that all patients missing calls would be followed up.  For the elderly next of kin numbers could be contacted.

It was also suggested that the Pathfields website publishes a reminder of the need to ensure the practice number is saved on your phone if possible.

The Care Home Project continues, staff are visiting all care homes to vaccinate the residents. For those patients the practice is using the Astra Zeneca vaccine.  Pathfields hopes to complete the over 80s and care home residents by mid February.

Helen also shared with us the difficulties they face.   Government guidance changes on sometimes a daily basis. This prevents effective forward planning . It is better to wait for a delivery before making appointments. Typically patients get 4 days notice of their appointment and the best way even for those with poor mobility is to get to the Pavillions where wheelchairs are available and if necessary get someone to take you there, this is an essential journey).   Information is available on the Pathfields Website.

Social media informs users that patients should have their NHS number with them to speed up the process. Phone lines to surgeries have been clogged up with patients wanting to know their NHS number. This is available on repeat prescription forms and Practice and Hospital correspondence and on the NHS App when downloaded. Helen told us that she did not have her NHS number with her when vaccinated and it did not hold up the procedure. There is much information on social media which may or may not be correct.

Vaccinating the housebound patients is challenging with restrictions on transporting the vaccines. Pathfields is working on a solution to this problem.

 

Concerns were expressed about accessing the practice.  eg a patient was sent a text by the practice to get a blood test. Long waits on the telephone were experienced and the only alternative was eConsult. Patients are not able to queue at the surgery nor can any appointments be made online.  Helen reported that phone lines are busy with people asking when they can have their vaccine. It was felt that there is enough publicity on tv newspapers and online to discourage these calls.     HB said 5.30 at the end of the day was a generally a quiet time to access. She checked her system and reported that at 10.30 on 11 January there were currently 13 people holding on.

When listening to the options on the telephone message we are reminded that there is a cancellation option if you no longer need an appointment. Your appointment can be given to someone else .

CL said that her pharmacy enabled her to ring up and order repeat prescriptions though HB said some pharmacies have ceased this practice. There are facilities for online companies to order and deliver your NHS prescriptions to you.

Members were concerned that elderly and often younger patients may not have access to the internet to use eConsult or to order repeat prescriptions and other facilities.  For eConsult patients do not need to be registered for online services.  Patients can go to the website and start an enquiry.

A patient who was recommended a blood test from a Doctor via eConsult reports that she was told to make an appointment at the surgery or turn up at Future Inn Derriford without an appointment where phlebotomy services are now located. She then turned up when they opened at 8am and was dealt with promptly and efficiently as the GP had mailed the information to the phlebotomy service. ( note, you cannot attend unless the GP has contacted them .)

Practice stats for December;

Prescriptions issued  15697       Sick notes  290       Cervical smears 144

Bloods    1294       Medication reviews  2402     Telephone appointments 3529

Online consultations 1486        DNA  581

 

Members of the group thanked Helen for her time and the information she was able to share with us.  The job of the Patient Group is to ask questions, share ideas and support the Practice on behalf of the patients.

Date of next meeting tba

 

 

 

ASTRA ZENECA VACCINE LEAFLET   

1. What COVID-19 Vaccine AstraZeneca is and what it is used for
COVID-19 Vaccine AstraZeneca is a vaccine used to protect people aged 18 years and older against
COVID-19.
COVID-19 is caused by a virus called coronavirus (SARS-CoV-2).
COVID-19 Vaccine AstraZeneca stimulates the body’s natural defences (immune system). It causes
the body to produce its own protection (antibodies) against the virus. This will help to protect you
against COVID-19 in the future. None of the ingredients in this vaccine can cause COVID-19.
2. What you need to know before you receive COVID-19 Vaccine AstraZeneca
Do not have the vaccine:
 If you have ever had a severe allergic reaction to any of the active substances or any of the other
ingredients listed in section 6. Signs of an allergic reaction may include itchy skin rash,
shortness of breath and swelling of the face or tongue. Contact your doctor or healthcare
professional immediately or go to the nearest hospital emergency room right away if you have
an allergic reaction. It can be life-threatening.
If you are not sure, talk to your doctor, pharmacist or nurse.
3
Warnings and precautions
Tell your doctor, pharmacist or nurse before vaccination:
 If you have ever had a severe allergic reaction (anaphylaxis) after any other vaccine injection;
 If you currently have a severe infection with a high temperature (over 38°C).
However, a mild fever or infection, like a cold, are not reasons to delay vaccination;
 If you have a problem with bleeding or bruising, or if you are taking a blood thinning medicine
(anticoagulant);
 If your immune system does not work properly (immunodeficiency) or you are taking medicines
that weaken the immune system (such as high-dose corticosteroids, immunosuppressants or
cancer medicines).
If you are not sure if any of the above applies to you, talk to your doctor, pharmacist or nurse before
you are given the vaccine.
As with any vaccine, COVID-19 Vaccine AstraZeneca may not protect everyone who is vaccinated
from COVID-19. It is not yet known how long people who receive the vaccine will be protected for.
No data are currently available in individuals with a weakened immune system or who are taking
chronic treatment that suppresses or prevents immune responses.
Children and adolescents
No data are currently available on the use of COVID-19 Vaccine AstraZeneca in children and
adolescents younger than 18 years of age.
Other medicines and COVID-19 Vaccine AstraZeneca
Tell your doctor, pharmacist or nurse if you are taking, have recently taken or might take, any other
medicines or vaccines.
Pregnancy and breastfeeding
If you are pregnant or breastfeeding, think you may be pregnant, or are planning to have a baby, tell
your doctor, pharmacist or nurse. There are limited data on the use of COVID-19 Vaccine
AstraZeneca in pregnant or breastfeeding women. Your doctor, pharmacist or nurse will discuss with
you whether you can be given the vaccine.
Driving and using machines
COVID-19 Vaccine AstraZeneca has no known effect on the ability to drive and use machines.
However, side effects listed in section 4 may impact your ability to drive and use machines. If you feel
unwell, do not drive or use machines.
COVID-19 Vaccine AstraZeneca contains sodium and alcohol (ethanol)
This medicine contains less than 1 mmol sodium (23 mg) per dose of 0.5 ml. This means that it is
essentially ‘sodium-free’.
This medicine contains a very small amount of alcohol (0.002 mg of alcohol (ethanol) per dose of
0.5 ml). This is not enough to cause any noticeable effects.
3. How COVID-19 Vaccine AstraZeneca is given
COVID-19 Vaccine AstraZeneca is injected into a muscle (usually in the upper arm).
You will receive 2 injections. You will be told when you need to return for your second injection
of COVID-19 Vaccine AstraZeneca.
The second injection can be given between 4 and 12 weeks after the first injection.
4
When COVID-19 Vaccine AstraZeneca is given for the first injection, COVID-19 Vaccine
AstraZeneca (and not another vaccine against COVID-19) should be given for the second injection to
complete vaccination course.
If you miss your second injection
If you forget to go back at the scheduled time, ask your doctor, pharmacist or nurse for advice. It is
important that you return for your second injection of COVID-19 Vaccine AstraZeneca.
4. Possible side effects
Like all medicines, this vaccine can cause side effects, although not everybody gets them. In clinical
studies with the vaccine, most side effects were mild to moderate in nature and resolved within a few
days with some still present a week after vaccination.
If side effects such as pain and/or fever are troublesome, medicines containing paracetamol can be
taken.
Side effects that occurred during clinical trials with COVID-19 Vaccine AstraZeneca were as follows:
Very Common (may affect more than 1 in 10 people)
 tenderness, pain, warmth, redness, itching, swelling or bruising where the injection is given
 generally feeling unwell
 feeling tired (fatigue)
 chills or feeling feverish
 headache
 feeling sick (nausea)
 joint pain or muscle ache
Common (may affect up to 1 in 10 people)
 a lump at the injection site
 fever
 being sick (vomiting)
 flu-like symptoms, such as high temperature, sore throat, runny nose, cough and chills
Uncommon (may affect up to 1 in 100 people)
 feeling dizzy
 decreased appetite
 abdominal pain
 enlarged lymph nodes
 excessive sweating, itchy skin or rash
In clinical trials there were very rare reports of events associated with inflammation of the nervous
system, which may cause numbness, pins and needles, and/or loss of feeling. However, it is not
confirmed whether these events were due to the vaccine.
If you notice any side effects not mentioned in this leaflet, please inform your doctor, pharmacist or
nurse.
Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible
side effects not listed in this leaflet.
If you are concerned about a side-effect it can be reported directly via the Coronavirus Yellow Card
reporting site https://coronavirus-yellowcard.mhra.gov.uk/ or search for MHRA Yellow Card in the
Google Play or Apple App Store and include the vaccine brand and batch/Lot number if available.
By reporting side effects you can help provide more information on the safety of this vaccine.
5
5. How to store COVID-19 Vaccine AstraZeneca
Keep this medicine out of the sight and reach of children.
Your doctor, pharmacist or nurse is responsible for storing this vaccine and disposing of any unused
product correctly.
Storage
Do not use COVID-19 Vaccine AstraZeneca after the expiry date which is stated on the carton. The
expiry date refers to the last day of that month.
Store in a refrigerator (2°C to 8°C).
Do not freeze.
Keep vials in outer carton to protect from light.
The vaccine does not contain any preservative and should be administered by a healthcare
professional. After the first dose is withdrawn, the vaccine should be used as soon as practically
possible and within 6 hours. During use it can be stored from 2°C to 25°C.
Disposal
COVID-19 Vaccine AstraZeneca contains genetically modified organisms (GMOs). Any unused
vaccine or waste material should be disposed of in accordance with local requirements. Spills should
be disinfected with an appropriate antiviral disinfectant.
6. Contents of the pack and other information
What COVID-19 Vaccine AstraZeneca contains
One dose (0.5 ml) contains:
COVID-19 Vaccine (ChAdOx1-S*
recombinant) 5 × 1010 viral particles *
Recombinant, replication-deficient chimpanzee adenovirus vector encoding the SARS-CoV-2 Spike
glycoprotein. Produced in genetically modified human embryonic kidney (HEK) 293 cells.
This product contains genetically modified organisms (GMOs).
The other excipients are L-histidine, L-histidine hydrochloride monohydrate, magnesium chloride
hexahydrate, polysorbate 80, ethanol, sucrose, sodium chloride, disodium edetate dihydrate, water for
injections.
What COVID-19 Vaccine AstraZeneca looks like and contents of the pack
Solution for injection. The solution is colourless to slightly brown, clear to slightly opaque and particle
free.
Pack sizes (not all pack sizes may be marketed):
 10 dose vial (5 ml) in packs of 10 vials.
 8 dose vial (4 ml) in packs of 10 vials.
Manufacturer
MedImmune UK Ltd
6 Renaissance Way
Liverpool, L24 9JW
United Kingdom
MedImmune Pharma B.V., Nijmegen
Lagelandseweg 78
Nijmegen, 6545CG
Netherlands
6
For any information about this medicine, please contact:
AstraZeneca UK Ltd
Tel: 08000541028