Existing national digital systems will not automatically recall patients requiring a fourth booster dose after their third primary vaccination dose. To help you support your patients, the RCP has published an update on the situation. The information is accurate as of 22 December 2021.
RCP has previously summarised the JCVI advice on people who are severely immunosuppressed and need to receive a third primary COVID-19 vaccination dose.
The identification of these patients was made through:
- specialty databases and registries
- pharmacy high-cost drugs databases
- primary care records
- trust data and subsets developed in 2020 to identify clinically extremely vulnerable people.
Approximately 80% of the patients identified by these routes have received their third primary dose.
In line with recent government announcements all adults are now eligible for a booster vaccination 3 months after their last primary course dose. It is particularly important that severely immunosuppressed people receive their booster given the new dominant Omicron variant. However, this is causing some difficulties as the system does not currently distinguish between a third primary dose and a booster.
Take note
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There is no automatic recall for a 3-month booster built into the national digital system for patients who are severely immunosuppressed and would be receiving a fourth dose.
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Additionally, at present patients are unable to book a fourth dose via the national online booking systems, because the patient's data shows that a total of three doses have already been administered. The system classifies these patients as having 'received a booster'.
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Severely immunosuppressed people will not be able to book their booster (fourth dose) 3 months after their last primary course dose using the NHS online booking system.
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They can, however, present at 91 days post-third dose to GPs, pharmacies and services offering unbooked appointments (‘walk-in’ or ‘drop-in’ centres). Some evidence of need for the booster as a result of their high-risk status will be required.
Action to take
Specialists (secondary care) will need to:
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communicate with their own high-risk specialty patient groups to ensure boosters are being taken up
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ensure severely immunosuppressed patients have some ‘evidence of need’ for the fourth dose (previous letters issued on the need for third primary dose could be used).
Moving forward
It is likely that further boosters (modified to deal with vaccine escape) will be required in future but no timelines are currently available for this.
Severely immunosuppressed patients who develop COVID-19 and receive a positive PCR test result will need to be referred to their local COVID medicines delivery unit (CMDU) for administration of sotrovimab (local arrangements will apply). Most severely immunosuppressed patients will have been sent a PCR test to use if they develop symptoms. If anyone has not received a testing kit they can obtain one by calling 119 and selecting option 1.