Summary of JCVI advice on third vaccines and boosters for the clinical community

Who is eligible?

Third primary dose for the immunosuppressed

• Acute and chronic leukaemias, and clinically aggressive lymphomas (including Hodgkin’s lymphoma) who were under treatment or within 12 months of achieving cure
  
• Individuals under follow up for chronic lymphoproliferative disorders including haematological malignancies such as indolent lymphoma, chronic lymphoid leukaemia, myeloma, Waldenstrom’s macroglobulinemia and other plasma cell dyscrasias (note: this list is not exhaustive) – this includes patients on active monitoring only
  
• Those who had received an allogeneic (cells from a donor) or an autologous (using their own cells) stem cell transplant in the previous 24 months 
  
• Those who had received a stem cell transplant more than 24 months ago but had ongoing immunosuppression or graft versus host disease (GVHD), see summary of eligibility for each programme for stem cell patients here.
  
• Persistent agammaglobulinaemia (IgG < 3g/L) due to primary immunodeficiency (for example, common variable immunodeficiency) or secondary to disease/therapy 

Individuals on immunosuppressive or immunomodulating therapy at the time of vaccination including: 

• Those who were receiving or had received in the previous 3 months targeted therapy for autoimmune disease, such as JAK inhibitors or biologic immune modulators including B-cell targeted therapies (including rituximab but in this case the recipient would be considered immunosuppressed for a 6-month period), T-cell co-stimulation modulators, monoclonal tumour necrosis factor inhibitors (TNFi), soluble TNF receptors, interleukin (IL)-6 receptor inhibitors, IL-17 inhibitors, IL 12/23 inhibitors, IL 23 inhibitors (note: this list is not exhaustive)
  
• Those who were receiving or had received in the previous 6 months immunosuppressive chemotherapy or radiotherapy for any indication 

Individuals who had received immunosuppressive therapy prior to vaccination including: 

• High-dose corticosteroids (equivalent to ≥ 20mg prednisolone per day) for more than 10 days in the previous month
  
• Long-term moderate dose corticosteroids (equivalent to ≥10mg prednisolone per day for more than 4 weeks) in the previous 3 months 
  
• Non-biological oral immune modulating drugs, such as methotrexate >20mg per week (oral and subcutaneous), azathioprine >3.0mg/kg/day, 6-mercaptopurine >1.5mg/kg/day, mycophenolate >1g/day in the previous 3 months
  
• Certain combination therapies at individual doses lower than above, including those on ≥7.5mg prednisolone per day in combination with other immunosuppressants (other than hydroxychloroquine or sulfasalazine) and those receiving methotrexate (any dose) with leflunomide in the previous 3 months 
  
• Individuals who had received high-dose steroids (equivalent to >40mg prednisolone per day for more than a week) for any reason in the month before vaccination, except for acute respiratory disease episodes (e.g. asthma)

Booster vaccination programme

• Priority groups 1 to 6, except the immunosuppressed. 

We understand this to include all leukaemia patients, other than those eligible for a third dose.

This does not directly map to the shielded patient list. Please see the JCVI guidance below for more information.