Criteria for Additional Doses of COVID-19 Vaccine in Those Aged 12 Years and Above
Individuals with primary or acquired immunodeficiency states at the time of vaccination due to conditions including:
- Acute and chronic leukaemias, and clinically aggressive lymphomas (including Hodgkin’s lymphoma) who were under treatment or within 12 months of achieving cure at the time of vaccination.
- 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).
- Adults and children aged 12 years and over with immunosuppression due to HIV/AIDS with a current CD4 count of <200 cells/μl.
- Primary or acquired cellular and combined immune deficiencies – those with lymphopaenia (<1,000 lymphocytes/µl) or with a functional lymphocyte disorder.
- Those who had received a stem cell transplant or chimaeric antigen receptor (CAR)-T cell therapy in the 24 months before vaccination.
- Those who had received a stem cell transplant more than 24 months before vaccination but had ongoing immunosuppression or graft versus host disease (GVHD).
- Persistent agammaglobulinaemia (IgG < 3g/L) due to primary immunodeficiency (e.g. common variable immunodeficiency) or secondary to disease/therapy.
Individuals on immunosuppressive or immunomodulating therapy at the time of vaccination including:
- Those who were receiving immunosuppressive therapy for a solid organ transplant at the time of vaccination.
- 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 immunosuppressive chemotherapy or radiotherapy for any indication in the 6 months before vaccination.
Individuals with chronic immune-mediated inflammatory disease who were receiving or had received immunosuppressive therapy prior to vaccination including:
- High dose corticosteroids (equivalent to ≥ 20mg prednisolone per day) for more than 10 days in the month before vaccination.
- Long term moderate dose corticosteroids (equivalent to ≥10mg prednisolone per day for more than 4 weeks) in the 3 months before vaccination.
- 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 3 months before vaccination.
- 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 3 months before vaccination.
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.
Criteria for Additional Doses of COVID-19 Vaccine in Children Aged 6 Months to 11 Years
Individuals with primary or acquired immunodeficiency states at the time of vaccination due to conditions including:
- Acute and chronic leukaemias, and clinically aggressive lymphomas (including Hodgkin’s lymphoma) who were under treatment or within 12 months of achieving cure at the time of vaccination.
- Individuals under follow-up for chronic lymphoproliferative disorders including haematological malignancies.
- Children with immunosuppression due to HIV/AIDS (children with a current CD4 count of <500 cells/µl in those aged 5 years and <200 cells/µl in those aged 6-11 years).
- Primary or acquired cellular and combined immune deficiencies – those with lymphopaenia (<1,000 lymphocytes/µ) or with a functional lymphocyte disorder.
- Those who had received a stem cell transplant or chimaeric antigen receptor (CAR)-T cell therapy in the 24 months before vaccination.
- Those who had received a stem cell transplant more than 24 months before vaccination but had ongoing immunosuppression or graft versus host disease (GVHD).
- Persistent agammaglobulinaemia (IgG < 3g/L) due to primary immunodeficiency (e.g. common variable immunodeficiency) or secondary to disease/therapy.
Individuals on immunosuppressive or immunomodulating therapy at the time of vaccination including:
- Those who were receiving immunosuppressive therapy for a solid organ transplant at the time of vaccination.
- 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 immunosuppressive chemotherapy or radiotherapy for any indication in the 6 months before vaccination.
Individuals with chronic immune-mediated inflammatory disease who were receiving or had received immunosuppressive therapy prior to vaccination including:
- High dose corticosteroids (equivalent to ≥ 1mg prednisolone per kg per day) for more than 10 days in the month before vaccination.
- Long term moderate dose corticosteroids (equivalent to ≥ 0.5 mg prednisolone per kg per day for more than 4 weeks) in the 3 months before vaccination.
- Any dose of non-biological oral immune modulating drugs (with the exception of hydroxychloroquine and sulfasalazine), such as methotrexate, azathioprine, 6-mercaptopurine or mycophenolate in the 3 months before vaccination. (Note: this list is not exhaustive).
Individuals who had received high dose steroids (equivalent to >2mg prednisolone per kg per day for more than a week) for any reason in the month before vaccination.