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Overview

This Guidelines  summary provides information to those who will be involved in the COVID-19 national vaccination programme.

The following COVID-19 vaccines are currently in use in the UK national COVID-19 vaccination programme:

  • COVID-19 Vaccine Pfizer BioNTech (Comirnaty 30 mcg/dose)
  • COVID-19 Vaccine Pfizer BioNTech (Comirnaty 10 mcg/dose)
  • COVID-19 Vaccine AstraZeneca (Vaxzevria)
  • COVID-19 Vaccine Moderna (Spikevax).

Information about any other COVID-19 vaccines that are given regulatory approval will be added when this occurs.

The information in this guidance was correct at time of publication. As COVID-19 is an evolving disease, some of the information may change. Updates will be made to this document as new information becomes available. You are therefore advised to consult the online version of the full guidance to ensure you are accessing the latest information.

This Guidelines  summary excludes some information from the full guideline. For the complete set of recommendations, refer to the full guideline. 

This summary has been abridged for print. View the full summary at guidelines.co.uk/455707.article

COVID-19 vaccination programme

  • The aim of the COVID-19 vaccination programme is to protect those who are at highest risk from serious illness or death from COVID-19 or at risk of transmitting infection to multiple vulnerable persons or other staff in a health or social care environment
  • For information about COVID vaccines in development, see the LSHTM COVID-19 vaccine tracker.

Groups affected by COVID-19

  • Increasing age and male gender have been shown to be significant risk factors for severe disease, and infection fatality ratios are highest in the oldest age groups
  • Comorbidities such as diabetes and severe asthma are associated with an increased risk of death, and obesity and other underlying health conditions can increase the risk for some people 
  • Deprivation and being from a black, Asian, or minority ethnic group also results in an increased risk of death from COVID-19
  • Health and social care workers are at increased risk of acquiring infection in their work setting and they may potentially transmit the virus to their families and to those in their care
  • Further information on high risk groups (those who are clinically extremely vulnerable) and moderate risk groups (those who are clinically vulnerable) can be found on the NHS.UK webpage: Who’s at higher risk from coronavirus (COVID-19)

COVID-19 vaccination eligibility

COVID-19 vaccines

  • In the UK, the following COVID-19 vaccines are currently in use in the UK national COVID-19 vaccination programme:
    • COVID-19 Vaccine Pfizer BioNTech (Comirnaty 30 mcg/dose) given authorisation for temporary supply by the MHRA on 2 December 2020 and then granted CMA on 9 July 2021. This vaccine is authorised for adults and adolescents from the age of 12 years
    • COVID-19 Vaccine Pfizer BioNTech (Comirnaty 10 mcg/dose) granted CMA by the MHRA on 22 December 2021. This vaccine is authorised for children 5–11 years of age
    • COVID-19 Vaccine AstraZeneca (Vaxzevria) given authorisation for temporary supply by the MHRA on 30 December 2020 and then granted CMA on 24 June 2021. This vaccine is authorised for adults from 18 years of age
    • COVID-19 Vaccine Moderna (Spikevax) given authorisation for temporary supply by the MHRA on 8 January 2021 and then granted CMA on 1 April 2021. This vaccine is authorised from 12 years of age, but it is not currently recommended it is given to those under 18 years of age
  • Any other COVID-19 vaccines that are given regulatory approval and supplied in the UK will be added to this summary when this occurs
  • The Pfizer BioNTech (Comirnaty) and Moderna (Spikevax) COVID-19 vaccines use an mRNA platform and the COVID-19 Vaccine AstraZeneca (Vaxzevria) is an adenovirus vector vaccine
  • All the currently authorised vaccines are supplied in multi-dose vials and require completion of a two-dose primary course. Using multi-dose vials can improve the efficiency of vaccine manufacture and distribution, enabling vaccine availability at the earliest opportunity.

COVID-19 vaccines schedule

  • For both adenovirus vector and mRNA vaccines, there is evidence of better immune response and/or protection where longer intervals between doses in the primary schedule are used
  • The JCVI is currently recommending an interval of 8 weeks between doses of all the available COVID-19 vaccines where a two-dose primary schedule is used for adults and children at high risk
  • For those 12–17 who are not in a high-risk group, a 12-week interval is recommended. This longer interval reflects strong evidence of high levels of protection against severe disease from the first dose, although it could be shortened to 8 weeks in periods of high incidence or where there was concern about vaccine effectiveness (for example, a new variant). Vaccinators would be advised when this interval should be shortened
  • The main exception to the 8-week lower interval would be those about to commence immunosuppressive treatment. In these individuals, the minimal intervals (21 days for Pfizer BioNTech vaccine or 28 days for Moderna and AstraZeneca vaccines) may be followed to ensure that the vaccine is given whilst their immune system is better able to respond.

Previous incomplete vaccination

  • If the vaccine course is interrupted or delayed, it should be resumed using the same vaccine but the first dose should not be repeated
  • Evidence from trials suggest that those who receive mixed (heterologous) vaccine schedules—including mRNA and adenovirus vectored vaccines—make a good immune response, although rates of side effects following the second dose are higher compared to those who received the same vaccine for both doses. Accumulating evidence now supports the use of heterologous schedules for primary immunisation and these are now recognised by the European Medical Agency
  • For individuals who started the schedule and who attend for vaccination where the same vaccine is not suitable, is unknown, or not available (for example, if the individual received their first dose abroad), one dose of the locally available product should be given to complete the schedule if that vaccine is suitable for age and not contraindicated (see Appendix 1 in the full guideline and the Individuals who received COVID-19 vaccination overseas section below). Individuals who experienced severe expected reactions after a first dose of AstraZeneca or Pfizer BioNTech vaccines should be informed about the higher rate of such reactions when they receive a second dose of an alternate vaccine.

For recommendations on individuals who received COVID-19 vaccination overseas, view the full summary online at guidelines.co.uk/455707.article

Individuals who received COVID-19 vaccination overseas

  • If a person (aged 18 years and over) has received a first dose of COVID-19 vaccine overseas that is also available in the UK, they should receive the same vaccine for their second dose (unless contraindicated)
  • If the vaccine they received for their first dose is not available in the UK, the most similar alternative should be offered
  • If the vaccine received overseas is not listed in the table (see Appendix 1 in the full guidance), a full course of the appropriate vaccine recommended for the individual in the UK (which may depend on their age) should be given
  • Those who are eligible to receive a booster dose should be given a full dose (30 mcg) of the Pfizer BioNTech Comirnaty 30 mcg/dose COVID-19 vaccine, or a half dose (50 mcg) of the Moderna vaccine. In this instance, the minimum interval of 3 months should be from their final primary dose
  • The above advice applies to individuals aged 18 years and older.

Children and young people aged 5–17 years

  • Children and young people aged 5–17 years who have commenced immunisation with an mRNA vaccine (Pfizer BioNTech or Moderna) overseas should continue their vaccine course as per the UK recommendations for their age and risk group. Those that received any other type of COVID-19 vaccine (not an mRNA vaccine) should be managed as per the advice in the table in Appendix 1 of the full guideline, but using age-appropriate dosing and schedules for the UK. For those under 18 years who are eligible for a booster dose, any additional doses of vaccine given may count as a booster if given at least 3 months after the second dose
  • Children and young people in both of the above groups should complete their schedule with the Pfizer BioNTech Comirnaty vaccine (10 mcg/dose vaccine or 30 mcg/dose vaccine as appropriate for age).

Booster doses received overseas

  • For individuals (aged 16 years and over) who have already received a booster dose of vaccine overseas, this dose would count as a valid booster dose if they had received:
    • a homologous course (primary and booster doses) of AstraZeneca (or Institute of India Covishield) or mRNA vaccine (Pfizer BioNTech or Moderna)
    • a heterologous course (primary and booster doses) that included at least one dose of AstraZeneca (or Institute of India Covishield) or mRNA vaccine (Pfizer BioNTech or Moderna)
  • If the booster dose received overseas was given less than 3 months after the last primary dose (regardless of which vaccine was given), the booster dose should be repeated in the UK using an mRNA vaccine (full dose Pfizer BioNTech or half dose Moderna [if over 18 years]) at least 3 months after the previous dose
  • For those individuals eligible for the UK 2022 spring booster (adults aged 75 years and over, residents in a care home for older adults, and individuals aged 12 years and over who are immunosuppressed), if they have already received a booster dose overseas which is being counted as a valid booster dose, they should be offered the spring booster around 6 months after the previous dose. This interval may be brought forward to a minimum of 3 months to ensure they receive the booster during the spring campaign
  • If an individual has not received any doses of either AstraZeneca (or Institute of India Covishield) or mRNA vaccine (Pfizer BioNTech or Moderna) as part of their previous course, then they should receive an additional booster dose of an mRNA vaccine in the UK at least 3 months after their last dose of COVID-19 vaccine
  • If they are eligible for the spring booster then this additional dose will count as their spring booster and no further doses are currently recommended before the autumn.

Booster programme

  • On 29 November 2021, in response to the emergence of the Omicron variant, the JCVI advised accelerating the booster programme and offering a booster dose to all adults aged from 18 years
  • On 22 December 2021, the JCVI recommended booster doses for all those aged 16 and 17 years, children and young people aged 12–15 years who are at higher risk from COVID-19 (as set out in the Green Book COVID-19 chapter), and those aged 12–15 years who are household contacts of immunosuppressed individuals of any age
  • Booster vaccination should be given at least 3 months after completion of the primary course
  • Boosters in children and young people aged 12–15 years who are not at high risk and in those aged 5–11 years will be reviewed in due course
  • On 21 February 2022, the JCVI recommended a spring booster campaign for individuals at higher risk of severe COVID-19. In order to sustain protection, the JCVI recommended that a booster dose should be given around 6 months after the last vaccine dose to:
    • adults aged 75 years and over
    • residents in a care home for older adults, and
    • individuals aged 12 years and over who are immunosuppressed

      A further booster programme is expected in autumn 2022.
  • Further information about the booster programme is available in the JCVI statements and also in the COVID-19 chapter of the Green Book.

Vaccine to be used for booster doses

  • The JCVI has advised that a full dose (30 mcg) of Pfizer BioNTech vaccine or a half dose (50 mcg) of the Moderna vaccine should be offered as a booster dose
  • Where both Pfizer and Moderna vaccines are clinically contraindicated, vaccination with the AstraZeneca vaccine may be considered for those who received at least one dose of this vaccine previously. In exceptional circumstances, individuals aged 40 years or over who received a mRNA COVID-19 vaccine previously may be offered a booster dose of AstraZeneca vaccine following a decision by a health professional on a case-by-case basis. Where individuals have inadvertently received a third dose or booster of AstraZeneca vaccine, the JCVI does not advise re-vaccination.

Pregnant women

  • In December 2021, the JCVI announced  that pregnant women should be considered a clinical risk group within the COVID-19 vaccination programme. Studies following the use of the COVID-19 vaccines in pregnant women have shown the vaccines to be safe and highly effective in preventing serious complications
  • Analysis by the UKHSA  looked at women who gave birth up to August 2021 and reassuringly found that there were similar rates of still birth, prematurity, and low birth weight in vaccinated and unvaccinated women. It also found that pregnant women who are vaccinated are far more protected against serious COVID-19 than those who are unvaccinated
  • There is no known risk associated with giving non-live vaccines during pregnancy
  • Because of more extensive experience with the Pfizer BioNTech and Moderna vaccines in pregnancy, these two vaccines are the preferred vaccines to offer to pregnant women aged 18 years and over. Pregnant women under 18 years of age should be offered the Pfizer BioNTech vaccine, as that is the vaccine currently recommended for this age group
  • Pregnant women who have already received a dose of AstraZeneca vaccine can complete with the same vaccine or with an mRNA vaccine (provided there are no contraindications to either)
  • Routine questioning about last menstrual period and/or pregnancy testing is not required before offering COVID-19 vaccine. Women who are planning pregnancy or in the immediate postpartum can be vaccinated with a suitable product for their age and risk status
  • If a woman finds out she is pregnant after she has started a course of COVID-19 vaccine, she should complete vaccination during pregnancy at the recommended intervals
  • Further information about the safety of COVID-19 vaccines when given in pregnancy  is available. Both the Royal College of Obstetricians and Gynaecologists  and the Royal College of Midwives  websites provide useful information and guidance about the COVID-19 vaccine.

Breastfeeding

  • There is no known risk associated with giving non-live vaccines whilst breastfeeding
  • The JCVI advises that breastfeeding women should be offered vaccination with any suitable COVID-19 vaccine
  • The developmental and health benefits of breastfeeding are clear and should be discussed with the woman, along with her clinical need for immunisation against COVID-19.

Children and young people

Table 1: Summary table of COVID-19 vaccine recommendations for children and young people aged 5–17 years

 Group

Recommendation 

Children aged 5–11 years with specific underlying health conditions that put them at risk of severe COVID-19 or who are household contacts of an immunosuppressed person

Offer two 10 mcg doses of the Pfizer BioNTech Comirnaty 10 mcg/dose vaccine with an interval of 8 weeks between doses

Offer a third primary dose to those who had severe immunosuppression at or around the time of their first or second primary COVID-19 vaccine doses at least 8 weeks after second dose

Children aged 12–15 years with specific underlying health conditions that put them at risk of severe COVID-19

Offer two 30 mcg doses of the Pfizer BioNTech Comirnaty 30 mcg/dose vaccine with an interval of 8 weeks between doses

Offer a booster dose at least 3 months after completion of primary course

Children and young people aged 12 years and over who are severely immunosuppressed

Offer two 30 mcg doses of the Pfizer BioNTech Comirnaty 30 mcg/dose vaccine with an interval of 8 weeks between doses

Offer a third primary dose to those who had severe immunosuppression at or around the time of their first or second primary COVID-19 vaccine doses

Offer a booster dose at least 3 months after completion of primary course

Children and young people aged 12 years and over who are household contacts of an immunosuppressed person

Offer two 30 mcg doses of the Pfizer BioNTech Comirnaty 30 mcg/dose vaccine with an interval of 8 weeks between doses

Offer a booster dose at least 3 months after completion of primary course

Young people aged 16 and 17 years in a clinical risk group or who work in health and social care

Offer two 30 mcg doses of the Pfizer BioNTech Comirnaty 30 mcg/dose vaccine with an interval of 8 weeks between doses

Offer a booster dose at least 3 months after completion of primary course

All other children aged 5–11 not in an at-risk group

 

Offer two 10 mcg doses of the Pfizer BioNTech Comirnaty 10 mcg/dose vaccine with an interval of 12 weeks between doses

All other young people aged 12–15 years not in an at-risk group

Offer two 30 mcg doses of the Pfizer BioNTech Comirnaty 30 mcg/dose vaccine with an interval of 12 weeks between doses

All other young people aged 16 and 17 years not in an at-risk group

Offer two 30 mcg doses of the Pfizer BioNTech Comirnaty 30 mcg/dose vaccine with an interval of 12 weeks between doses

Offer a booster dose at least 3 months after completion of primary course

Vaccination of children and young people who have recently had SARS-CoV-2 infection

  • In children and young people under 18 years who are not in high risk groups, it is recommended that vaccination is deferred for 12 weeks from onset (or sample date) of SARS-CoV-2 infection
  • This 12-week recommendation includes children and young people who developed paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS)
  • It also applies to second doses for any individuals aged between 12 and 17 years not in an at-risk group who develop proven SARS-CoV-2 infection in the period between their first and second dose. For these individuals, the second dose of vaccine should be given 12 weeks following SARS-CoV-2 infection, or 12 weeks following the first vaccine dose, whichever is later
  • This interval may be reduced to 8 weeks in healthy under 18 year olds during periods of high incidence or where there is concern about vaccine effectiveness (for example a new variant). Vaccinators will be informed when or if this interval should be reduced
  • This 12 week recommendation does not apply to those aged 5–17 years in at-risk groups. These individuals should be offered COVID-19 vaccine if there has been a 4-week period following their positive test. Young people in these groups should also receive any vaccine doses due at a minimum interval of 4 weeks after a confirmed SARS-CoV-2 infection.

For recommendations on circumstances in which a different second vaccine to the first can be given, such as for housebound patients or care home residents, and individuals who experience severe adverse reactions after the first dose, refer to the full guideline.

For recommendations on administration of COVID-19 vaccine, view the full summary at guidelines.co.uk/455707.article

Administration of COVID-19 vaccine

Infection prevention and control

  • All those attending for vaccination and those delivering vaccination should wear appropriate personal protective equipment as described in the infection prevention and control advice current at the time of administering the vaccine
  • Hand hygiene is critical to prevent the spread of infection and hands should be cleaned with alcohol-based gel or soap and water before vaccine preparation, between patients, and so on. Those preparing and administering the vaccine should maintain good hand hygiene throughout and should take care not to touch the vial bung with their fingers.

Injection technique

  • COVID-19 vaccines should be administered by intramuscular injection, preferably into the deltoid muscle of the upper arm
  • Individuals who have minimal muscle mass in the deltoid area of the upper arm, or a particular reason to avoid immunisation in the deltoid muscle, can be given their vaccine in the vastus lateralis muscle in the thigh if necessary
  • The area for injection should be clearly visible and accessible. Garments with long or tight sleeves may need to be removed. The injection site does not need to be cleaned unless visibly dirty. If cleaning is required, water should be used, and the area dried with a gauze swab. It is not necessary to disinfect the skin
  • Insert the needle into the injection site far enough to ensure it will deliver the vaccine into the muscle and depress the plunger. There is no need to pull back on the plunger (aspirate) before the plunger is depressed to release the vaccine into the muscle because there are no large blood vessels at the recommended injection sites
  • Ensure the full dose is administered, as a partial dose will not evoke a full immune response. Remove the needle and if there is any visible blood at the injection site, the patient can apply pressure to the site with a piece of gauze or cotton wool.

For information on administering COVID-19 vaccine to individuals with a bleeding disorder and/or taking anticoagulants, refer the full guideline.

Timing of administration of COVID-19 vaccine to individuals who are immunosuppressed

  • Individuals who have immunosuppression and HIV infection (regardless of CD4 count) should be given COVID-19 vaccine in accordance with the recommendations and contraindications stated in the COVID-19 vaccine PGDs and Protocols and Green Book COVID-19 chapter
  • Individuals with immunosuppression may not make a full immune response to vaccination
  • Specialists may advise their patients based on their knowledge and understanding of their immune status and likely immune response to vaccination, but should also consider the risk from COVID-19 and the patient’s likelihood of exposure
  • The small number of patients (aged 5 years or above) who are about to receive planned immunosuppressive therapy should be considered for vaccination prior to commencing therapy (ideally at least 2 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
  • As some individuals who are immunosuppressed due to underlying health conditions or medical treatment may not mount a full immune response to COVID-19 vaccination, the JCVI has recommended a third primary dose vaccination for patients who were severely immunosuppressed at or around the time of their first or second primary COVID-19 vaccination
  • Most individuals whose immunosuppression commenced at least 2 weeks after the second dose of vaccination do not require an additional primary vaccination at this stage. Individuals who had received brief immunosuppression (40 mg prednisolone or less per day) for an acute episode (for example, asthma/chronic obstructive pulmonary disease/COVID-19) and individuals on replacement corticosteroids for adrenal insufficiency are not considered severely immunosuppressed sufficient to have prevented response to the primary vaccination
  • Advice for patients on chemotherapy is available. The general principles for the administration of a third dose and the criteria for a third primary dose are described in the JCVI advice and the Green Book COVID-19 chapter
  • For those aged over 18 years, the JCVI advises a preference for mRNA vaccines (a full dose of Pfizer BioNTech 30 mcg/dose vaccine or a full dose of Moderna vaccine) for the third primary dose. The Pfizer BioNTech 30 mcg/dose vaccine is preferred for 12–17-year-olds, and the Pfizer BioNTech 10 mcg/dose vaccine for 5–11 year olds. AstraZeneca COVID-19 vaccine is an option for individuals aged 16 years and above who have received this vaccine previously where mRNA vaccines are clinically contraindicated. In exceptional circumstances, people aged 40 years or over who received a mRNA COVID-19 vaccine previously may be offered a third dose of AstraZeneca vaccine following a decision by a health professional on a case-by-case basis
  • Those aged 12 years and above in this group will also require a booster dose to extend protection from their primary course. Those who have not yet received their third dose may be given their third dose now to avoid further delay. A further booster dose can be given in 3 months, in line with the clinical advice on optimal timing in relation to the degree of immune suppression
  • As individuals in this group are also eligible for the spring booster dose, a further booster should then be given during the spring campaign, provided there has been at least 3 months from the previous dose. Individuals who completed primary vaccination later, and so received their first booster (fourth dose) during the spring campaign, do not need an additional spring dose but are expected to next become eligible during the autumn booster campaign
  • Although eligible for a third primary dose, advice on booster doses for children aged 5–11 years in this group is still under review by the JCVI
  • Individuals aged 5 years or over who are household contacts of immunosuppressed patients of any age should be offered COVID-19 vaccination to reduce the risks of exposure
  • Information about post-vaccination antibody testing of individuals with severe immunosuppression is provided in the Green Book COVID-19 chapter.

Period of observation following immunisation with COVID-19 vaccine

  • Following COVID-19 vaccine administration, individuals should be observed for any immediate reactions whilst they are receiving any verbal post-vaccination information (such as possible reactions and what, if anything, to do about these) and exiting the vaccination centre
  • The MHRA will continue to closely monitor anaphylaxis post-COVID-19 vaccination. Reporting of adverse events via the Yellow Card Scheme is strongly encouraged
  • Vaccinated individuals should be informed about how to access immediate healthcare advice in the event of displaying any symptoms. A patient information leaflet, Waiting after your COVID-19 vaccination, is available to inform vaccinees about these
  • Patients with a personal history of allergy will require a period of observation following vaccination (either 15 or 30 minutes depending on their clinical history). These individuals should be managed as described in table 5 of the Green Book COVID-19 chapter. No specific management is required for patients with a family history of allergies.
  • There is no routine requirement for 15 minutes observation following the AstraZeneca vaccine. However, as fainting can occur following vaccination, all those vaccinated with any of the COVID-19 vaccines should either be driven by someone else or should not drive for 15 minutes after vaccination.

Advice to vaccine recipients following immunisation with COVID-19 vaccine

For recommendations on advising vaccine recipients abou thrombosis with thrombocytopenia syndrome, moycarditis and pericarditis, and Guillain-Barré syndrome, refer to the full guideline.

Immune thrombocytopenia

  • There is now emerging evidence of a small risk of immune thrombocytopenia (ITP) or ITP relapse following COVID-19 vaccination. To date, this has been reported extremely rarely, and the MHRA Yellow card summary states that this is usually short-lived and of minor severity
  • Previous ITP is not a contraindication for vaccination, but guidance produced by the UK ITP Forum Working Party advises discussing the potential for a fall in platelet count in patients with a history of ITP receiving any COVID-19 vaccine, and recommends a platelet count check 2–5 days after vaccination (British Society for Haematology COVID-19 updates).

Additional advice for vaccine recipients

  • Vaccine recipients should also be advised that it may take a few weeks for protection from their COVID-19 vaccination to develop and that they should continue to follow advice current at the time regarding practicing social distancing, wearing a facemask, and washing their hands thoroughly and frequently
  • Vaccinees should also be advised to follow the current advice on testing and self-isolation if they develop any coronavirus symptoms or undergo regular testing as a health or social care worker. Vaccination will not affect testing
  • As no vaccine is completely effective, some people may still become infected with COVID-19 despite having been vaccinated (although this should be less severe)
  • The vaccine cannot cause COVID-19 infection.

For information on COVID-19 vaccine and clinical trial participants, surveillance of COVID-19 cases in vaccinated individuals, and adverse reactions following vaccination (including reporting adverse reactions), refer to the full guideline. 

COVID-19 vaccine contraindications and precautions

  • Relative contraindications to receiving a COVID-19 vaccine are:
    • individuals who have had a previous systemic anaphylaxis reaction to a COVID-19 vaccine
    • individuals with a prior allergic reaction to any component (excipient) of the COVID-19 vaccine, for example polyethylene glycol
  • The COVID-19 chapter of the Green Book provides full details about the contraindications and precautions to COVID-19 vaccine.

For recommendations on thrombosis, thrombocytopenia syndrome, and capillary leak syndrome, refer to the full guideline.

For recommendations on minor illness at time vaccination due, view the full summary at guidelines.co.uk/455707.article

Minor illness at time vaccination due

  • Minor illnesses without fever or systemic upset are not valid reasons to postpone immunisation
  • If an individual is acutely unwell, immunisation may be postponed until they have fully recovered. This is to avoid confusing the differential diagnosis of any acute illness (including COVID-19) by wrongly attributing any signs or symptoms of the illness as being possible reactions to the vaccine.

Vaccination of individuals with a current or previous history of COVID-19 disease

  • People currently unwell and experiencing COVID-19 symptoms should not attend vaccination sessions to avoid infecting anyone else in the vaccination centre
  • As deterioration in some people with COVID-19 can occur up to 2 weeks after infection, ideally vaccination of adults and high-risk children should be deferred until they have recovered to around 4 weeks after onset of symptoms or 4 weeks from the first confirmed positive test in those who are asymptomatic to avoid confusing the differential diagnosis
  • There is no need to defer immunisation in individuals after recovery from a recent episode with compatible symptoms who were not tested unless there are strong clinical and epidemiological features to suggest the episode was COVID-19 infection. The 4-week interval may be reduced to ensure operational flexibility when rapid protection is required, for example high incidence or circulation of a new variant in a vulnerable population
  • In younger people, after natural infection or a single dose of vaccine, protection from serious complications of COVID-19 infection is likely to be high for a period of months
  • Therefore, vaccination should ideally be deferred until 12 weeks from onset (or sample date) in children and young people under 18 years who are not in high risk groups. This interval may be reduced to 8 weeks in healthy under 18 year olds during periods of high incidence or where there is concern about vaccine effectiveness (for example, a new variant)
  • Current advice for children who developed PIMS-TS in association with COVID-19 infection is that an interval of 12 weeks should be observed, although earlier administration can be considered in those at risk of infection and or who are fully recovered
  • There is no convincing evidence of any safety concerns from vaccinating individuals with a past history of COVID-19 infection, or with detectable COVID-19 antibody, so people who have had COVID-19 disease (whether confirmed or suspected) can still receive COVID-19 vaccine
  • Children or adults who have tested positive for COVID-19 infection in the previous 28 days and who require other vaccines (such as DTaP/IPV/Hib/HepB-containing or flu vaccines) can receive these vaccines once they have recovered and have completed the required isolation period for COVID-19
  • Recent vaccination with other vaccines such as MMR and Td/IPV-containing vaccines do not affect testing for COVID-19 infection.

Vaccination of people experiencing prolonged COVID-19 symptoms (‘long COVID’)

  • Having prolonged COVID-19 symptoms is not a contraindication to receiving COVID-19 vaccine but if the patient is seriously debilitated, still under active investigation, or has evidence of recent deterioration, deferral of vaccination may be considered to avoid incorrect attribution of any change in the person’s underlying condition to the vaccine.

Treatments for COVID-19 disease and vaccine administration

  • Monoclonal antibody preparations containing specific man-made antibodies have recently been licensed for the treatment and prophylaxis of COVID-19 infection
  • Primate data suggests that administration of the AstraZeneca combination monoclonal antibody product did not interfere with the subsequent response to active vaccination. Based on this limited evidence, therefore, no specific interval is required between receipt of these products and COVID-19 vaccination, or vice versa
  • Steroid treatments such as dexamethasone may be given to patients experiencing severe COVID-19 symptoms to suppress the immune response and reduce inflammation
  • As none of the currently authorised COVID-19 vaccines contain live replicating virus, response to COVID-19 vaccine will not be affected by prior or recent receipt of anti-viral medication
  • It is recommended that following infection, ideally vaccination of adults and children aged 12–17 years should be deferred to around 4 weeks after onset of symptoms or 4 weeks from the first confirmed positive specimen in those who are asymptomatic and for 12 weeks for those under 18 years not in high-risk groups (see section on vaccination of individuals with a current or previous history of COVID-19 disease).

For recommendations on co-administration of COVID-19 vaccine with other inactivated or live vaccines, view the full summary at guidelines.co.uk/455707.article

Co-administration of COVID-19 vaccine with other inactivated or live vaccines

  • Based on experience with other vaccines, any potential interference is most likely to result in a slightly attenuated (weaker) immune response to one of the vaccines. There is no evidence of any safety concerns, although it may make the attribution of any adverse events more difficult
  • As the Pfizer BioNTech, AstraZeneca, and Moderna COVID-19 vaccines are considered inactivated, where individuals in an eligible cohort present having recently received another inactivated or live vaccine, COVID-19 vaccination should still be given. The same applies for most other live and inactivated vaccines where COVID-19 vaccination has been received first or where a patient presents requiring two vaccines
  • Where co-administration does occur, patients should be informed about the likely timing of potential adverse events relating to each vaccine. If the vaccines are not given together, they can be administered at any interval, although separating the vaccines by 1 or 2 days will avoid confusion over systemic side effects.

For information on vaccination of children and young people who have recently had SARS-CoV-2 infection, adverse reactions, legal aspects of vaccine administration, inadvertent vaccine administration errors, and storage and preparation of the COVID-19 vaccines, refer to the full guideline.

Want to learn more about this guideline?

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Read the related Guidelines in Practice article, COVID-19 vaccination programme: practice pointers for primary care.

Full guideline:

UK Health Security Agency. COVID-19 vaccination programme: information for healthcare practitioners. Version 4.2. March 2022. Available at: gov.uk/government/publications/covid-19-vaccination-programme-guidance-for-healthcare-practitioners

Contains public sector information licensed under the Open Government Licence v3.0.

Published date: 27 November 2020.

Last updated: 09 March 2022.

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