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News Archive

The Pfizer/BioNTech vaccine | Your Questions Answered

The national coronavirus (COVID-19) vaccination programme is the largest in Britain history and the most complex and extensive we at BHWC have been involved in. We are receiving many questions about the vaccine so have tried to answer them in this FAQ. Our receptionists do not have all the answers and the lines are terribly busy as we are channelling all our resources towards booking people in for the vaccination.

PLEASE DO NOT PHONE THE SURGERY WITH COVID VACCINE RELATED QUERIES.

If you have a question we have not yet answered you can email sxccg.vaccineenquiries@nhs.net or you can call the Covid Vaccine Helpline on 0800 433 4545 (9am – 4pm, Monday to Friday). Note: You will not be able to book a vaccine on this number.

We also have an FAQ about the Covid Astra Zeneca/Oxford vaccine.

The BHWC vaccination Programme

The Vaccination schedule

About the Pfizer/BioNTech vaccine

We also have an FAQ about the Covid Astra Zeneca/Oxford vaccine.

Before you have your vaccination

After your first dose

The BHWC Vaccination programme

How is the BHWC vaccination programme being rolled out?

We are working extremely hard to book all our BHWC patients in for an appointment for the coronavirus (COVID-19) vaccination at the Portslade Health Centre (PHC). Thank you for being patient whilst we work our way through the cohorts. We will continue to give you regular updates via the website and our newsletter.

Where will I be given the Covid vaccine?

BHWC patients can choose between the four sites:

Brighton Racecourse

  • If you are a BHWC patient and in cohort 1-9 (vulnerable, extremely vulnerable or over 50) you can book your appointment by calling 0300 303 8060.

Mobile Vaccination Unit

  • Coming soon!
  • We are setting up a more local mobile vaccination unit.
  • The unit will be set up on the 6th and the 9th of April.
  • If you are a BHWC patient and in cohort 1-9 (vulnerable, extremely vulnerable or over 50) you can book your appointment by calling 0300 303 8060.

Portslade Health Centre

Brighton Centre

  • If you are a BHWC patient and in cohort 1-9 (vulnerable, extremely vulnerable or over 50) you can book your appointment here.

If you have a question you can call the Covid Vaccine Helpline on 0800 433 4545 (9am – 4pm, Monday to Friday).

What if I cannot get to Portslade Health Centre?

We have the following solutions/arrangements in place

  • No 1 and 1a bus stop outside the health centre
  • If you are housebound, we will vaccinate you at your home with the Astra Zeneca/Oxford vaccine when it is available
  • We can now offer all our patients fee Covid-secure transport from your home to the centre. This service is co-ordinated by BHWC with the help of a few volunteers from our local community. To arrange this you do not need to call us, simply let us know when we contact you to book you in.

Please do not phone us, as the lines are very busy. We will call you.

How will I receive my invitation for the first dose?

  • We will phone you to book you in at the racecourse or at the mobile vaccination unit
  • You will receive an sms from BHWC asking you to call 0300 303 8060
  • We phone everyone at least three times
  • If we are unable to get hold of you we will write to you by post

How will I receive my invitation for the second dose?

Why are we not vaccinating every day?

We are now vaccinating most days (updated 30-03-2021)

I am not well, how do I cancel my appointment?

Please email us as soon as possible with your name, date of birth, appointment time and date. Please do not call the surgery as the lines are very busy.

In the unlikely event of BHWC being incapacitated by the virus, will responsibility be passed to another surgery or will the delivery of the covid vaccination programmes cease or be put on hold until the surgery can resume that function?

The NHS covid vaccination programme is one of the most comprehensive initiatives ever rolled out and BHWC partners, managers, clinicians and team members have all been planning the delivery of the vaccinations to our patients for several weeks. In the last two weeks we have had a separate dedicated team working full time to ensure all our patients are offered the Covid vaccination efficiently and timely. The delivery of the vaccination being at the Portslade Health Centre ensures that it will always be staffed by members of a collaboration of GP practices across the city. In the unlikely event that BHWC is incapacitated by the virus our dedicated teams will continue to book in patients and this will be uninterrupted. We have also put in place alternative contingency plans. The delivery of the vaccine will be of highest priority for BHWC along with the continuation of the normal services at the surgery.

Will I be forced to get the vaccine?

No, the vaccine will not be compulsory, akthough we are encouraging everyone to have it to be able to achieve herd immunity and to protect everyone.

The Vaccination Schedule

Which cohorts have been vaccinated so far?

All patients in Cohorts 1-9 have been invited for their vaccine. If you are in one of these and have not been vaccinated yet, please call 0300 303 8060 to book your first dose.

I am a frontline health and care worker and have not been contacted yet

We have now offered the vaccination to all our healthcare workers.

Please update your records using the online services. Please do not call reception as this blocks the phone lines. Supplying us with your correct information will assist us with delivering the COVID19 vaccinations and improve your future care by identifying accessibility needs and maintain accuracy of other health-related information.  Please go to your SystemOnline Account or use your Airmid app to complete the Personal Information Update Questionnaire (SystemOnline: got to questionnaires and Airmid: go to Surveys) and your data will be automatically added to your medical record. If you do not have your online registration details you can request these here.

Health and care workers are now also able to book a vaccination at one of the six hospital-based vaccination sites across Sussex. You will need to take ID for this. They get booked up so you may need to revisit daily. Please go through to this link.

How do I know if I am recorded as clinically extremely vulnerable, clinically vulnerable or a carer?

We are working night and day to ensure all clinically extremely vulnerable and those with underlying health conditions which put them at higher risk of serious disease and mortality are contacted under the correct cohort. If we need any more information, we will contact you. We will also be sending out a link to help us identify carers. Meanwhile, If you feel your records need updating, please do not phone reception as it blocks the phone lines, please use your SystemOnline Account or your Airmid app to complete the “Personal Information Update Questionnaire”. (SystemOnline: got to questionnaires and Airmid: go to Surveys) and your data will be automatically added to your medical record. If you do not have your login details you can submit a request to have them resent to you here.

Who is being prioritised to get the vaccine?

Currently, this is the order of priority as decided by the JCVI (Joint Committee on Vaccination and Immunisation), the expert committee which advises the UK government on immunisation. But it’s possible that practical issues (for example, the Pfizer/BioNTech vaccine needs very cold storage) may also influence the rollout.

  • Residents in a care home for older adults and their carers
  • Frontline health and social care workers, and all those 80 years of age and over
  • All those 75 years of age and over
  • All those 70 years of age and over and Clinically extremely vulnerable people (the shielding group)
  • All those 65 years of age and over
  • All individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality
  • All those 60 years of age and over
  • All those 55 years of age and over
  • All those 50 years of age and over

Pregnant women, and those planning a pregnancy within 3 months, are not being advised to get the vaccine, because it hasn’t been tested in pregnancy.

It is also not currently planned to be given to under-16s, as the vaccines haven’t been tested in younger children, and because very few children get seriously ill from coronavirus.

Can I pay to have the vaccine sooner?

At the moment, national governments are the main customers of the vaccines. It may be in future that it becomes possible to have the vaccine privately. For now, the best thing you can do is to wait to be offered it, and in the meantime follow all the coronavirus guidance to reduce your risk of passing the disease or passing it on.

Who is included in the cohort “all individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality?”

The national protocol for clinical at-risk patients include:

Chronic respiratory disease Individuals with a severe lung condition, including those with asthma that requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission, and chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD).
Chronic heart disease and vascular disease Congenital heart disease, hypertension with cardiac complications, chronic heart failure, individuals requiring regular medication and/or follow-up for ischaemic heart disease. This includes individuals with atrial fibrillation, peripheral vascular disease or a history of venous thromboembolism.
Chronic kidney disease Chronic kidney disease at stage 3, 4 or 5, chronic kidney failure, nephrotic syndrome, kidney transplantation.
Chronic liver disease Cirrhosis, biliary atresia, chronic hepatitis.
Chronic neurological disease Stroke, transient ischaemic attack (TIA). Conditions in which respiratory function may be compromised due to neurological disease (e.g. polio syndrome sufferers). This includes individuals with cerebral palsy, severe or profound learning disabilities, Down’s Syndrome, multiple sclerosis, epilepsy, dementia, Parkinson’s disease, motor neurone disease and related or similar conditions; or hereditary and degenerative disease of the nervous system or muscles; or severe neurological disability.
Diabetes Any diabetes, including diet-controlled diabetes.
Immunosuppression Immunosuppression due to disease or treatment, including patients undergoing chemotherapy leading to immunosuppression, patients undergoing radical radiotherapy, solid organ transplant recipients, bone marrow or stem cell transplant recipients, HIV infection at all stages, multiple myeloma or genetic disorders affecting the immune system (e.g. IRAK-4, NEMO, complement disorder, SCID).

Individuals who are receiving immunosuppressive or immunomodulating biological therapy including, but not limited to, anti-TNF, alemtuzumab, ofatumumab, rituximab, patients receiving protein kinase inhibitors or PARP inhibitors, and individuals treated with steroid sparing agents such as cyclophosphamide and mycophenolate mofetil.

Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day.

Anyone with a history of haematological malignancy, including leukaemia, lymphoma, and myeloma and those with systemic lupus erythematosus and rheumatoid arthritis, and psoriasis who may require long term immunosuppressive treatments.

Some immunosuppressed patients may have a suboptimal immunological response to the vaccine.

Asplenia or dysfunction of the spleen This also includes conditions that may lead to splenic dysfunction, such as homozygous sickle cell disease, thalassemia major and coeliac syndrome.
Morbid obesity Adults with a Body Mass Index > 40 kg/m2.
Severe mental illness Individuals with schizophrenia or bipolar disorder, or any mental illness that causes severe functional impairment
Adult carers Those who are in receipt of a carer’s allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill.
Younger adults in long-stay nursing and residential care settings Many younger adults in residential care settings will be eligible for vaccination because they fall into one of the clinical risk groups above.

Given the likely high risk of exposure in these settings, where a high proportion of the population would be considered eligible, vaccination of the whole resident population is recommended.

Younger residents in care homes for the elderly will be at high risk of exposure, and although they may be at lower risk of mortality than older residents should not be excluded from vaccination programmes (see priority 1 above).

For consideration of children under 16 see Action to be taken if the patient is excluded.

 

Am I listed as a frontline healthcare and social worker at BHWC?

We sent out a link for everyone to confirm and update your records. If you have not done this please update your records using the online services. Supplying us with your correct information will assist us with delivering the COVID19 vaccinations and improve your future care by identifying accessibility needs and maintain accuracy of other health-related information.  Please go to your SystemOnline Account or use your Airmid app to complete the Personal Information Update Questionnaire (SystemOnline: got to questionnaires and Airmid: go to Surveys) and your data will be automatically added to your medical record. If you do not have your online registration details you can request these here.

Will the vaccine be offered to my children?

Not currently. The Pfizer vaccine is currently not licensed for persons under the age of 16 and the Astra Zeneca vaccine is not licensed for persons under the age of 18. The vaccines have not been tested in younger children, and very few children get seriously ill from coronavirus.

Why are BAME groups not being prioritised?

There is clear evidence that certain Black, Asian and minority ethnic (BAME) groups have higher rates of infection, and higher rates of serious disease, morbidity and mortality. There is no strong evidence that ethnicity by itself (or genetics) is the sole explanation for observed differences in rates of severe illness and deaths. Certain health conditions are associated with increased risk of serious disease, and these health conditions are often overrepresented in certain Black, Asian and minority ethnic groups.

Societal factors, such as occupation, household size, deprivation, and access to healthcare can increase susceptibility to COVID-19 and worsen outcomes following infection. Prioritisation of persons with underlying health conditions will also provide for greater vaccination of BAME communities who are disproportionately affected by such health conditions.

The advice is for NHS England and NHS Improvement, the Department of Health and Social Care, Public Health England and the devolved administrations to work together to ensure that inequalities are identified and addressed in implementation.

This could be through culturally competent and tailored communications and flexible models of delivery, aimed at ensuring everything possible is done to promote good uptake in Black, Asian and minority ethnic groups and in groups who may experience inequalities in access to, or engagement with, healthcare services. These tailored implementation measures should be applied across all priority groups during the vaccination programme.

About the Pfizer/BioNTech Vaccine

How safe is the Pfizer/BioNTech vaccine

The data from the clinical trials is very reassuring as no safety concerns were reported in those who received the vaccine. Any common serious side-effects should have become apparent in this large number of vaccine recipients, participating in clinical trials.

The side-effects seen in vaccine recipients were mild and self-resolving. Local reactions, such as pain at the injection site, were fairly common following vaccine administration. Systemic reactions (reactions affecting the whole body) such as tiredness, headache, chills, fever, muscle aches and joint pain were also reported but these are reactions that follow many vaccines such as flu vaccine.

Ongoing follow-up of those given the vaccine in the clinical trials will continue, both to monitor long-term safety and long-term vaccine effectiveness.

How effective is the Pfizer/BioNTech vaccine

In phase 1 human clinical trials, antibody responses to the spike protein were seen 21 days after the first dose; these responses increased further after the second dose. Levels of neutralising antibodies, which bind to the virus and block infection, were the same as, or higher, after two doses of vaccine compared with the level of neutralising antibodies seen in patients recovering from COVID-19 disease. A good T-cell response was also seen in those who received the vaccine in the clinical trials

The phase 3 trial demonstrated a vaccine efficacy of 95%, with consistent efficacy across different age, gender, racial and ethnic groups. The observed efficacy in adults over 65 years of age was 94%. The trial also showed around 95% efficacy in the participants at risk of severe COVID-19, including those with one or more comorbidities that increase the risk of severe COVID-19 disease (e.g. asthma, chronic lung disease, diabetes, high blood pressure or a body mass index ≥ 30 kg/m2.

What trials have been carried out?

The safety and immunogenicity of the COVID-19 mRNA Vaccine BNT162b2 has been evaluated in clinical trials carried out in six countries: the USA, Germany, Brazil, Argentina, South Africa and Turkey.

The clinical trials enrolled over 44 000 participants of different ages, gender, race and ethnicity. Half of the participants (aged 16 years older) received at least one dose of COVID-19 mRNA Vaccine BNT162b and the other half received a placebo as a comparison.

Demographic characteristics were generally similar with regard to age, gender, race and ethnicity among participants who received COVID-19 mRNA Vaccine BNT162b and those who received placebo.

How does it work?

The COVID-19 mRNA Vaccine BNT162b2 is a messenger ribonucleic acid (mRNA) vaccine. It contains the genetic sequence (mRNA) for the spike protein, which is found on the surface of the SARS-CoV-2 virus, wrapped in a lipid envelope (referred to as a nanoparticle) to enable it to be transported into the cells in the body.

When the vaccine is injected, the mRNA is taken up by the host’s cells, which translate the genetic information and produce the spike proteins. These are then displayed on the surface of the cell. This stimulates the immune system to produce antibodies and activate T-cells which prepare the immune system to respond to any future exposure to the SARS-CoV-2 virus by binding to and disabling any virus encountered.

As there is no whole or live virus involved, the vaccine cannot cause disease. The mRNA naturally degrades after a few days.

How has it been developed so quickly?

Because of the global emergency, developing this vaccine has been prioritised by scientists, drug companies and governments, and a huge amount of collaboration has helped this to happen as fast as possible. The vaccines that have been developed have all been through the same amount of testing and safety processes as other vaccines. Any vaccine that is approved will still have been rigorously tested on tens of thousands of people.

Before the pandemic even started, scientists had been planning for an outbreak of a new disease and thinking about how a vaccine could be developed as quickly as possible. It helped that Covid-19 is caused by a coronavirus (like SARS) so scientists already knew about how coronaviruses work, including the “spikes” on the surface which can be used to trigger a reaction from the immune system. Vaccine technology has also improved in recent years.

Some of the processes which are usually involved in scientific research have been speeded up so that the vaccine can be available more quickly. For example, trial participants were recruited whilst the study was still being set up, so that they were ready to start as soon as the research was approved. All the usual phases have been gone through, but without waiting between them, and once the initial safety trials were finished, some of the later trials were run at the same time rather than one after the other. Drug companies also decided to start producing the vaccines on a large scale whilst the trials were still happening. That brought them the risk that they would have to destroy them if the vaccine wasn’t approved, but means they are ready to be distributed much more quickly.

The approval by the MHRA has also been quicker than usual because it was conducting reviews as new evidence became available. The MHRA has also said its staff have been working “round the clock” to assess the vaccine. There has been a strong commitment from regulators to make sure that the vaccine has been assessed as carefully as possible, in order to prioritise public safety, while also working quickly.

Why are there different vaccines?

Because of the urgent global need for the coronavirus vaccine, different groups of scientists have been working on this problem in order to try different avenues and get a solution as quickly as possible. With any vaccine development, there tend to be many options that are tried and that don’t reach the final stages. Because of the scale of the problem of coronavirus and the worldwide need for a vaccine, it’s better if more than one vaccine exists, in order to increase availability, and to offer more than one way to tackle the problem. So it’s a good thing that in this case there seem to be several promising vaccines. At BHWC we are currently only being supplied the Pfizer/BioNTech vaccine. As soon as we receive the Oxford/AstraZeneca vaccine we will let you know.

Should we be concerned that the vaccine is not 100% effective?

The evidence so far suggests that the approved Pfizer/BioNTech vaccine and others which have reached an advanced stage of development are very effective. No vaccine can be 100 per cent effective. Having the vaccine when you are offered it will give you the best chance of being protected, and will help to protect those around you.

What are the other substances (excipients) contained in the vaccine?

In addition to the highly purified mRNA (BNT162b2 messenger RNA embedded in lipid nanoparticles), the COVID-19 mRNA Vaccine BNT162b2 also contains:

ALC-0315 = (4-hydroxybutyl) azanediyl)bis (hexane-6,1-diyl)bis(2-hexyldecanoate)

ALC-0159 = 2-[(polyethylene glycol)-2000]-N,N-ditetradecylacetamide

1,2-Distearoyl-sn-glycero-3-phosphocholine

Cholesterol

Potassium chloride

Potassium dihydrogen phosphate

Sodium chloride

Disodium hydrogen phosphate dihydrate

Sucrose

Water for injections

Will I have a choice in which vaccine I will be given?

We are currently only receiving Astra Zeneca vaccines so only able to offer this. We have received Pfizer in the past but are unlinkely to receive this in the near future. Please visit our FAQ on Covid Astra Zeneca/Oxford vaccine.

Before you have your vaccination

Can I have the vaccine if I have allergies?

A very small number of individuals have experienced anaphylaxis when vaccinated with the
Pfizer BioNTech vaccine. Following close national surveillance, the MHRA is NO LONGER
advising that individuals with a history of anaphylaxis to any vaccine, medicine or food do
not get the vaccine. Anyone with a previous history of allergic reactions to the ingredients of
the vaccine should not receive it, but those with any other allergies (such as a food
allergy) can now have the vaccine. 

Antibiotics

The Green book (Public Health England) states that individuals with previous allergy to an identified drug, including anaphylaxis, can receive the Pfizer-BioNTech COVID-19 vaccine.
The manufacturer information about antibiotic content states that:

  • Kanamycin is used during the manufacturing process of one of the raw materials used in the vaccine production; however it is not expected to be in detectable quantities in the final product presentation.
  • No other antibiotics (such as penicillins, sulphonamides and neomycin) are used during the manufacturing process.
  • They cannot guarantee that minute amounts of substances are not contained in raw materials obtained from their suppliers.

Other drugs

The Green Book (Public health England) states that individuals with previous allergy to in an identified drug, including anaphylaxis, can receive the Pfizer-BioNTech COVID-19 vaccine. However, it also states that individuals with a history of immediate onset-anaphylaxis to multiple classes of drugs should not receive the vaccine.

Polyethylene glycol (PEG) and polysorbate 80

Individuals with an allergy to polyethylene glycol (PEG) should not receive the vaccine.

The Pfizer-BioNTech COVID-19 vaccine contains PEG, a known allergen commonly found in medicines and also in household goods and cosmetics. Additionally, many biologics/monoclonal preparations contain PEG or related compounds.  The Green Book (Public health England) advises that a known allergy to PEG is extremely rare but would contraindicate receipt of this vaccine. Patients with undiagnosed PEG allergy may have a history of unexplained anaphylaxis or of anaphylaxis to multiple classes of drugs. Individuals who have a history of systemic allergic reactions to biologics should not receive the Pfizer-BioNTech COVID-19 vaccine except on the expert advice of an allergy specialist.

The Green Book (Public health England) also advises that the AstraZeneca vaccine does not contain PEG and may be used as an alternative in people who are allergic. PEG is not listed as an excipient according to the AstraZeneca Information for Healthcare Professionals.

Whether PEG is the cause of reactions in patients with systemic allergic symptoms after the first dose of the Pfizer-BioNTech vaccine is unclear; such patients may be considered for a second dose using the AstraZeneca vaccine, and should be observed for 30 minutes following vaccination.

The Pfizer BioNTech COVID-19 vaccine does not contain polysorbate 80, however, it is advised that polysorbate 80 is quite similar in structure to PEG, therefore individuals with confirmed polysorbate 80 allergy should discuss this with an allergist/ immunologist before receiving the Pfizer-BioNTech COVID-19 vaccine. Patients with a confirmed polysorbate 80 allergy will have been diagnosed by an allergy specialist; if there is any doubt over the suitability of an individual patient for a specific COVID-19 vaccine, advice should be sought.

Sulfa medicines

Individuals with previous allergy to “sulfa” medicines, including anaphylaxis, can receive the Pfizer-BioNTech COVID-19 vaccine.

The manufacturer’s information states that sulphonamide antibiotics are not used in the manufacturing process of the Pfizer-BioNTech COVID-19 vaccine. Additionally, there are no non-antibiotic “sulfa” drugs listed as an excipient.

The British Society for Allergy and Clinical Immunology (BSACI) has advised that:

Individuals with a history of immediate onset-anaphylaxis to multiple classes of drugs or an unexplained anaphylaxis should not be vaccinated with the Pfizer BioNTech vaccine. The AstraZeneca vaccine can be used as an alternative (if not otherwise contraindicated)

Individuals with a localised urticarial (itchy) skin reaction (without systemic symptoms) to the first dose of a COVID-19 vaccine should receive the second dose of vaccine with prolonged observation (30 minutes) in a setting with full resuscitation facilities (e.g. a hospital)

Individuals with non-allergic reactions (vasovagal (fainting) episodes, non-urticarial skin reaction or non-specific symptoms) can receive the second dose of vaccine in any vaccination setting

Can I have the vaccine if I am unwell?

Minor illnesses are not a valid reason to postpone immunisation but if an individual is acutely unwell for example with a temperature immunisation may be postponed until they have fully recovered.

Individuals currently experiencing symptoms of COVID-19 disease or who have tested positive for Covid-19 should not attend for vaccination. As some people with COVID-19 disease can continue to develop new symptoms or experience worsening of their symptoms for up to 2 weeks after infection, vaccination should ideally be deferred until around 4 weeks after onset of symptoms, or from the first positive test in those who are asymptomatic.

Those with a previous history of COVID-19 disease (whether confirmed or suspected) can still receive COVID-19 vaccine because it is not yet known how long antibodies made in response to natural infection persist and whether immunisation could offer more protection. There is no evidence that it is harmful to receive a COVID-19 vaccine if antibodies have already been made to the disease following natural infection. Vaccination in these circumstances would be expected to boost any pre-existing antibodies.

If you have been booked in for the vaccine and are experiencing covid symptoms or have been told to self-isolate, please let us know immediately.

Can I have the vaccine if I am pregnant?

Although the available data do not indicate any safety concerns or harm to pregnancy, there is currently insufficient evidence to recommend the routine use of COVID-19 vaccine during pregnancy.

However, the JCVI has advised that, for women who are offered COVID-19 vaccine, vaccination in pregnancy should be considered where the risk of exposure to SARS-CoV-2 infection is high and cannot be avoided, or where the woman has underlying conditions that put them at very high risk of serious complications of COVID-19. In these circumstances, clinicians will discuss the risks and benefits of vaccination with the woman, and she will be made aware about the absence of safety data for the vaccine in pregnancy.

JCVI does not advise routine pregnancy testing before receipt of a COVID-19 vaccine. Those who are trying to become pregnant do not need to avoid pregnancy after vaccination.

If a woman finds out she is pregnant after she has started a course of COVID-19 vaccine, she should complete her pregnancy before finishing the recommended schedule. Women should be offered vaccine as soon as possible after pregnancy.

Termination of pregnancy following inadvertent immunisation is not be recommended.

Can I have the vaccine if I am breastfeeding?

There is no known risk associated with giving non-live vaccines whilst breastfeeding. JCVI advises that breastfeeding women may be offered vaccination with the COVID-19 mRNA Vaccine BNT162b2.

The developmental and health benefits of breastfeeding should be considered along with the woman’s clinical need for immunisation against COVID-19, and be aware that there is no safety data for the vaccine in breastfeeding women.

Will the vaccine protect me?

It may take a week or two for your body to build up some protection from the first dose of vaccine. Like all medicines, no vaccine is completely effective, so you should continue to take recommended precautions to avoid infection. Some people may still get COVID-19 despite having a vaccination, but this should be less severe. You will still need to wear a mask as it has not been confirmed whether or not the vaccine stops you from being a carrier.

What if I have had another vaccine recently?

Until more information is known about concomitant vaccination, it is recommended that COVID-19 vaccines are not given at the same time as any other vaccine and that there should ideally be an interval of at least 7 days between COVID-19 vaccine and a different vaccine to avoid incorrect attribution of potential adverse events.

Can I get it at the same time as my flu jab?

The Pfizer/BioNTech vaccine is recommended to be given at least two weeks apart from your flu jab. It’s better to be protected from flu as soon as possible, so if you are eligible for a flu jab and haven’t yet had it this winter, contact your GP or community pharmacy. Don’t wait to have the coronavirus vaccine first.

Should I avoid having my flu jab so that I can get the coronavirus jab sooner?

At the moment, it’s impossible to how soon you will be offered the coronavirus vaccine. If you are eligible for the flu jab, get it soon as possible, if you haven’t it already. It’s important that you are protected from the flu and the serious illness it can cause, as well as from the risk of having flu and coronavirus at the same time.

Is it safe to take with my medication?

Like most vaccines, the coronavirus vaccine is injected into the muscle of your upper arm. As with any injection, there is some risk of bleeding. Injections into your muscle may bleed a little more than injections that are given under the skin, but less than those that are given into a vein. If you are taking a blood thinner such as warfarin, or a new anticoagulant, the bleeding may take a little longer to stop and you may get more bruising on your upper arm.

Public Health England and the Department of Health have said that you can have the vaccine if your anticoagulant treatment is stable. That generally means that you will have been taking the same dose for a while and that if you are on warfarin, that your INR checks are up to date and that your latest INR level was in the right range. If you are taking warfarin, you will be asked to bring your INR booklet with you on the day of your appointment.

There are currently no other medications with contra-indications to receiving the covid vaccine. It can even be taken with HIV mediations and with immunosuppressants.

Is the vaccine suitable for vegetarians?

Yes, the vaccine does not contain any animal products, any meat derivatives or porcine products. Furthermore, unlike other vaccines (such as the flu jab) this virus has not been grown in eggs or biological samples (such as cells originating from dogs). It is therefore classed as suitable for vegetarians/vegans.

Please note that It has been tested on animals, which is a regulatory requirement of all vaccines approved in UK. Furthermore, we cannot confirm whether animal products have been used during development stage.

Is it latex free?

Yes, it is latex free.

I have had the Covid-19 illness already, do I still need to have the Covid-19 vaccine?

Yes. If you’ve had the disease, you may have some level of immunity, but this varies and may not last long. Although there hasn’t yet been time to test how long protection from the vaccine will last for, it has been deigned specifically to give reliable, lasting immunity. The MHRA has considered the issue and decided that getting vaccinated is just as important for those who have already had Covid-19 as it is for those who haven’t. Please note: The Pfizer vaccine is only licensed for use from 4 weeks after you first tested positive for Covid-19.

Are COVID-19 vaccines safe for people with autoimmune disease?

There is no advisory against vaccinating people with autoimmune diseases, and experts say there is no reason to believe that the current COVID-19 vaccines on the market will be unsafe for these populations.

The Pfizer/BioNTech vaccine is  made with mRNA technology, which contain genetic instructions for one part of the coronavirus instead of the entire virus itself. Experts, including Wilbur Chen, MD, vaccine researcher, professor of medicine at the University of Maryland School of Medicine, and Ted Mikuls, MD, MSPH, Umbach Professor of Rheumatology at the University of Nebraska, expect that vaccines made with this technology to be safe for immunocompromised patients and those on immunosuppressant drugs.

However, Mikuls adds that more data is needed understand whether immunosuppressant medications or unchecked disease activity may reduce vaccine effectiveness. Even so, he anticipates the vaccine will provide protection for the vast majority of patients with arthritis and rheumatic diseases.

Rheumatologists Liana Frankel, MD, MPH Professor Adjunct, Yale School of Medicine and Eric Ruderman, MD, Professor, Northwestern Medicine, are recommending that all their patients get the vaccine as soon as it’s available to them. Some DMARDs have been shown to blunt immune responses to other vaccines such as those for influenza, pneumonia and Hepatitis B. Whether holding or delaying DMARD therapies might lead to improved vaccine responses with available and emerging COVID vaccines is currently unknown.

The American College of Rheumatology (ACR), which is set to release COVID-19 vaccine guidance for rheumatologic populations early next year, said in a December 14th statement that they “anticipate recommending that all patients, including rheumatology patients, receive an approved COVID-19 vaccine.” Those who have a history of severe allergic reactions should talk to their rheumatologist for advice.

Should you stop taking your immunosuppressnt medication?

The current advice is that you should not stop taking your medications unless advised to do so by your rheumatologist or rheumatology nurse. By stopping your medication, you’re more likely to have a flare, which could make you more likely to pick up an infection.

Guidance about taking steroids

If you are already taking steroid tablets you should carry on taking them, unless your doctor tells you otherwise. If you’ve been taking steroid tablets for four weeks or more, and you develop symptoms of COVID-19 talk to your GP or rheumatology team as soon as possible about your medication. They may tell you to stop taking some drugs, but the latest advice is that steroids should be continued if you have COVID-19. However, the dose you take and when during the day you need to take your tablets may need to be changed slightly. It’s important you talk to your doctor about this.

If you’re not currently taking steroids and you develop joint pain and swelling, your doctor should only start steroid tablets or give you a steroid injection if there are no other options for your condition. And in which case your doctor should give you the lowest possible dose of steroids for the shortest possible time.
It can be dangerous to suddenly stop taking steroids, as they can cause withdrawal symptoms. If you are taking steroid tablets you should carry a steroid alert card. It is important for a healthcare professional to know if you are on steroids and the dose you are taking, in case you suddenly become ill or have an accident.

Can people with RA have the Pfizer vaccination?

Generally, yes. People with auto-immune conditions who were considered to have well controlled disease for at least 6 weeks before were included in the clinical trials. There was no significant difference in their response to the vaccine. So, at this time there is no reason why someone with stable disease should not be offered the vaccine. However further analysis of data is ongoing. At present, there is no specific evidence from trials of this vaccine in groups of people with RA or JIA. It is therefore not currently known whether the vaccine may trigger a general flare in some cases.

Can people with RA have the Astra Zeneca vaccine?

The Astra Zeneca vaccine has been found to be safer to give to children, the elderly and anyone with a pre-existing condition such as diabetes. Chimpanzee adenoviral vectors are a very well-studied vaccine type, having been used safely in thousands of subjects. It is therefore predicted to be safe in RA although further trials would be ideal.

Should I stop taking my immuosuppressant when I have my vaccine?

As the Pfizer/BioNTech vaccine is not a LIVE vaccine, it will be safe to take. However, it may not have as strong a response. If you have complex disease and/or other co-morbidities it is best to discuss this with your rheumatologist. There is currently no firm evidence available to make a recommendation in this area.

The COVID-19 vaccine requires two doses and will not be effective until a few weeks after the second dose. This would require a significant pause to treatment as a result and therefore it is unlikely to be recommended due to the risk of flares. Advice may vary on a case-by-case basis to maximise the chance of effect from the vaccine whilst managing your disease activity. It is important to discuss the timing of your vaccine with your consultant if you are due to have an infusion of rituximab.

I am taking Rituximab, can I have the covid vaccine?

Existing guidance prior to the pandemic is that patients should be up-to-date with vaccinations before rituximab treatment, as vaccination may not be as effective if given after. BSR advise that, where clinically possible, COVID-19 vaccines should be given four weeks or more before rituximab. Be aware that there may be a sub-optimal response to COVID-19 vaccines, especially for people within six months of the last dose of rituximab, or those who must have maintenance treatment due to their underlying clinical condition. Where clinically appropriate, consideration should be given to using alternative therapies to rituximab, because of the potential that after rituximab there may be sub-optimal response to a COVID-19 vaccine. This should be on a case-by-case basis, balancing the need for rituximab and the suitability of alternative therapies for the relevant clinical situation.

After your first dose 

What side effects does the vaccine have?

Like all medicines, vaccines can cause side effects. Most of these are mild and short-term, such as pain at the injection site, tiredness or a headache. These will normally go away within a few days of appearing. If side effects such as pain and/or fever are troublesome, they can be treated by medicines for pain and fever such as
paracetamol. Many people don’t get any side effects. It can happen with many vaccines that some people might feel slightly unwell because their immune system is responding to the protein, but this is not a Covid-19 illness and the vaccine can’t give you coronavirus.

Side effects may occur with following frequencies:
Very common: may affect more than 1 in 10 people

  • pain at injection site
  • tiredness
  • headache
  • muscle pain
  • chills
  • joint pain
  • fever

Common: may affect up to 1 in 10 people

  • injection site swelling
  • redness at injection site
  • nausea

Uncommon: may affect up to 1 in 100 people

  • enlarged lymph nodes
  • feeling unwell

Rare side effects: may affect up to 1 in 1,000 people

  • temporary one sided facial drooping

Not known (cannot be estimated from the available data)

  • severe allergic reaction

There has not been enough time to determine if the vaccine will result in long term side effects.

Reporting of side effects
You can submit your side effects in this form, where we are colating side effects data and can help our patients with advice on how to deal with side effects. This includes any possible side
effects not listed in this leaflet. If you are concerned about an adverse event, it should be reported on a Yellow card. Reporting forms and information can be found at https://coronavirus-yellowcard.mhra.gov.uk/.

When will I get the second dose of the Pfizer vaccine?

We have started inviting patients for the second dose. You will receive an sms which will contain a link to book in directly via the Portslade Hub. Your sms which will look like this:

Your second dose will be around 11 weeks after your first dose. You will be vaccinated with the same covid vaccine that you had your first dose (Pfizer or Astra Zeneca).

How quickly does the vaccine work? And how long does it last?

Your immune system needs to generate a response, so generally the protection from the virus starts after seven to 10 days. The Pfizer/BioNTech vaccine needs to be given in two doses, and immunity begins seven to 10 days after the second dose. So it’s really important to go back for your second dose.

We don’t yet know for sure how long protection will last, and this may vary between different vaccines. It is likely to be at least several months, but it may be that repeat vaccinations are needed. Researchers are studying this closely.

Can the vaccine give me coronavirus?

No. You can’t get coronavirus from the vaccine. A vaccine would not be approved for use if it could give you the disease it is supposed to protect you from.

The Pfizer/BioNTech vaccine does not contain any live virus, and nor does the Moderna vaccine. The Oxford vaccine contains a harmless form of a different virus, which has been altered so it cannot cause an illness.

Does the vaccine work against the new strain of the virus?

As far as we know, the vaccine will still work against the new strain of the virus.

Will I be able to pass on the virus to others if I’ve had the vaccine?

We don’t yet know for sure, but it seems that it may be possible for you to pass the virus on even if you’ve been vaccinated. The vaccines work by causing your body to create a rapid immune response to the virus so it doesn’t make you ill, but don’t stop the virus from entering your body in the first place. So even if you’ve been vaccinated, it’s really important to follow guidelines around social distancing, hand washing and other guidance to stop the spread of coronavirus. You’ll still need to self-isolate if you have symptoms or have been in contact with someone who has.

Can the COVID vaccine make me test positive for COVID-19?

The Covid vaccine does not affect your Covid test so if you have tested positive then this is highly likely because you contracted COVID-19 in the last few days before you tested positive. You need to self-isolate and follow government guidance following a positive test.

Will the COVID Vaccine be effective if I test positive for COVID a few days after?

There is currently no published advice on this.

I have tested positive after the first COVID vaccination. Can I have the second dose?

Individuals with prolonged COVID-19 symptoms (“long COVID”) can be vaccinated; however, if the individual 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.

Individuals with COVID-19 past history or detectable COVID-19 antibodies can be vaccinated. There is no evidence from clinical trials of any safety concerns in vaccinating such individuals. This is because it is not known how long antibodies made in response to natural infection persist and whether immunisation could offer more protection. If antibodies have already been made to the disease following natural infection, receiving COVID-19 vaccine would be expected to boost any pre-existing antibodies.

Can you give COVID-19 to anyone if you have had the vaccine?

The vaccine cannot give you COVID-19 infection, and a full course will reduce your chance of becoming seriously ill. We do not yet know whether it will stop you from catching and passing on the virus, but we do expect it to reduce this risk. So, it is still important to follow the guidance in your local area to protect those around you. To protect yourself and your family, friends and colleagues you still need to practice social distancing, wear a face mask and wash your hands carefully and frequently.

Can I have the vaccine doses 3 weeks apart as Pfizer recommended?

We have to follow the government guidelines stated in the national protocol for Covid-19 vaccinations which states that the second dose of the covid vaccine should be given towards the end of 12 weeks rather than in the previously recommended 3-4 weeks.

The reason for this change is to enable prioritisation of giving the first doses of vaccine (whether the Pfizer and BioNTech one or that of Oxford University and AstraZeneca) to as many people as possible on the priority list to “protect the greatest number of at-risk people overall in the shortest possible time.” Delaying the second dose meant that the prioritisation process “will have the greatest impact on reducing mortality, severe disease and hospitalisations and in protecting the NHS and equivalent health services,”

For the Pfizer-BioNTech vaccine, trials did not compare different dose spacing or compare one with two doses. The trials of the Oxford-AstraZeneca vaccine did include different spacing between doses, finding that a longer gap (two to three months) led to a greater immune response, but the overall participant numbers were small.

In the UK study 59% of the participants who had two standard doses received the second dose between nine and 12 weeks after the first. In the Brazil study only 18.6% received a second dose between nine and 12 weeks after the first. The combined trial results found that vaccine efficacy 14 days after a second dose was higher in the group that had more than six weeks between the two doses (65.4%) than in the group that had less than six weeks between doses (53.4%).

In their joint statement the chief medical officers said that data provided to the Medicines and Healthcare Products Regulatory Agency (MHRA) showed that, although optimal efficacy was achieved through two doses, both vaccines “offer considerable protection after a single dose, at least in the short term.”

Vaccinating only half of a vulnerable population will lead to a notable increase in cases of covid-19, with all that this entails, including deaths. When resources of doses and people to vaccinate are limited, then vaccinating more people with potentially less efficacy is demonstrably better than a fuller efficacy in only half.

A paper published in the New England Journal of Medicine stated that the efficacy of the Pfizer-BioNTech vaccine was 52.4% between the first and second dose (spaced 21 days apart).5However, in its “green book” Public Health England said that during the phase III trial most of the vaccine failures were in the days immediately after the first dose, indicating that the short term protection starts around day 10.6 Looking at the data from day 15 to 21, it calculated that the efficacy against symptomatic covid-19 was around 89% (95% confidence interval 52% to 97%). Meanwhile, Pfizer has said that it has no evidence that the protection lasts beyond the 21 days.

In the case of the Oxford-AstraZeneca vaccine, PHE said, “High protection against hospitalisation was seen from 21 days after dose one until two weeks after the second dose, suggesting that a single dose will provide high short term protection against severe disease . . . An exploratory analysis of participants who had received one standard dose of the vaccine suggested that efficacy against symptomatic covid-19 was 73% (95% CI 48.79-85.76%).”

In a joint statement Pfizer and BioNTech said, “The safety and efficacy of the vaccine has not been evaluated on different dosing schedules as the majority of trial participants received the second dose within the window specified in the study design . . . There is no data to demonstrate that protection after the first dose is sustained after 21 days.”

With most vaccines an extended interval between the prime and booster doses leads to a better
immune response to the booster dose. There is evidence that a longer interval between the first and
second doses promotes a stronger immune response with the AstraZeneca vaccine. There is currently no strong evidence to expect that the immune response from the Pfizer-BioNTech vaccine would differ substantially from the AstraZeneca and Moderna vaccines.

The rate of vaccine delivery in the UK is currently limited by vaccine supply rather than by workforce
capacity. An extended interval between vaccine doses together with initial prioritisation of the first
vaccine dose would increase the flow of vaccine supply

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